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.

Share on Facebook

How to end illegal immigration

"We don't want the government to do anything."

That's the mindset of some folks, despite the fact the U.S. Constitution actually calls for government to manage things such as defense, domestic tranquility, etc. Oddly, by doing away with the government, we no longer have illegal immigrants. We also do away with pundits pretending to be objectively covering politics and all those ads during the election. That's a fair trade-off for no more taxes, right? In a way, it's interesting - it's utopian:

I don't need anybody regulating the food I buy; I don't need anybody checking the efficacy of the drugs I use; I'm never going to need a fire-fighter or a policeman! I don't need roads and bridges built or maintained by some big agency - no not me! I'm fine with private, "free market" solutions to everything, including education, defense, and immigration.

Call it a little naive, maybe, but... the sound bites seem appealing until you ponder little things such as: who deals with pollution in the streams you fish in, or how a family living in a hut copes with forest fires, hurricanes, or immigration (at least there'd be no more illegal immigrants.)

The problem seems to stem from how any given person views and values their community. If you believe you can be totally self-sufficient, that there's no gain from being able to drive to the grocery store, have utilities connected to your property, or turn to an outside authority about a potential dispute about just what IS your property, well, then there's not much the government offers, I suppose. But if you value other people (say, for instance, somebody who will make your bullets, or mine copper to help make pipes so you can build solar heating panels, or simply to keep your descendants from inbreeding,) then unless you always get along perfectly with everybody it follows that there's a certain value in civilization - which is to say, society.

Community values, shared vision and common goals, lead to things such as fire departments, public beaches, Navies to deal with piracy on the seas so you can get certain goods you can't grow or make yourself, the FDA, even bridges and national parks - but none of that is without a cost, that we must share. Even hermits benefit from agencies that limit the pollution in the water and connect the dots between pesticides and reproduction in wild animal populations, after all. What will the mountain man, living on the fish in his stream, do when somebody removes that food supply?

Debating the role of government is great...

Look, I'm no fan of paying for somebody else to sit around doing nothing, and I think the IRS rules are needlessly obscure and convoluted for the wrong reasons -- but as long as my share of the taxes collected is fair I'm not against taxes or governments in principle. The process of democracy in the U.S. is obviously not perfect; I envy the Iraqis who have health care access guaranteed by their new constitution, but I'm very fond of what we've built in this country and I'm fine with contributing to the betterment of my community - which extends considerably beyond the edges of my little chunk of land.

Digg it!

Have Town Halls jumped the shark?

The town hall format is attracting a lot of attention, but people obviously come based on partisan goals, emotions run high, and political reporters determine how the story is played in the media.

The Washington Post, for instance, recently ran with

"The DNC kickoff rally in Phoenix attracted about 1,200 reform supporters, but a raucous meeting on the other side of town hosted by Obama's former presidential campaign rival Sen. John McCain (R-Ariz.) attracted hundreds more -- most of whom were loudly opposed to Democratic reform proposals."

This at best inconsistent with the reports from the Associated Press, which indicated McCain faced a hostile town hall crowd in favor of health care reform. Quoting, again,

"After McCain opened it up to questioning, one man angrily pointed at him and asked the senator why he deserves a better health care plan than him."

A more academic setting where the focus is on facts rather than carefully scripted appearances intended to mimic open forums quite probably does more to forward any discussion. Given how adept partisans and pundits of both sides are at dismissing any assertions advanced by their opponents, the chance to have a voice from outside politics, an experienced respected scientific researcher, discussing facts is overdue.

Recognizing that, Dr. Morrison Hodges, Professor Emeritus at the University of Minnesota School of Medicine (and formerly the Director of Cardiology at Hennepin County Medical Center) will describe the forces that shaped the U.S. health care system in a lecture on September 17, 2009. He intends to cover how we arrived at a "market based health care system funded by employers" and how well is it's working in comparison to other countries. Dr. Hodges will explain the history of U.S. health care and how it compares in quality and cost to other functioning systems. Dr. Hodges believes he can outline how the United States can cover everyone with quality health care "without breaking the bank."

The town hall format has done much to illuminate how central the problems with our health care insurance system are in our communities. With one in six citizens uncovered, we've all come to realize that we end up paying for their medical problems anyway, be it through increased premiums, or more subtly when they're forced to file for bankruptcy protection (over half of personal bankruptcy filings in the U.S. are triggered by medical costs.) We've come to resent that money collected to pay health care premiums is spent at a rate of over a million dollars per day just to support lobbyists seeking to continue "business as usual" in D.C., and resent paperwork that drives up costs and bureaucrats that countermand medical decisions without improving outcomes.

It's time to peel back the rhetoric, to get past the sound-bites and the spin-mongering "pundits" -- to stop pretending this is about death panels or a way to cover illegal immigrants, and find a way to preserve our American way of life by insuring that every citizen can afford decent medical care as needed. I applaud Dr. Hodges and those who have made it possible for him to share his knowledge in an academic setting, even if it doesn't make for such dramatic TV coverage.

For more information about the Hodges lecture, see:
http://tinyurl.com/kqvg2c