Going Beyond National Health Care

Public Health: Beyond Obama
December  29, 2008

Today’s Old Mole started with Neil Clark’s report from Europe, read by Tom Becker, summing up the resurgence of  Socialist parties and programs across the continent – albeit with Bill Resnick’s caveat  added by Tom, that electoral gains by parties calling themselves socialist are not enough to transform our economy into one that has as its principal aim the good of all rather than profits for a few.  Then we heard in the conversation between Paul Gorman and Bill Resnick about the contradiction between caring for people and private profits.   Private insurers are in business to make money, and the less care they deliver the more money they deliver to their stockholders.  As one  scientist  recently remarked, “The incentives in the current health insurance system are upside down. The less care you provide, the bigger your profits.” Let’s  look some more at this contradiction and see why resolving it in the case of health care might lead  us in the direction of the socialism Tom Becker’s  piece talked about and toward the people’s movement Bill Resnick  reminds us is needed. 

A single-payer, government-sponsored health care system is rarely mentioned in mainstream discussions of health insurance, and yet, the public has always favored exactly that. For  example, last year the State of California and major health foundations sponsored state-wide  public meeting to discuss health insurance.  The organizers set the agenda to exclude single-payer plans, but the 3500 randomly chosen participants  rebelled and forced the issue on to the table.  In the final report, however, the preference  for single-payer was buried in the back pages, leaving the impression that only various plans involving the insurance companies  were worth discussing.   (See details here)

A single payer health system is one in which everyone, rich or poor, healthy or sick, would have equal access to the best medical care the nation can provide.  Instead of throwing our money into profit making insurance companies so they can manage our medical care according to their profit margins, we would pay, through progressive taxation, one agency to pay for all our health care at a tremendous savings in administration costs and red tape.  This system works so well that no politician in the countries that have it dares to challenge it. 

The best progressive  argument for a publicly funded health system is that health is a public good.  Why do we pay taxes to pay for parks, highways, air traffic control, the currency system, education, the police and fire departments?   Most people understand that these services are public goods: they are benefits to all of us.  Take away the money system, highways and the justice system, and our lives would fall into chaos.  Take away police and air traffic control, and our lives become dangerous.  Take away education, and we have to deal with ignorant fellow citizens and workers.  We now have no public health care system, and what is the result?  Higher infant mortality and  shorter average life-spans than most other industrialized countries and many non-industrial ones.   Higher absentee rates at work and school.  Lots of personal bankruptcies due to catastrophic illness. Economist Dean Baker blames the long-term federal deficit on the  “broken US health care system: a system that costs more than twice as much per person as the health care system in most of the countries who enjoy longer life expectancies than we do.”

With all this evidence, most people should be able to agree that health care is a public good and should no more be controlled by private profit-making businesses than highways and education.  And once they see this, capitalism itself  begins to seem doubtful. profit-maximizing enterprises control many of the goods and services we need to live our lives.  The management of a capitalist enterprise is first and foremost the management of capital, and only secondarily the production of goods and services people need.  If the investment of stockholders can best be protected or increased by closing a hospital in a poor neighborhood or by increasing the costs of prescription drugs, that is what the managers of capital will do.   If no profits are to be made by building low-cost housing, then we have to bear the personal and social costs of homelessness. This is what comes of leaving the production of public goods in private hands.   The argument for national health care makes it easy to see the problem.  Health care is a public good, so it should be run by and for the public, not for private profit.  But there are many other public goods as well. 

The public good that is most poorly served by capitalism is work.  When a corporation closes a hospital or a supermarket, not only are health care and groceries no longer available in that neighborhood, but even more importantly, neither is work.   Nothing is more devastating to individuals, to families, and to communities than the loss of jobs.  Work is the spine of our lives, as Frithof Bergmann has put it.  It gives us our place in the world,  it channels our productive activity.  When there is no  work, there follows a long list of traumas, including gang activity, crime, alcohol and drug abuse, suicides, and deteriorating neighborhoods. Surely work is a public good.  Why should it depend on the ups and downs of private investment decisions?

Work is important in another way as well: work is what meets all our material needs.  Whatever or whoever directs our work determines which needs shall be met and which shall not.  If nurses and teachers are not being trained and hired, the quality of health care and education suffers.  A good society, a society that is good to live in, is one in which the public good of work is directed to the production of public goods.  So the creation and direction of work has to be made a matter of public policy.  Since work is created by investment, investment should be in the hands of the public, not in the hands of private individuals.  

The task of   the left in the coming national debate over  funding health care should look to, but also beyond, building a consensus among the American People that health care should be available to everyone.  Let's work to extend that consensus to all the things we need  to live good and productive lives. 

I’m Clayton Morgareidge for the Old Mole Variety Hour