Fact: when anyone walks in the door of America’s “health care system”, the first question we ask isn’t “How can we fix you?”, it’s “How’re you gonna pay for this?”. From the point of view of a for-profit health care system (an oxymoron’s oxymoron which we’ll get to shortly), that’s great. It’s the perfect question. From every other point of view though – medical, economic, moral – it’s despicable. It violates the whole idea of health care because it thinks health care is a privilege one can buy as much of as one likes – if one has the money. No other industrialized nation treats health care the way America does – as a commodity for those who can afford it. In fact, in America, we don’t even think of our health care from the point of view of our health care, we think of it from the point of view of view of “how we’re going to pay for it” first! Because if we can’t pay for it somehow – via a relationship between our insurance company and the medical facilities and practitioners THEY have relationships with (minus our co-pays and deductibles) – then we ain’t getting it. The emphasis here is entirely on the wrong syllable!
How the hell did we get here (where no other country went)? There’s an answer. It starts with patriotism and ends in naked greed. How very American. No, I take that back. That’s how America has become because of corruption. Let’s be frank: because of corrupt white people.
You have to have power and/or money to begin with in order to be corrupt. In America, white, Christian, land-owning men began with all the money and all the power. For their various reasons, these men chose to split the colonies from England, forming a new nation based upon “French enlightened” ideals of self-government. For some, like James Madison, ideals mattered above all else. For everyone invested in the slave economy? It was about money (democracy better not get in its way). Money corrupts like nothing else. Even power itself will succumb to money. Greed really is the most evil of human evils (with racism, bigotry and misogyny forcing a call at the wire). When America made a deal with slavery, we were making a deal with greed.
At its bottom line, slavery is stolen labor. The whole point of having a slave is to have their work product for free (minus whatever it costs to clothe, house and feed the slave). The entire Southern economy relied upon cotton, sugar cane and tobacco – three labor intensive agricultural products requiring massive amounts of labor to get from tillage to planting to harvesting to prepping for market. The South did all that by paying zero for labor. Imagine if, instead, the South had been forced to pay a fair market rate for all the labor it got for free (now without having to bother with the costs of food, clothing and housing). The South would never have risen the way it did – on the back of all that slave labor. Perhaps, in the Confederacy’s place, a worker’s paradise would have arisen.
A democratic socialist can dream, can’t he?
America, don’t forget, was founded on ideals, not a budget. As a nation, we have truly soared when we’ve lived by our ideals. We’ve stumbled, fallen and struggled to find our feet again every time we’ve chased a buck instead. Our current health care conundrum began during World War Two. In order to funnel every dollar possible into the war effort, the federal government froze everyone’s salary. That hamstrung businesses trying to keep good employees (who might want to stray to a company where the frozen pay for their job was higher) or lure new ones. Large companies (with a bit of cash on hand) offered “Hospital Insurance” as an incentive. Hospital insurance wasn’t full health insurance, it would only cover an employee in the event they were hospitalized. But, at the time, that must have been incentive enough. Plenty of American workers took that deal.
Then the war ended. But the hospital insurance didn’t. It began morphing into full on health insurance (not the care itself, the payment mechanism – the insurance). On the one hand, it meant a large group of Americans now had something they didn’t before the war – a way to PAY FOR their health care. Or, part of it anyway.
The big companies that kept employer-provided health coverage going hated administering their employees health coverage. It put them into businesses they didn’t want to be in: insurance and health care. Seeing and seizing a giant business opportunity, the health insurance industry spawned itself into being. Now, let’s be clear about who and what our health insurance companies are and aren’t. Every time we discuss health care in America, a bunch of nitwits will haul out the “Americans love their coverage!” argument as if it held water. It does not.
Americans love the health care providers they trust. Insurance companies stand between Americans and those providers – behaving as the thing they are: GATEKEEPERS. Americans will stop loving any company that cuts them off from the health care they need and want. So long as the gatekeepers say yes, sure – Americans love their insurance! But the second some bean counter in an office somewhere decides that the procedure a paying customer wants or needs is superfluous? That love is gone.
Nobody loves their health insurance. Nobody loves the terror we all feel when we even contemplate getting sick because we can never be one hundred percent sure our insurance carrier will cover it. And, as we all know, if you walk in the door of any health c are provider without that insurance card? You’re going to pay retail-retail for whatever goods or services you get. Ten bucks for a Tylenol tab worth pennies, for instance.
How is it hospitals do that – flagrantly charge stupid sums for everything? That’s because they’re not public concerns, they’re private. They’re corporate – owned by companies motivated by profit. Profit, of course, is the whole point of capitalism. It’s what drives innovation: beyond just the problem solving itself, there’s the lure of reaping the rewards of one’s good ideas and hard work. But some services need to stand outside the world of profit because the service they provide is incompatible with profit. Health CARE, for instance.
A corporation has a fiduciary responsibility to its shareholders (its preferred shareholders, not its common stock shareholders) to make every dollar it can. They have no such responsibility to “patients”. From a purely budgetary point of view, patients represent dollars OUT and every dollar out is a dollar less profit for the corporation. From the corporation’s perspective, they’re meeting their obligation by turning you down for the procedure you need.
The health insurance industry sees universal single payer as a death sentence. If the government is handling all those claims, it means the health insurance companies aren’t. From a hospital’s point of view, if the government runs and manages its budget then no one’s going to make huge profits from running it.
Let’s get something straight. America’s health care is a serious business that must be peopled by our very best and brightest. `We want them to be well compensated. We want their expertise and professionalism rewarded. But, they’re not gods. The work they do needs to be part of something larger and holistic both for us as individuals and for us as a nation. In Sweden, say, if you have a health issue, you walk in the door of a health care facility and, for a very affordable (to most people) co-pay ($10ish), you get fixed. You get the thing you needed.
The co-pay comes later. It’s not the trigger for treatment.
America’s health care debacle is what happens when the inmates take over the asylum. It’s what happens when greed and stupidity design health care instead of health care designing it. America’s health care system also is what happens when racism and bigotry have a hand in the design specs.
It’s not a coincidence that the same folks who want Americans paying through the nose for their health care are the same folks who want only white people to vote. Could the irony be any sweeter that those same white people are the ones still dying in droves from COVID-19 because they refuse the health care they need – that’s available to them for free?