Following up on on my earlier harangue on Socialized Medicine(SM), here are a few remarks I’d like to add.
The objections to SM are usually cloaked in a fog of free market rationalizations. That is all, of course, bullshit. To begin with, medicine has nothing to do with the market. A product that can get you killed if you don’t purchase it is immune to sanctimonious Adam Smith hand-waving. You don’t just have access to the usual consumer options; you can’t refuse to get medical care, you (or your family) will get sicker, stay in pain or die. If you need medicine, for the most part, you have to have it. Its that simple. Of course, if you don’t seek medical care (or insurance) in a private system because you can’t afford it you are certainly free to take your chances, aren’t you? I believe the free marketeers call that “freedom of choice”.
Of course, there are myriad other ways it can be shown this is not a free market, in the classical capitalist definition. Medicine is highly regulated, at every level, by both the government and its practitioners and their professional organizations. You have to go to an authorized physician to get treated, you have to buy prescription drugs from a licensed vendor and government, board, commission and Association requirements keep a stranglehold on the whole process. I have no problem with this, I’m fairly well satisfied with how medicine is regulated, but lets not bring up this free market crap any more. It is irrelevant to what we are discussing here.
Whatever value these regulations, certificates, diplomas and controls may actually have to health care, the primary purpose for them is to protect those in the system from competition from those who are not. Sure, there are quacks along the edges of the profession, and a vast phony patent medicine industry, but you and I know if something is REALLY wrong with your kid you don’t go to your health food guru, or your acupuncturist, or your chiropractor. All that “freedom” is wonderful, but as Emily Dickinson points out, “Microscopes are prudent in an emergency”.
This uncapitalistic business model immediately drove prices for health care through the roof, our lackluster performance in medical care (compared to many other industrialized and prosperous nations) is purchased for at the highest price per capita of any nation in the world. This is no accident, it follows inevitably from a government enforced monopoly run by careerist opportunists. It works for the military, of course it will work for medicine. The high prices for even the most routine medical care also allow for the introduction of yet another profitable bureaucracy, one that does absolutely nothing but shuffle paper and collect its 20% off the top: the health insurance industry!
Other than the fact that too many people are getting rich off this system, there is one more factor that keeps it firmly entrenched, defended by professional organizations, lobbies and every pious patriotic right wing Rotarian in Congress. The conditions are in place to ensure that any meaningful reform to the system will be simply overwhelmed by the sheer economic power and financial momentum insisting that the system remain unchanged. You don’t need a boardroom conspiracy, just too many people are profiting by things remaining the same.
During WWII, a shortage of labor, and a failure of the work force to respond to ever-higher wage and salary offers, prompted private employers to include generous health insurance packages to attract workers. The trade unions, of course, backed this big time! But for workers not covered by union contracts, this development eventually led to inflation of medical costs (prices will always rise to meet the available cash). Not only that, it is impractical to change jobs just to get better insurance, so there goes the last “free market” excuse. Today, health costs are so high that employers are doing everything they can to avoid paying even a part of them–shabbier insurance plans, hiring part-time and temporary workers ineligible for benefits, outsourcing, the gig economy, subcontracting, wag, wag, wag. Its not that they’re evil people, its just the inevitable result of how our system evolved. Lets face it, if we want to give EVERYONE a basic level of health care, EVERYONE is going to have to pay for it.The only other option is to ration medicine only to those who can afford it. Yeah, “free enterprise” sounds so much better than “death panels”.
If you do happen to have a half-way decent insurance benefit from your employer, you will put up with any shit he hands out because if you quit or are fired its highly unlikely you will find another to match it. As far as salaries are concerned, there is still a free market in the workplace (IF you have a critical job skill). But even if you score another job at a comparable salary, chances are it will be without benefits. When you are constrained by market forces from getting a better job, for whatever reason, all that free market crap does you no good at all. You are a wage slave.
So that’s the background. My earlier essay on how this national debate affected me is the human result of all that policy and economics I tediously plowed through above. Actually, I’m doing OK, I always had good insurance from the companies I worked for, and I had VA and Medicare when the companies started cutting back, or forcing out those old-timers they couldn’t cut back. But its not because I’m smarter, or more competent, or have a stronger work ethic, or because I’m a better, more responsible, more honest person. Its primarily because I was born in 1947.
I hit the demographic sweet spot. If you didn’t, tough shit. That’s not my problem. I (and many others) tried all our lives to sound the alarm and work for a fairer health care system. But nobody cared, nobody listened, nobody was willing to give up just a little so we could all live better. It was all just “Socialized Medicine” to them and no one wanted to hear it.
Love it or leave it, mofo. The hippies were right, they tried to warn you. You just wouldn’t listen.