Saturday, August 22, 2009

Health care safety net: ideology of profit vs. a Human Right of civilized society

Realism must overcome seductive ideological formulas:

The most repetitive argument I hear against broad health care coverage is that the government should "get the hell out of the way". I don't know what is the appropriate response to this sort of ideological chauvinism. It reminds me of the bizarre "revolutionary" formulas that were proposed by similarly inflamed radicals, in the opposite end of the political spectrum, back in the 70's, in an analogous historical context of economic despair for a large segment of society. What they have in common is the self righteousness that comes with the impatience with a world that does not want to fit into a neat little formula, which is so obviously at odds with reality if you can step back from the narrow view. Unfortunately that self righteousness is not unlike any other form of closed world view that commonly devolves into plain bigotry.

Clearly someone who thinks "markets do whatever they do and humans better get used to it", have their values twisted by a need to justify a world view that in many ways satisfies their narcissism. It's human nature to think that their privileges are the result of an order that rewards those who are deserving and punishes all others. I don't know that it is possible to bridge the gap and find common ground with someone that is a proponent of this point of view, which is confined to a historical condition they cannot overcome.

Let's look at facts that don't necessarily support the myths we've been living with for 30 years:

The reality is that we live a period of extreme economical distress for half of the population and shrinkage of options for the Middle Class. The health care problem is the tip of the iceberg. It results from an increasing difficult set of realities for the working poor, who find it physically impossible to overcome their condition. While their income has gone nowhere (2.5% increase for half working Americans since Reagan came into office) their share of GDP growth was used to leverage the increasingly predatory growth of the the top 1% whose share of the pie increased from 8% to 22%, leveraging the effect of economic growth (116% since 1981) by a factor of 3. Part of this wealth effect has skewed the cost of health care, education, housing, which have also grown at a higher rate than the GDP pushing 1 in 2 Americans further down into the underclass that has less options today than it ever had since we recovered from the last Depression.

The simple mechanism of extending Medicare to everyone by choice, at cost, would be very easy to implement. But it would be highly threatening of the health insurance industry that failed to provide security in this environment of increasing economic disparity. They're fighting a loosing battle. There is simply no capacity for the underclass to access a service that is tailored by and for people who live a different reality.

The type of fiscal policy that allowed us to overcome a higher relative debt burden after World War II is impossible to defend these days as any gain by the beneficiaries of so called free-market policies is stridently protected with accusations of socialism against any threat to their greed driven machine that aims to counter the increasingly growing disparity. In the current environment, policies that taxed more than 90% of the stratospheric slice of the highest incomes to provide free higher education and sustainable levels of wage disparity, would be considered downright “communistic” by today's self proclaimed defenders of American values and Capitalism. We may have evolved much over the last 30 years, but while we focused on bringing the country together by breaking down social barriers resultant form historical patterns of bigotry, we let ourselves go along with economics of greed by swallowing the palatable concept that the wealthy are the providers of opportunity and the motor of this economy, and free markets are self regulating. This ideology is historically predictable, and those who buy into it are well advised to broaden their views. Every time an elite finds ways to establish dynastic privileges to a life of leisurely opulence it provides itself with an ideological justification to gain acceptance by a larger segment of society, that extends the longevity of the unsustainable status quo. The reality of economic success is coincidental with the growth of an enterprising Middle Class that has access to the consumption of the goods its growing productivity delivers. Any society where the state does not provide mechanisms to equalize access to opportunity tends to digress towards extreme inequality and deliver unsustainable deterioration of living conditions reflected in areas such as access to life sustaining health care, education, and housing. Since the policies that regulated that balance started to be challenged with Reagan there has been a decline of standards of living for half of our population (even for the vast majority of the other half their economic success hasn't kept pace with the GDP growth). Right wing ideologues would have us believe that these are people deserving of their fate, except when they cynically use their systematically promoted ignorance to manipulate them into supporting the policies that keep them from opportunities for success. Not unlike the slaves that paradoxically fought besides their masters in various turning points in History, including the American Civil War.

The current trend towards economic disparity is alarmingly unsustainable, and the deep precipice we reached at the end of the Bush administration is likely to pull us down further if we don't find a way to overcome the deep delusion many have been living under, since Reagan proposed the seductive panacea of tax cuts to overcome economic sluggishness.

The protection of a Human Right is incompatible with profit motive:

Basic health care delivery cannot be a profit motive any more than other safety nets provided by the state in all developed societies. Who would think of for-profit unemployment insurance? Does not mean individuals are not well advised to provide for their own capacity to survive unexpected income fluctuations, and there is wide room for an industry that caters to the aspiration to financial independence beyond that level of protection. Likewise, there is plenty of room for supplementary benefits to be offered by a profit driven health insurance industry.

The question is, what are the basic levels of health that should be protected and what is the cost that we can sustain on a universal access model. There are too many holes currently leading to bankruptcy, premature death, and avoidable disability. It's not for the private insurance system to provide the solution as they proposed in 1994 and have amply demonstrated themselves to be incapable of. The argument I make is that there is in fact no room in the solution for that industry, and any attempt to accommodate it is an oxymoron and doomed to fail.

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