The Health Care Issue In A Nut-shell.
Posted: Wednesday, March 17, 2010
by Tex Norman
It is not only easy to argue, it is extremely easy to argue about something when no one knows what they are arguing about. This goes doubly so for the Health Care in America issue. We are arguing not about the big picture but about little shards and slivers of the whole thing. Religious conservatives may be side-tracked because they want the bill to have stronger clearer language about not using tax dollars to fund abortion. Progressives are side tracked by the public option, or their preference for a single payer plan. The deliberately ignorant opponent of any position not coming from a Republican may be side tracked by their fear of death squads.
Sometimes I feel like we are facing a dragon but we are arguing a single scale on the beast while being totally unaware that there is a dragon attached to that scale.
I've been thinking about the BIG PICTURE for some time and I think I can distill the issues into a single sentence:
Will the US consider Health Care a product, or will we think of it as a basic human need so important that it's provided by the government and financed with tax dollars?
Commercial products are bought and sold. Commercial products fall neatly into a free enterprise system. There are other areas of our life, that do not fall so neatly into capitalism. Almost anything can be forced into a capitalism/free enterprise system, but some of these services are considered basic, essential, and yet not particularly good revenue makers.
Roads can be forced into a free market system. We could allow all roads to be owned by corporations or entrepreneurs, so that when you back out of your drive way you pay a toll to some company, but here is the deal. If roads are part of a free enterprise system, then road builders would only make roads that could contribute to their bottom line. It would be commercially logical to build and own roads in Dallas , New York , LA and Chicago, but roads in Wewoka Oklahoma would never earn enough money to pay for the roads or their maintenance.
Conservatives are quick to say UPS makes money, and the Post Office loses money and they are right. The problem is that this comparison is an apples/oranges comparison. The USPO does home delivery six days a week and provides home delivery to basically every home in the US . UPS delivers packages ONLY. There is money to be made in shipping packages, but home delivery is just a black hole of cost. With the increase of faxes and email the customer base for the post office is shrinking, making the cost for the home delivers even more expensive. The extinction of postal home deliver seems possible, and perhaps inevitable, but consider how many people have no computers, and how many have no internet access. Think of how many people are luddites who just don't like or trust doing online banking and getting paperless bank statements. I would guess there are hundreds of thousands of people who would be dramatically handicapped if there were no home mail delivery, and yet, home delivery is not a money maker and wise entrepreneurs will shy away from such a business.
Education has long been considered so basic a need that the US provides 12+ years of free education to children. After high school graduation, if young adults want more education the government along with private industry provides assistance so that they can be assisted with the costs of a college education.
Again, some point out that there are private schools that produce students who test higher and perform better than students in public schools, but this is another apples and oranges comparison. Private schools have the right to pick or reject students, while public school does not have that same option. Emotionally Disturbed students are not accepted in some of these private college preparatory schools. Poor children from drug using abusive parents can't get into a school with a high tuition and requirements for parental involvement. Disruptive students are expelled from private schools, while public schools are required to provide alternatives for troubled and defiant students. Could a private school continue to have such positive results if they had to accept every student that showed up at their doors?
When it comes to health care the debate should not be limited to the details of a particular bill, because the BIG issue, the decision we need to make is in how we view health care. Is health care more like roads and schools, or is it more like blue jeans and boiled peanuts. Are we going to sell health care the way we sell refrigerators and plumbing services, or are we going to consider health care a basic human need so vital that it will be supported by all of us (rich and poor) in order to be available to all of us rich or poor.
Consider the consequences of this decision. If health care is only a service, like dog grooming and drain cleaning then availability will be tied to an ability to pay. If a poor person can't afford to groom his dog then he lives with a shaggy dog. If a poor person has a child sick with an infection, but can't afford the doctor's fees, the lab tests, and the cost of the medicine, then that child stays sick until he or she gets better, or the child stays sick until he or she dies from a lack of treatment.
In my town the fire department is typically the first responders to accidents. There are fire stations scattered through out the town, so they are closer and there are more of them than EMTs. But fire department are finding that their budgets just do not cover the cost of being first on the scene. Years ago, if the firemen showed up, and a guy was having a heart attack they would perform CPR,. But that was about it. Now firemen have emergency medicines they inject, they set up IVs, they can shock a sleeping heart back into action. The quality of services provided by the fire department is much better, but the cost of those services are high. The local government is cutting the budget not increasing it. The citizens are given a choice, add money each month to be a subscriber for first responder services, OR pay nothing, and if they are called to help you the bill will be $1000.
The fear, of course, is that people will be reluctant to call because of the cost and people will die gambling on their health to save money.
