On Economics

Mary makes a well-written case for Single Payer health insurance at Pacific Views today.

"America's health care system is imploding. Despite the fact that America devotes more of its GDP to health care than any other developed country, the real outcome for a significant portion of our country is miserable. And despite all the initiatives that claimed to fix the problem, the problem is getting worse."

As someone who administers state Medicaid in Pacific County and who becomes aware of as many uninsured citizens in an hour as an enterprising researcher could find in a day, I consider the above seriously understated.

"Getting worse" actually means something far fouler smelling than what you see in Sicko.

Mary has more:

"Universal health care is particularly unsuited for a market-based approach because people are unable to do a lot of comparison shopping when they are sick and the overwhelming need for health care is when someone is sick, not when they are well."

A market-based approach in this country is the failed altruism of corporate capitalism which for decades has trumpeted the idea that the market could and WOULD take care of society's poor. That by definition is an impossibility given the formal constitutional definition for a "corporation."

That definition literally justifies - even encourages - a single-prioritized bottom-line profit-based approach to enterprises supposedly created to accomplish public good because individuals and small communities cannot create sufficient capital to accomplish it by themselves. It's an approach that has everything to do with some sort of corporate right (a la a human citizen/person's right) to the pursuit of happiness - precisely because corporate pursuit of happiness is pursuit of profit, not public good. It would be like giving a giant leech a constitutionally guaranteed right and protection to suck up the life blood of  every citizen and community.

... unless of course one "conservatively " defines "public good" as equal to what's good for business.

I'm against any kind of market-based approach to universal health care.

Our objective should not be that the highest priority is what's good for business in this regard. That's the attitude immediately and transparently  revealed  as harmful and inadequate when ideologically, an American president attempted to suspend minimum wage in the Katrina disaster area;

when he immediately asserted opportunity for profit before securing a disaster area;

- suggesting that the public good is best served if profits are prioritized first.

It borders on oxymoron to even suggest that government should be run as a business first and foremost. One primary reason is that profit unreasonably gets asserted as more important than the public good.

Bushco has amply demonstrated the failure of corporate capitalism to successfully care for its citizens or even to wage war (as if waging war were a constitutional obligation rather than national expediency) in the most economically wise and efficient manner. The Medicare D Supplement in reality is a massive act of corporate capitalist foolishness birthed by greed and lobby payments - not honest public discourse on the highest public good.

Speaking "capitalistically" and "market-basedly" we do not - when our house catches fire - call the fire department and make arrangements to pay a deductible before they will come. Our taxes have already paid for that.

... or if we hear an intruder in the house, we do not call the police and negotiate a deductible or co-pay term before they come out to keep us safe. Our taxes pay for that.

... Why the hell do we do that to ourselves regarding our most precious personal asset - health?

"Because taxes could go up," defenders of the market-based capitalist religion declare.  To which even non-MBA's like me who have spent hundreds of hours at the kitchen table working out budgets reply,

So it's all in the budget priorities. We must be spending too much somewhere else, eh? Like perhaps on a paranoid and insecure  but profit-driven wide-eyed defense and weapons industry?

The assumption is false and we are asleep. Market-based corporatists want us to stay that way.

It is all about bull shit ...the selling of bull shit ... the buying of bull shit ... the lying about bull shit ... and the harming of an entire society by overdosing on bull shit.

When a wild-eyed elderly woman comes into my office saying she's heard terrible horror stories about socialized medicine in Canada I'm ready to throw up or throw my hands in the air.

Think about it. 

 Great Britain apparently (at least per Sicko) launched their version of socialized medicine right after WW II when they were not far removed from financial insolvency. They ain't even come close to scrapping it.

Why not?

Well hell, because maybe what they've got - what Canada and France have - works fine enough that their national public good and well-being far outweighs whatever problems come up. Regardless of American corporate lies, those problems certainly are not the nightmares our  lobbied-and-prompted politicians, insurers and care providers constantly try to scare us with.

How DO they pay for it? With taxes of course.

Why COULDN'T we pay for it with taxes?  We could, of course.

We might have to give up or cut back to reasonable levels some other kind of spending - like defense.

Of course we could and of course we should.

Those opposed to cutting back military spending are not driven by fear of a massively global military monolith with resources approaching a trillion dollars and planning an all-out attack and invasion of our homeland.  They are driven by a fear of loss of profits.

Get the terrorists yes ... but with honest police work and funded actions appropriate to legitimate need as a wise economic response.

