National medical care is not hard

This is why national health care plans always win out over our ridiculous greed-driven plan.

Just imagine you go in for a checkup and the doc gives you bad news. You have a cancer. Fortunately, it’s treatable. She schedules you for a CT scan and a number of other tests. You are scheduled to see an oncologist, who will be in charge of your case. You go in. The oncologist reviews your CT and your lab tests, and establishes a series of treatments that include the very latest developments. She consults with a nearby teaching hospital, which gives you a series of injections and medications that make your own body attack your cancer. After a number of treatments you are returned to health. Your oncologist monitors your health for years after your treatment. For this extensive and expensive medical care you pay nothing out of pocket.

Who gets paid, and how much? Everyone is paid a salary. Nobody gets money for scheduling extra tests. Nobody gets more for scheduling extra appointments. Or for prescribing a particular drug. Nobody’s salary is ridiculously huge; nobody’s is too low. The technologists and administrative personnel are also salaried. There are far fewer administrators because there are no insurance companies to pay. All pay follows a government pay scale, with adjustments according to locale, with extra pay in occupations and in places where there is extra need. All personnel earn more with longer service and more advanced expertise.

The government pays off the educational debt of newly minted physicians. They do not need insurance, because the government treats all conditions, including bad outcomes, and accommodates patients who were injured by their treatment. Each doc’s practice is monitored by government agencies, and extra training is required in the case of deficiencies. The government requires continued training to keep them up to date.

Every person in the country receives unlimited medical care paid through taxes. Health care workers are salaried, and all products, including medicines, are not allowed to be exorbitant as at present.

Is national health care free, as we so often hear? Of course not. It’s paid for through our taxes. But paying for it through taxes means it costs 50% of the market-driven cost we pay now.

Here are some of the reasons we pay so much now. Docs graduate with enormous education debt, which requires them to earn a high salary from the first. They also pay huge malpractice insurance premiums. The technologists in their service are paid moderately. The many administrative personnel who are required to manage the massive paperwork required by the insurance companies are paid the least the system can get away with.

But insurance companies are the biggest reason our health care costs so much. Insurance companies try to minimize all services in order to maximize profit for their shareholder owners. They pay full time people to disallow medical care. They may disallow expensive tests. They may refuse to pay for the treatments the doctor requests. They may refuse to renew any patient’s insurance, or even pay for treatment if the patient’s condition is presumed to exist prior to signing on to their insurance plan, or even if they decide it’s too expensive. Their upper executives are paid tens or even hundreds of millions of dollars every year. Stockholders expect a significant return on their investment.

The result is that our healthcare costs literally double what other countries pay. Double! Moreover, the quality and success rate of our medical care is inferior to many others, not to mention that many Americans have no insurance at all, and their health suffers for it. Lack of insurance often results in medical bankruptcy, or death from untreated conditions.

And yet conservative Republicans will not even consider proven superior systems. Why? Mostly because that would remove the possibility for the top administrative officers to become billionaires, and it is Republican dogma that says making the rich still more rich will somehow benefit the country. In spite of years of claims to the contrary, Republicans simply do not have a viable plan for health care. That is because they insist on a for-profit capitalist plan, and not a single dollar of the billions spent on for-profit insurance goes toward medical care of any kind.

The real purpose of our present plan is to maximize profit and executive pay.

Taxes As Theft

The supply of money during any limited period, such as a few decades, is finite. Therefore, wealth can only come from upward redistribution, which automatically creates difficulties for those at the low end of the income scale.

Those who strive for wealth by honest means deserve to be adequately rewarded for their initiative and hard work. That means everyone from the common laborer to the wealthiest businessman. The lesson of communism shows us clearly that a bleak economy results without this motivation. Cuba has great equality but everyone is poor.

But it’s also true that great wealth in non-communist economies controls the political discourse, and results in shifting ever more wealth to the already wealthy in a self-reinforcing loop that is very difficult to reverse and has extreme ill effects on the least wealthy. (See here.) The recent Supreme Court ruling removes all vestiges of fairness in election financing, which will greatly exaggerate this effect.

Some of the wealthy argue that all taxes are theft. This is an asinine argument. We learn in grade school that taxes pay for what we all use. Didn’t any of those guys go to grade school? There isn’t a rich person in the world who became wealthy without using the infrastructure and services we all paid for with our taxes.

Some of the wealthy argue
that all taxes are theft.
This is an asinine argument.