If health care is just a product to buy and sell then people will literally be priced too death. Actually it is happening now. Some of my readers know that I am a social worker, and I recently started working the night schedule of the State Abuse Hot Line. We take calls about child abuse and Adult abuse.
It is common to get a call where a woman has dementia and depends on their husband to give them their medication, the medication is too expensive, so, to save money the husband gives the wife her medicine every other day, instead of daily. Or they pick which meds they will buy this month and which ones they will go without.
I really don't think most people are looking at the debate in this simple and direct way. Is health care a basic need that society should be sure is available to everyone (like education) or is health care going to be like diamonds, valuable, beautiful, very expensive, and rare.
I do understand why some people object to national health care. People would need less health care if they were healthy. Often when people need health care it is because of their own poor choices. They eat too much, smoke too much, drink too much, exercise too little, have too much unprotected sex with careless, promiscuous people. Why should I have to pay for someone else's poor choices?
Of course to not pay for sick people's health care we are sitting by watching people die for mistakes made when they were younger. Do we really think that a bad choice makes it OK for us to have the ability to prolong their life, yet we'll sit by and watch them die because they started smoking at age 12. How many of us are comfortable having the ability to prolong a person's life but instead we'll let a 50 year old person die because they did something stupid when they were 12?
My answer to the question is NO. No I am not OK with letting people die when we have the means to cure their illnesses. Yes, I want our government to support free public education to our children. No I don't want health care to be a commodity. Yes, I want health care to be a basic human right.
Here comes my uncomfortable assumption. I believe that the answer for millions of conservative Americans is the opposite of my views. I believe that the poorly hidden secret of Republican strategists and think tank scholars is this: they would prefer for health care and education to be privatized. There are some Carl Rove Americans who really do believe that they have no obligation at all to share in the cost of society. There are Tea Baggers who believe we could actually roll government back to the size it was before Teddy Roosevelt, before there was such a thing as progressive income tax. There are some among us who would have no problem going back to child labor, and paying grown men 75 cents a day for 10 hrs of work. There are conservatives who feel that feeding the poor is the job of churches and not the governments. If the churches don't feed them, and if they are too lazy or stupid to get good jobs and take care of their own needs, then well, it's "tough, tough, cream puff."
I've been thinking about the BIG PICTURE for some time and I think I can distill the issues into a single sentence:
Will the US consider Health Care a product, or will we think of it as a basic human need so important that it's provided by the government and financed with tax dollars?
Commercial products are bought and sold. Commercial products fall neatly into a free enterprise system. There are other areas of our life, that do not fall so neatly into capitalism. Almost anything can be forced into a capitalism/free enterprise system, but some of these services are considered basic, essential, and yet not particularly good revenue makers.
Roads can be forced into a free market system. We could allow all roads to be owned by corporations or entrepreneurs, so that when you back out of your drive way you pay a toll to some company, but here is the deal. If roads are part of a free enterprise system, then road builders would only make roads that could contribute to their bottom line. It would be commercially logical to build and own roads in Dallas , New York , LA and Chicago, but roads in Wewoka Oklahoma would never earn enough money to pay for the roads or their maintenance.
Conservatives are quick to say UPS makes money, and the Post Office loses money and they are right. The problem is that this comparison is an apples/oranges comparison. The USPO does home delivery six days a week and provides home delivery to basically every home in the US . UPS delivers packages ONLY. There is money to be made in shipping packages, but home delivery is just a black hole of cost. With the increase of faxes and email the customer base for the post office is shrinking, making the cost for the home delivers even more expensive. The extinction of postal home deliver seems possible, and perhaps inevitable, but consider how many people have no computers, and how many have no internet access. Think of how many people are luddites who just don't like or trust doing online banking and getting paperless bank statements. I would guess there are hundreds of thousands of people who would be dramatically handicapped if there were no home mail delivery, and yet, home delivery is not a money maker and wise entrepreneurs will shy away from such a business.
Education has long been considered so basic a need that the US provides 12+ years of free education to children. After high school graduation, if young adults want more education the government along with private industry provides assistance so that they can be assisted with the costs of a college education.
Again, some point out that there are private schools that produce students who test higher and perform better than students in public schools, but this is another apples and oranges comparison. Private schools have the right to pick or reject students, while public school does not have that same option. Emotionally Disturbed students are not accepted in some of these private college preparatory schools. Poor children from drug using abusive parents can't get into a school with a high tuition and requirements for parental involvement. Disruptive students are expelled from private schools, while public schools are required to provide alternatives for troubled and defiant students. Could a private school continue to have such positive results if they had to accept every student that showed up at their doors?
When it comes to health care the debate should not be limited to the details of a particular bill, because the BIG issue, the decision we need to make is in how we view health care. Is health care more like roads and schools, or is it more like blue jeans and boiled peanuts. Are we going to sell health care the way we sell refrigerators and plumbing services, or are we going to consider health care a basic human need so vital that it will be supported by all of us (rich and poor) in order to be available to all of us rich or poor.
