Monday, August 17, 2009

Socialism, Public Option, Obama and Health Care

August 17, 2009, 5:30 p.m.

General Semantics Meets "Socialized Medicine"
(brought to you by*)

The news that we're not only not going to get the system of "universal, single payer" health care that every other industrialized country offers its citizens, we're not even going to get the watered down "public option," comes as no great surprise, but as a great disappointment nonetheless.
Sheryl Gay Stolberg, "‘Public Option’ in Health Plan May Be Dropped,"
New York Times, August 17, 2009.

What it means is that we're not even going to get health care, we're going to get health insurance. There's a big difference. As Congressman Dennis Kucinich often says, "I don't want every American to have health insurance, I want every American to have health care."

There are many things the free market, competitive, for-profit corporate system does not only well but efficiently. Keeping Americans healthy is not one of them.

* Fast food chains can sell more, have higher profits -- and stock prices -- by fattening up Americans, selling the various combinations of sugar, salt and fat that encourage our eating more -- as well as promoting diabetes and obesity -- than from fruits and vegetables.

* There's more profit from processed foods that keep forever than from fresh produce that spoils.

* More profit from the sale of automobiles (and their associated expenses) than from bicycles.

* More from beer and other alcohol than from V-8 juice or tap water.

* And it all comes to us in the sea of multi-billion-dollar advertising through which we must swim.

* Pharmaceutical companies advertise prescription drugs to potential patients -- who are legally prohibited from buying them ("illegal drugs") -- for the same reason toy companies advertise toys to children who don't have the money to buy them. Toy companies know that children will put pressure on their parents; Big Pharma knows potential patients will, with equal success, put pressure on their doctors -- doctors who might never have prescribed the high-profit drug (as heavily advertised drugs tend to be) without that patient's insistence.
It stands to reason that a heavily advertised "labor saving" lifestyle promoting as little exertion and exercise as possible, coupled with a nutritional food source that is not good for us, will end up producing more obesity, heart disease, cancer, stroke and diabetes -- among other things -- that will require medical and hospital care.

And who do we look to for the cure? The sickness lobby.

Sickness insurance companies don't increase profits by paying policy holders' doctor and hospital bills. They increase profits by not paying claims, contesting and refusing legitimate bills, refusing to insure those likely to have above average costs, and dropping those enrollees who do have high costs -- and by doubling our premium payments every few years. As a result some 47 million Americans have no coverage at all. Their only option is hospital emergency rooms that run up costs that are multiples of a doctor's visit -- costs that are then shifted to the rest of us in the form of higher bills than what we'd otherwise get, and ultimately even more increases in our premiums.

It is the sickness insurance industry that has created our problems. Why on earth would we turn to it, of all potential saviors, to solve the problems? It's nuts. It's like asking convicted child molesters to guard our children's playgrounds.

But it's also the way Washington works.

Following his comment about disparity of earnings among Americans, Warren Buffett was asked if he wasn't talking "class warfare." He replied along these lines: There's class warfare, all right, but the war is over and my class won.

Or as the old adage, rewriting the even older Golden Rule, has it: The Golden Rule is that them that has the gold makes the rules.

An industry willing to spend $1.3 million a day lobbying Congress, and willing to be among the most generous sources of campaign contributions, can prevent even a puny "public option" from coming into being.

And what's the argument of the public option opponents? As Stolberg reports, "opponents denounce him [President Obama] for promoting “'socialized medicine.'”

Put aside the revealing irony of the reported comment of a town meeting protester, "Keep your government hands off of my Medicare" and the fact that we already have a good deal of "socialized medicine": Medicare, Medicaid, medical services for those in the military and VA hospitals for those who once served, and the sickness insurance benefits for government employees (local, state and federal). That's a lot of "socialized medicine," folks. It's not like, if only you can defeat the public option proposal you will have rid America of socialized medicine.

"Socialism" is defined in, as modified for our purposes, as "a theory or system . . . that advocates the vesting of . . . ownership and control . . . in the community as a whole." The Wikipedia entry says, "Economically, socialism denotes an economic system of state ownership . . .."

I use these definitions because to talk of "socialized medicine" suggests government ownership of a particular function -- not a "socialist society" or "socialist economy" in which all means of production are owned by the state.

When lecturing to business crowds I have occasionally asked the audience, with a show of hands, how many consider themselves "socialists." Usually not a single hand goes up. I then ask, "How many of you drove here today? [Most hands go up.] How many drove on Interstates [inserting the numbers of the local Interstate highways]? [Most of the hands stay up.]" I then ask, "Did you realize you were driving on a socialist highway? Now that you know that, does it trouble you?"

"Socialism" is, for many, an emotionally charged word, an expletive, a swear word you might say. During the 1950s era of Senator Joseph McCarthy the word "communist" carried even more opprobrium -- along with "fellow traveler," "red," and "pinko." "Liberal" has come to carry similar connotations for many today. Such words are conclusory -- they remove the possibility of any additional meaningful conversation, and certainly any further rational analysis. They are used to describe something the speaker believes has no redeeming qualities, something perhaps even indisputably "evil."

Given the American experience, which is clearly a mixed public-private economy, it doesn't make much sense to use the word "socialist" from a descriptive or analytical perspective -- however politically expedient it may be in weakening President Obama, strengthening the Republican Party for next year's elections, or merely defeating any health care reform legislation.

There are so many "government-owned, socialist" enterprises in this country that are something between widely accepted and even celebrated, such as our history of public ("socialist"): libraries, K-12 public schools, National Parks (as well as state, county and city parks), Interstate highways (plus state, county and city roads), the military, Medicare and Medicaid -- essentially every program funded by any governmental unit.

We can be proud of our nation's generally rational, practical, pragmatic approach to these questions. For example:
* Monopolies and quasi-monopolies can be "privately owned," in a sense, but may have their rates, rate of return, and business practices regulated (as with broadcasting stations and the FCC -- at least from the 1920s to the 1960s).

* The Tennessee Valley Authority, and Hoover Dam, are examples of a "public option," offering a benchmark, an alternative, to private power.

* Social Security is a socialized retirement system.

* Barge traffic on the Mississippi, and flood control, are made possible by the Army Corps of Engineers -- as airline operations are made possible by the FAA's air traffic controllers.

* Highways may be "owned" by government, but they are built by private contractors enlisted by the government from the marketplace.

* At least some defense contractors might as well be "government owned," given the large percentage of their cash flow that comes from taxpayers.

* Publishers are given discounts on subsidized rates for books, magazines and newspapers.

* Have we "socialized" agriculture by providing price supports and subsidies?

* Some cities own their cable television systems.

* We have government involvement in the economic model called cooperatives, such as the role of the early Rural Electrification Administration, Rural Electric Co-ops, and the current proposed alternative to the public option.

* And the tax code is riddled with so many special breaks for individual companies and industries that is resembles Swiss cheese.
There seems to have been no limit to the thousands of mix-and-match combinations of economic models we've tried.

Our approach has clearly been pragmatic rather than purist. We have not cared whether a given approach was called "socialist" or "capitalist." What we cared about was getting the best combination of economic models -- in a given instance and throughout the entire economy.

That's what we ought to be doing now with health care. This is no time for ideology, for using "socialist" as an expletive. It's time to help the American people regain their health, and not have to risk bankruptcy when they're sick.

* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson

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