But do we really need full-monte massive military assaults with nukes, 37 divisions plus the 4th, 5th , 6th, 7th, and 8th Fleets and the 98th, 99th and 100th Bomber Wings ... hell no!!

But of course that's another story to debate elsewhere whenever we get serious about sourcing and budgeting much more important issues, like being 37th in global health effectiveness.

Besides, that attack and invasion has already occurred.

It began years ago when we naively swallowed corporate bait-and-switch philosophy - without any critical thinking or understanding that lobbyists were serious (they always MEANT business) - hook, line and sinker.

We were attacked and invaded by corporate sharks who only got more openly savage about it after 2000 when Dirty Dingus McBush open the trapdoors and helped the corporate Trojan Horse drop a massive pile of stinking biscuits smack dab in every living room and homeless shelter in America.

So in terms of market-based medicine for America, our medicine-based marketing sharks would be the ones in ICU if we ever woke up,

if we ever narrowed our wide-eyed naïveté

and went shopping for a better system.   

Your comment is better than my artticle.

I don't know why you didn't post it as an article.

The more we talk about this sort of stuff at Washblog, the more competition we give to repetitive rumbles about party politics, candidates and legislative districts - which at Washblog read much like the writing fantasy sports bloggers share with each other on Yahoo Sports, SI or the Sporting News, etc..

So I'll peel off my garden hat and try to write a Triple A response to your major league thoughts.

First, our discussions here - as do most discussions - originate more or less out of intellectual environs and not tavern talk, church talk or shopping talk where more opinions by far get shared.

But that's the nature of discussions that might result in movement in the direction of change. Works best when spontaneous thinkers and opinionaters start talking about it.

Open Markets

The rules to play by are hidden in one corner under a bag of sh*t - precisely where the corporate capitalists and their lip service want them. That corner is the one least likely visited by anyone with a fuse short enough to be lit by awareness of snake oil marketing and market manipulation.

I see the most rapid solution as that of moving the discussion out of the realm of governmental political discourse and into the realm of word-of-mouth indignation at specific corporate practices or specific corporate entities themselves.

Scale and size are more important in generating publicity and ill will toward a corporate entity or practice rather than a hope for some direct legal action against a specific illegal, unethical or self-serving corporate behavior.

As a union member, I stopped shopping at Walmart a few years ago. In fact my cheap computer here is the last thing I've ever purchased at Walmart.

Walmart's treatment, manipulation and abuse of it's employees is now sufficiently imbeded in public awareness that there has been an impact.

I'm not satisfied with the size of that impact and wish that the corporate reputation were more sufficiently sullied as to facilitate some dictation to Walmart by a coaliton of labor and consumers. But for now it will do.

Gathering, rallying and organizing potential boycotters - or the threat or imminence OF a specific boycott - are things I see as having the potential of waving a club at market abusers.

But none of what I write can I suggest as viable solutions because of the simple fact that we as market participants, as corporate marks, as rubes, consuming gullibles and manipulatees are left to our own devices to get the shell gamers to play more fairly.

This because economic think tanks are not trustworthy. Their funding sources and all that.

Back to Open Markets. I personally do not see the open market as even a legitimate source of delivery of health services and health care. In having already put our communal health condition at the mercy of an open market, we seem to have made of health and well being a commodity - the ownership and distribution of which can be obtained, monopolized and ... to quote your word ... rationed.

Our health, our health care and especially that heroic life-saving aspect of health care where our collective skills are superlative (as opposed to preventative health care where our collective skills are inadequate) are something of which we need new dialogue ...

... to discuss whether it belongs in the open marketplace at all ...

or not ....

I think not.

Externalities

Having read up on environmentalism/ecology, economics, and environmental economics, I, like most "greens" that I know, regard stuff like pollution as an accounting problem. If the costs aren't on the balance sheet, they're not factored into the decision making process.

When someone pollutes, or spoils a commons, or over exploits a resource, that's simply a form of theft. Some favored party/person is profiting at everyone else's expense.

So it is with health care.

Point well made.

But from my perspective it's only valid if we agree that health care is a commodity that can be owned and rivaled over in an open market with free choices and subject to the temptation of every lie ever told as advertisment - as if getting you to by were more important that getting you to behave responsibly.

And I think we could do with more judgemental sentimentality in our appreciation of open market free choices which include the impact of wounding or wounded environment.

We could do with a lot more blowback against any business entity that openly harms the environment in undeniable ways but hides profit or business survival motives behind a facade of wise or accepted business practice which of course includes lengthy review and assessment of environmental issues while the abuse goes on.