Consider the consequences of this decision. If health care is only a service, like dog grooming and drain cleaning then availability will be tied to an ability to pay. If a poor person can't afford to groom his dog then he lives with a shaggy dog. If a poor person has a child sick with an infection, but can't afford the doctor's fees, the lab tests, and the cost of the medicine, then that child stays sick until he or she gets better, or the child stays sick until he or she dies from a lack of treatment.
In my town the fire department is typically the first responders to accidents. There are fire stations scattered through out the town, so they are closer and there are more of them than EMTs. But fire department are finding that their budgets just do not cover the cost of being first on the scene. Years ago, if the firemen showed up, and a guy was having a heart attack they would perform CPR,. But that was about it. Now firemen have emergency medicines they inject, they set up IVs, they can shock a sleeping heart back into action. The quality of services provided by the fire department is much better, but the cost of those services are high. The local government is cutting the budget not increasing it. The citizens are given a choice, add money each month to be a subscriber for first responder services, OR pay nothing, and if they are called to help you the bill will be $1000.
The fear, of course, is that people will be reluctant to call because of the cost and people will die gambling on their health to save money.
If health care is just a product to buy and sell then people will literally be priced too death. Actually it is happening now. Some of my readers know that I am a social worker, and I recently started working the night schedule of the State Abuse Hot Line. We take calls about child abuse and Adult abuse.
It is common to get a call where a woman has dementia and depends on their husband to give them their medication, the medication is too expensive, so, to save money the husband gives the wife her medicine every other day, instead of daily. Or they pick which meds they will buy this month and which ones they will go without.
I really don't think most people are looking at the debate in this simple and direct way. Is health care a basic need that society should be sure is available to everyone (like education) or is health care going to be like diamonds, valuable, beautiful, very expensive, and rare.
I do understand why some people object to national health care. People would need less health care if they were healthy. Often when people need health care it is because of their own poor choices. They eat too much, smoke too much, drink too much, exercise too little, have too much unprotected sex with careless, promiscuous people. Why should I have to pay for someone else's poor choices?
Of course to not pay for sick people's health care we are sitting by watching people die for mistakes made when they were younger. Do we really think that a bad choice makes it OK for us to have the ability to prolong their life, yet we'll sit by and watch them die because they started smoking at age 12. How many of us are comfortable having the ability to prolong a person's life but instead we'll let a 50 year old person die because they did something stupid when they were 12?
My answer to the question is NO. No I am not OK with letting people die when we have the means to cure their illnesses. Yes, I want our government to support free public education to our children. No I don't want health care to be a commodity. Yes, I want health care to be a basic human right.
Here comes my uncomfortable assumption. I believe that the answer for millions of conservative Americans is the opposite of my views. I believe that the poorly hidden secret of Republican strategists and think tank scholars is this: they would prefer for health care and education to be privatized. There are some Carl Rove Americans who really do believe that they have no obligation at all to share in the cost of society. There are Tea Baggers who believe we could actually roll government back to the size it was before Teddy Roosevelt, before there was such a thing as progressive income tax. There are some among us who would have no problem going back to child labor, and paying grown men 75 cents a day for 10 hrs of work. There are conservatives who feel that feeding the poor is the job of churches and not the governments. If the churches don't feed them, and if they are too lazy or stupid to get good jobs and take care of their own needs, then well, it's "tough, tough, cream puff."
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Top-level comments on this article: (4 total)I appreciate your perspective, Tex. I know you walk the walk. I'm ready for this whole health care debate to be over, it shouldn't have lasted this long, but I believe it's an important enough issue that it is worth fighting for, even if the fight spans decades.Thanks Bruce: as you know, I'm liberal, a progressive to excess, and I find myself agreeing with Republicans though for different reasons. The Bill for Heath Reform being pulled about in Congress is not a good bill. Of course, the bill I would favor would be seen as worse in the eyes of most Republicans. Like you I am tired of the health care debate. If it passes, it will not have much impact on regular people for as long as 5 years, maybe. That is more than enough time for opponents to undo much if not all of it. This health reform bill is just not a good bill, and I have written about my objections before. The thing that matters to me is the principals by which our government makes decisions. I know it is not fair to Paint anyone with a big brush, and not all Republicans are self-centered money hungry bullies who care little or nothing for the less fortunate. But given the Tea Bagger Pailanites rhetoric it just feels like the country is about to swing toward a conservatism that is more like fiscal libertarianism, and not traditional Republican principals of budget restraint. I am in one of the reddest states in the nation, so I may not have a good feel for the whole country. Here in Oklahoma it seems that most people just want there to be NO federal government, and only a skeleton crew at the local level, The people here seem intent on eliminating taxes and essential needs of society be damned. The ONLY reason I have a job, is not because child abuse is so common, it is because the state has been sued for failing to protect abused children, and so the state is forced to have a Child Welfare system in place. I like it when the state is sued for failing to protect children and kids in foster care, because the results of those suits is that they hire more people, and improve the services to protect abused children. If there were no law suits I have no doubt that my state would cut the child welfare budget down to some percentage very close to zero. It feels like avoiding taxes is all that matters. So if Health Care needs tax dollars they want no health care. If protecting abused children takes tax revenue then let's mind our own business and let the care givers beat and rape the children. I think there are more crumbling roads and more potholes in Oklahoma than in any state in the US. The principal that some things are worth having even if it takes tax dollars is just not something tea baggers and Oklahomans, and Libertarian Republicans can accept.
