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As Long as We Remember...

October 4, 2007

For National Healthcare

Tony Soltero

It can be endlessly argued exactly how "free" most of our economic sectors are, given how many industries are, in effect, monopolies - or near-monopolies - run by only a small handful of players (tried to switch to a different cable company lately?).

But it is true that - in theory - the free-enterprise system is the most effective economic model for producing wealth and generating jobs and income given enough competition for labor and goods.

But just because a particular economic philosophy functions well for, say, the automobile industry or the software industry, it doesn't mean that the same model works just as well across the board. And the single biggest Achilles' heel in the free-enterprise system is in its treatment of healthcare as just another commodity to be bought and sold, not unlike high-definition TV's, haircuts, or lawn tractors.

The belief that "the market" is the best medium for providing and delivering healthcare is rooted in laissez-faire economic dogmatism. And it is this dogmatism that has produced the train wreck that the American healthcare system has become. America regularly lags well behind the rest of the industrialized world (and even a few third-world countries) in just about every health indicator - life expectancy, infant mortality, per-capita health costs, and others.

It is a completely self-inflicted problem. A nation that can afford to spend a trillion dollars on ill-conceived Middle Eastern military adventures has no excuse for not having an efficient domestic healthcare system.

The main purpose of the healthcare system we currently have in place is not to heal the sick, or comfort the afflicted, or to safeguard the healthy from developing illnesses. It is to generate profits for the insurance and pharmaceutical industries. If regular people happen to benefit from this, it's considered to be a nice bonus. But that's not the main thrust of our healthcare priorities and policies.

So, in what way is the free-enterprise model for healthcare so flawed? The answer lies in the basic idea that we don't "shop" for healthcare the way we shop for SUV's or computers or leather jackets.

If we want to buy a new Mercedes, but can't afford one at this time, we have several choices: we can hold onto our old car a little longer while we save some extra money; we can simply settle for a cheaper vehicle; or we can look for a used model. If we want to get a new big-screen TV for our living room, but find them too pricey, we can always decide to put off the purchase until we can afford it.

This isn't the case with healthcare. If we develop a serious illness or sustain a major injury - or even a minor one, we need healthcare NOW. We don't get to wait until we have the money, and we have limited opportunities to shop for a better deal.

A health-care crisis is emotionally draining enough in and of itself. The financial blows that come with it are nothing but an extra, massive burden. And this applies even if one is insured; half of personal bankruptcy cases in America are a direct result of healthcare crises, and many of them had insurance, or thought they did.

Our system also provides powerful incentives for insurance companies to deny coverage to patients. After all, dead people don't file claims. And the fewer claims you pay out, the more money you make, and the higher your stock price soars.

Once again, it is in the financial self-interest of the insurance industry to have its customers die, especially when they reach an age at which they begin to "consume" a disproportionate amount of care.

While it is tempting to rail against the insurance industry for this kind of crassness (and it, no doubt, deserves much of the condemnation directed its way), the bottom line is that the real fault lies with an economic philosophy that makes sickness and death profitable. The insurance industry is simply acting rationally within the system.

The insurance business is also in the habit of delaying coverage of treatments it deems "unnecessary," with the criteria for "necessity" fueled as often by financial concerns as by medical ones. This results in long waits for patients and at times rationing and outright denial of lifesaving coverage. Ironically, the same attacks the right spuriously levels at countries with some form of national healthcare. There have also been reports of insurance companies pressuring doctors to prescribe more "profitable" medication than warranted by the patient's condition.

Our healthcare system also imposes an enormous burden on American businesses, making them less competitive worldwide, especially against businesses in countries that enjoy national healthcare. There's no inherent, inevitable reason a person's healthcare must be tied to his employer. That's an artifact of the mid-20th century, where competition for labor was such that companies offered health coverage to sweeten the pot for potential employees.

The world economy is far different now, and many American companies are buckling under runaway health costs. The government provides our businesses with roads and infrastructure, police and fire protection, and schools to educate and train a labor force, why not also healthcare?

Most of our presidential candidates - the Democrats, at least - have floated plans for reforming health care. Typically, the Republicans still insist that our healthcare system is just wonderful, despite it being the #2 issue for Americans after Iraq.

But they don't amount to much more than tinkering around the edges. It's better than nothing, but we're not really going to see any significant progress until we attack the basic concept of for-profit healthcare.

Are there issues with national healthcare? Sure there are. That doesn't mean they can't be overcome. It is, for instance, not inevitable that doctors make less money under a national healthcare system than they do under our current one. But we need to have an honest discussion about health care in this country, and acknowledge that our system is currently dysfunctional.

The free-enterprise system is wonderful for a lot of things. Health care is not one of them.

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