That's where we need to get sentimental ... no, downright bitchy about ... the sort of indignation that pushes back first, then asks why and perhaps then calms down.

On the public good

The Public Good

Citizens invest in fire stations to protect the public good. The preventative costs are minimal compared to the costs of disaster.

It's a public health and safety issue. When we all do better, we all do better.

Health care is also a public health and safety issue. Enlightened societies invest in health care to protect society's investment.

My take on the Public Good is that there are certain aspects of the public good that have an automatic stance to them - a pre-programmed or mutually agreed-upon knee-jerk reaction that gets inititated on demand when circumstances require.

That's what fire and police stations do.

That's what hospitals and ambulatory services do.

That's how we ought to define public good and why we should pre-program ourselves to exclude health care from any public investment economic strategy that includes inviting one half of the open market .

Public good in terms of health, shelter and defense do not by default get offered to merchants who will unavoidably gravitate toward monopoly, self-preservation and that irresponsible expansion that ultimately demands constant expansion as a survival consequence.

The public good does not include elevating or creating greater opportunities for market participation to corporate merchants at the expense of little merchants and the entire base of the market, all the individual consumers.

And as long as the public good is up for discussion, none of our conversations about the economy as a society will be valid until we examine our public spending priorities.

We seriously need to question our spending on military offense and defense that is so far out of proportion to actual need that the rest of our economy is only pretend.

Business Climate and Cultural Maturity

Business Climate

Just like with fire stations, public schools, and pollution, we're now sophisticated enough to determine how health insurance policies impact our economy.

Companies like Toyota have located new facilities in Canada. Because the local workers are better educated and more healthy. So productivity is higher. And Toyota direct investment in each employee is lower.

Domestic companies, who previously opposed universal healthcare, are now totally on board. The reason is competitiveness. The foreign competitors, based in countries with universal healthcare, have less overhead and are therefore more competitive.

It's pretty straightforward. If society chooses to save money by switching to universal healthcare, it'll grow the economy.

Cultural Maturity

Our current laissez faire (free market) system is feudalism. Very old school. Pretty easy to understand. The profiteers love the system. Everyone else can eat cake.

Universal healthcare, single payer, and the variants are all products of a socialist worldview. In the same way that fire stations, public schools, and clean water are socialist. Don't be too shocked, the USA has had socialism lite in various forms since WWII. Social security, collective bargaining, trust busters, electrifying the country, etc. For the most part, these programs have worked out great.

Above, Arthur says he's against any market-based solution. I'm not so sure.

Currently, unbridled corporations profit from disease, ill-health, and NOT providing health care. That's clearly against society's self-interest.

Markets are based on incentives and rewards. If we want to encourage innovation and increase productivity, many would argue that you need to right incentives.

I'm not original in suggesting that we should find some way to reward keeping people, society as a whole, healthy.

When first discharged from the military in 1975, I took my family to Houston because in Omaha the best job offer was $600 a month as a manager trainee in a Grand Central store. 9Would have been the equivalent of taking myself into mgt training at Walmart today.)

But in Houston I found a subsidy of $1000 a month as an insurance agent for Lincoln National. That training offered me all these new and wonderful insights into the conceptual origins of insurance and community assumption of risk. Also taught me about cultural maturity and how easier it is to sell insurance if you can summon the vision of a hearse backing up to your prospect's door.

Property and Casualty insurance based on those conceptual origins makes sense.

Even using community-shared risk assumption with insurance to address the need provide for one's self and family after a physical catastrophe (what we now call disability insurance) makes sense.

What doesn't make sense is that evolution of health insurance that lead to the community-shared risk becoming a corporate community concept in which citizens naively but willingly give up too much control over their combined ability to dictate just how the community will take care of its own.

The blind assumption that free and open market capitalism is the basis of America's economic well-being from get-go has now come back to bite us on the butt.

Whatever free and open markets really are and whether or not they include choice, we have passively and apathetically let the hired help organize into corporations and take over the family business, the family farm, the family home and the community's well being.

Your ultimate sentence is of course my sentence too:

... we should find some way to reward keeping people, society as a whole, healthy.

And we are under no obligation as a mature society - the grownups, if you will, who underwrite the well being of the nation - to assume that the current corporate capitalist version of a market economy is best for everyone. We absolutely must insist on refuting that lie.

If we don't, the debate gets lowered to the level of whether or not you need two bathtubs on a cliff and a bottle of pills to get a 36-hour erection.

I find almost all of the advertising - political and consumer - to be highly offensive and insulting. But then I suspect that when it comes to the highest good of all concerned we are not a society of cultural maturity.