Well, if the Congressional Budget Office is to be believed (and so far I haven't heard any real allegations of partisanship in the CBO) this plan is to shave the national debt by $100 billion in the first 10 years and $1 trillion in the second 10 years, and within the first 90 days it is supposed to make it illegal for an insurance company to drop someone because they get sick. I think this is a good start, anyway.I know what you're talking about with Oklahoma. Texas isn't much better, and I live in just about the reddest part of the state. I'm pretty sure I would get my car keyed if I put an Obama bumper sticker on it. You've probably been seeing the headlines lately about the Texas State Board of Educations requirements for new science and history books. It's almost unbelievable how they want to re-write history, except that censorship has been done throughout history, so I guess I can believe it.I still see reason to be optimistic. There are good things happening, it's just that the meanest and the loudest are making headlines. I read the other day that just 2% of Tea Partiers are aware that Obama cut taxes for 95% of the population. 68% incorrectly believe that he has raised taxes. With so much misinformation out there, it's easy to give in to the pessimism. The new education tax credit sure is helping my family this year.I work with a housing project in Houston's 5th Ward, and for most of the residents there, these are the best days of their lives. Not because of government handouts, but because they have more opportunity to better themselves now than ever. Maybe I should move there. I've seriously considered it.Anyway, keep up the good work.
Outstanding, thanks Tex.
Best.......e
Tex,I have a hard time figuring out where I want to start with this comment. Overall, I am in favor with the National Vision, as per our last Election. I want the military out of Iraq, I want an emphasis on jobs, and I even want health care. I am all for nationalized health care, I would prefer it. Call me Communist, I don't care, I think of it as socialist, but if health care were part of my income tax, then I would be in favor of it.But, so far as I have been able to tell, the government isn't considering health care at present. They are considering something entirely different: Health insurance.What's the difference? Tex, I have had employee paid health insurance in the past (but haven't for many years, and in fact I am completely uninsured now). When my employer paid my health insurance, and when I was sick with poison ivy, I could afford the deductible, because I was well paid. That's not the case with me any more. If I have to pay one-third of what little income I have (which would drive me right out onto the sidewalk, by the way, or mean I had to choose between eating and health insurance) besides having NOTHING left over at the end of the week, I still couldn't afford going to the doctor. If I worked at a grocery store as a checkout clerk, and had health insurance, that doesn't mean I can afford health care. If I were to get sick, it might cost me hundreds of dollars (and we know the costs go up for serious problems). My point is, now that I have to buy health insurance, I can't actually afford health care. So what good is it? It's unfair to me. It might be fair to you, because you are making good money (hypothetically), and your health insurance is paid for.This new bill doesn't do that, it is really an unfunded mandate that will force people to buy health insurance. It's a decree, "You shall buy health insurance!" It does nothing for health care, and only makes the reality of health care a distant dream. That's my understanding of what is currently being considered for legislation, and that's my fear, is that I will end up paying for one more big thing I simply don't have the money for.Sorry, that was me, Greg Lewis.
Wow, that's a lot to fit into a nutshell. I think the problem people have with this thing is as follows:1) It's not really health care, it's health insurance.2) It's not really for all Americans, it's only for those who cannot afford their own. Those who currently have insurance will not want to change to a government-run option, regardless of cost. The lines at the post office (which is broke) make that a negative.3) It's too complicated to figure how it will be paid for. I don't think anyone likes the 'depends on who you ask' answer.You make some good points, and objectively it would be wonderful if real health care was availabe to all. Unfortunately, the Dems have failed miserably at selling it to the American people, and the Republicans have trounced them on their ever-changing 'message'. Simplify it, make it revenue-neutral, and you might have something. Otherwise, the tricks and deals and misinformation will continue and we have business-as-usual in Washington and in the end, only a few will benefit and the majority will get skewered.Good job, sir.
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