25 September 2009

Communities of Interest

There was a time when the concept of community was strictly geographic - in practical terms, what happened to people who directly affected your chance of survival was what mattered. Trade started to broaden the area, of course, since a trader serves as a broker in cases where geography makes it impractical for interested folks from one community to deal directly with those in another, say to obtain tea from hundreds of miles away while still maintaining your agrarian way of life, working as a blacksmith, etc.

Money, (the use of a system with banks and other financial entities) and technology (such as transportation, and rapid, non-face-to-face communication) have profound ramifications for how we see communities and how they function. It's not necessary, for example, to persuade neighbors to give up their time and labor to help build a home or raise a barn, we negotiate with a banker about the value of such projects and either arrange a mortgage or engage a contractor to attain our goals. We can eat blueberries or other perishable delicacies from halfway around the world; we can see pictures of natural disasters, or wars, as they happen. We are touched by evidence of suffering after a tsunami, or the plight of refugees.

Our sense of community grows - our definition of community is no longer about neighbors in the original sense; our neighbors, the non-family people we are concerned about, include not only those who might dump noxious stuff into our water supply or start a fire that threatens our property, but some living on other continents. We know the plight of workers in India, or China, impacts the standard of living of our relatives and "proximate" neighbors as surely as if they were competing for the same jobs - because in point of fact, they are.

It behooves us, according to most philosophies and religions, to treat our neighbors with the care, interest, and respect we want them to employ when dealing with us.

Yet, in the most technologically advanced nation in the world, the United States of America, we are debating the merit of extending health care coverage to tens of millions of our closest friends and neighbors by making it affordable.

Large capitalist organizations are trying to avoid competing in an open, free market for customers, preferring to pick and choose those they can make the most profits on - while the reality is that everybody does get health care, because if you get sick and you can't afford it the hospitals will admit you to the Emergency Room, but then to insure their own survival they must absorb that effort by raising the prices on their other services. Logic alone obviously dictates that we find a method to spread those costs fairly.

Human compassion argues for doing so, as well.

We're not getting great health care in the United States, we're getting very expensive health care that costs even the wealthy more than it should. Yet, rather than examine the successes in other countries and adopting their best practices, big business interests in this debate are spending millions of dollars every day (collected from health care premiums) to influence the men and women in Congress, who are sorely outnumbered by the lobbyists. It's a travesty - a sham - that makes a mockery of the alleged reliance on free markets to insure efficiency and improvement of goods and services.

The "profit motive" is great. It brings consumers choices for fair trade coffee and tea parties, and "out-of-season" blueberries, and Blackberries™, and a veritable plethora of choices for our transportation, wardrobes, and more. It also brings the cost of MRIs down in Japan, by an astonishing margin compared to what we pay in the USA - why is that?  Because we've let the system of paying for health care mimic a competitive market, while in practice it's not possible for a consumer to make a real, let alone well-informed choice. 

When you're in a serious car accident you don't shop around for the best doctor charging the lowest rates, you trust an ambulance or flight for life chopper (is that socialized health care?) will transport you to the nearest hospital or clinic (are those for-profit entities?) and you agree to pay the price that facility needs to charge you to cover being there, on call, day and night, and cover their overhead, which includes doing all the paperwork for insurance claims and the costs of those who arrive uninsured and broke.

Half of the personal bankruptcies in the USA are triggered by medical expenses.  Bankruptcy isn't some magic wand, though, it means that all the people who were owed money by that person end up getting less than they agreed to originally - sometimes virtually nothing at all - and so THEIR costs of doing business go up much the same way a hospital or clinic has to "absorb" the costs of treating those in the community who cannot afford it.

One way or another, we pay.  One way, we also pay 8-digit salaries and bonuses to CEOs and lobbyists who profit from rising costs that have outstripped inflation for three decades.  Those costs do get spread across the area where the insurers do business, of course.
There's certainly no "perfect" system, and there's big money riding on keeping things "as is,"  but one thing has become obvious to even the most casual observer: there's lots of room for improvement in the current scheme, for finding a fairer way to distribute the costs while controlling the expenses, and the benefit of improvement will flow to you, and me, and our community - no matter if you think of community as the neighborhood, the city, the country, or the planet.
The Congressional Budget Office figures show that tethering a public option to Medicare reimbursement rates would save the government $110 billion! That's even more than the "public option" in which the government has to negotiate rates with doctors and other health care providers. There are LOTS of fiscally conservative ways to improve the bottom line, and places where the profit motive can drive innovation and reduce costs -- but the bottom line is:

Let's get the profit motive out of health care payment.

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1 comment:

Tom Hayes, the Synergist said...

According to politico.com, the source of the "$110 billion" figure:

"There has been some confusion among members this afternoon about the actual score that CBO released - ours is based on multiple conversations with members and staff. It looks like the total savings for a public option that was included in the Education and Labor Committee (which reimburses health care providers at rates that are 5 percent higher than those set by Medicare) would save the government $110 billion. A public option in which the government must negotiate its rates with doctors and other health care providers would save the government $25 billion. So the difference is $85 billion, not $110 billion, as I previously wrote.

But none of these figures is based on an actual CBO report; instead, these are based on conversations with lawmakers and aides who attended an afternoon caucus meeting in the Capitol basement on Thursday.