If I seem to be spending all my blogging energy on health care finance these days, the reason is that the issue is important and immediate. My view of blogging is participating in public debate, so it makes sense to write about the issue while it’s on the public radar. War and foreign policy, another key obsession in this space, are certainly way down on the priority discourse, so if I want to engage the moment, health care will be the topic. Which brings me to today’s variation on how to pay the costs of this vital public good: Infrastructure. That’s right, infrastructure--roads, bridges, power grids, water and sewage systems—the things that make life possible in a mass society. Like infrastructure, health care is a vital public service.
In the United States these days this health care is largely directed by private sector interests under the guise of a competitive market place that claims to offer consumer choice. Thinking infrastructure again, we would not accept a highway system designed by multiple parties, coordinated--if at all--in a complicated and time consuming manner. We would find it even more unacceptable if we saw our neighbors with a more effective system.
So why do we put up with private interests from large corporations controlling and directing important public service? I’m pretty sure it’s because we don’t trust the government either, so we are willing to tolerate the devil we know rather than an uncertain change. A better reason is that competition and innovation among private interests can also contribute to the public weal. Somewhere between private parties maximizing their interests and socialized medicine lies the sweet spot of the proper balance.
American health care these days is anything but balanced. Certainly not when corporate health care interests earn profits that enable them to spend hundreds of millions in lobbying, lavish money on Congressional campaigns, fund mergers that remove decisions even farther from the doctor-patient relationship we supposedly values highly and pay huge salaries and bonuses. Every one of those dollars is a health care dollar that is not buying any health care. On the other end—patients, their employers and governments—are spending vast sums on a system that leaves even the insured vulnerable and produces modest overall outcomes even as it creates the world’s most advanced medical technology.
Obama has ruled out a government “takeover” of one-sixth of the nation’s economy, a sentiment I can agree with. But that should hardly mean a withdrawal or even a minor role in shaping the nation’s health care system. The public interest requires a strong regulatory presence that ensures open competition and fairness—you know, government as umpire. We had something like that in place for seven decades in financial services after the Crash of 1929 and it worked pretty well until dismantled by a Republican Congress and Democratic President in 1999. We do the same with the national power grid, operated by private entities but with a strong regulatory eye (we claim) on the public interest. A strong governmental presence in an important economic sector does not frighten me. Hell, as an individual with no real money and limited power, I want someone representing the broad public interest in this marketplace of capitalist sharks. The gravest danger to a society, as the Constitution’s Framers well knew, was concentrated power. In their world, the Executive posed the greatest threat of concentrated power and the Framers took great pains to circumscribe and limit that power. The tremendous economic and political power of the modern corporation, no doubt, would trouble the Framers.
So I want to see Obama stressing a strong public interest in two areas. One is universal access; everyone must have access to health care. The second is that we learn how to pay for what we want. My interest in universal access is humanitarian; I want for everyone else what I want for myself. Staying healthy and finding care when I need it gives me a security and independence that I value highly. I extend that right to all others since I want them to do the same for me. Universal access is also practical. If everyone can obtain medical care, they are less susceptible to pandemics; healthy people are more able to work and live independently.
Paying for health care and who gets how much profit out of the system is the touchstone issue in the current reform. Here I agree with the Blue Dogs and other conservatives that carp about fiscal reform. I strongly believe in sustainable finance. Health care is far from free and someone will need to pay for it. If I am using it then that someone should be me, either directly or through the premiums and taxes I pay to insurance companies and government that will help meliorate the costs. I should not be paying with someone else’s (say, future generations’) money. That, to me, is simply driving headlong toward the cliff with our kids and grandkids in the back seat. So I am right on with the Blue Dogs on that.
Where we part company is on how to pay the costs. They say “no new taxes” and I say “no more wars”. They refuse to look beyond their infatuation with private markets and consider alternate models of health care delivery. I say look at structural and transformative change. Health care is a public good, essential to the general welfare. Americans, through their elected representatives, have every right to create a system that provides the necessary public services.
Hell, we do it for highways. Nothing tells me that we cannot do the same for health care.