They also argue that taxes are a disincentive to create jobs, which they claim only they can do. But that claim sounds pretty hollow today. Post-2008, virtually all the wealth has gone to the richest of the richest, whose wealth grew at record rates immediately after the Wall Street crash. But job creation has been very much inadequate, and concentrated in jobs that pay meager wages without benefits. The Job Creators don’t actually create jobs anyway, unless you count the ill-paid jobs making stuff in poverty-stricken Third World countries for us to buy cheap. Jobs are created when everyone has enough money to buy stuff.

Given these facts, it seems obvious that the only fair income tax is progressive. The only questions are how steep the curve should be, and what should be taxed. History suggests that the point at which progressive income taxation becomes a disincentive is quite high. Even when the highest tax rate was above 80%, the national economic health was strong and many people were rich. The top rate of taxation, therefore, does not seem to be the primary element that determines either fairness or economic fitness. I submit that the slope of progression that preserves economic health at the lowest income levels is the only reasonable one. I also suggest that a generous Living Wage law would accomplish much of what is needed.

But the true injustice comes not from inadequate taxation on income, but from a total failure to tax wealth. The rich pay little tax on income, and virtually none on wealth.

The rich are never crushed
by their “crushing taxes”.

The rich complain loudly about crushing taxes, believing that they actually earned all their wealth all by themselves. But they are never crushed. They get progressively richer, because the greatest part of their income is not taxed, and because great wealth increases almost automatically.

It is the poor who are crushed, not by taxes, but by inadequate pay. Minimum wage incomes that hold them forever in poverty and result in ever decreasing fortunes and vanishing opportunity, for themselves and future generations. Even minimally adequate income requires several jobs in a family, and results in high-stress living that is always one false step away from destitution. This is completely inexcusable in the richest country in history.

The single thing that would change this most is Living Wage. Every person who works full time at any job whatsoever should earn enough to provide basics for himself and his family, including health care and retirement savings. This is not luxury. Living Wage provides essentials only, but a family surviving on living wage is not destitute, and the two greatest worries, health care and old age, are relieved.

It is the poor who are crushed,
by inadequate pay.

Conservatives blame the poor when they can’t earn enough money, but the fact is, their troubles come from lousy pay and lack of opportunity, both of which are closely tied to the super-wealth at the other end of the spectrum. Not from a racial inferiority that conservatives claim, of a large population of ghetto African-Americans who simply refuse to work, yet expect to luxuriate forever on undeserved welfare checks.

No such population of lazy moochers exists. What does exist is a great body of poor people of all races and cultures in all parts of the country eager to work and to improve their lot. It is lack of opportunity and nothing else that prevents these good citizens from working.

Conservatives are so worried that someone will get something he doesn’t deserve that they have built a series of hoops the poor must jump through to stave off disaster with ever-diminishing government help. Medical help for the uninsured to treat serious problems has required the ill to literally bankrupt themselves and their families before the government will help at all. This ruins all opportunity for that entire family for at least one additional generation.

Sasha Abramsky (The American Way of Poverty) cited one man who had to shutter his business after the crash of 2008. He was ready to try again a couple years later, but had a new health problem. In order to address the health problem he would have to sell everything he owned, after which he would be unable to open his business again. That’s called Catch-22.

Conservatives worry that someone
will get something undeserved,
so they create odious and insulting hoops
for the poor to jump through.

As a country, as a culture, the US fails to adequately value the social contribution of the ordinary worker. There is no work that is not valuable. This point is most easily demonstrated in hospitals, where common cleaning and sanitizing is absolutely crucial to proper treatment of patients and prevention of hospital infections. Every worker is important, not just in hospitals, but everywhere.

Obviously, taxes are not theft, as some reality-challenged rich people argue, and the low taxes on the rich do nothing to moderate their steadily increasing wealth. Obviously, it is the poor who need a break, not the rich.

Inequality in the US: (4) Health Care

Now let’s talk about another basic right, yet another one that Republicans do their best to deny to as many citizens as they can: health care.

Health care is a basic right in a modern democratic society, as is retirement income. It’s not a luxury, or a frill. Everyone will need professional health care at various times during their lives, and universal health care benefits the nation in numerous ways. It is essential, and should be available to everyone regardless of their income. There should be no one who is unable to obtain professional treatment for a health problem as needed, no matter how large or how small that problem is.

Health care is a basic right
in a modern democratic society.

Consider the following situation.

Penicillin came on the market in the 1930s, and remains one of the most useful and powerful medicines of all time. It and its successors are still standard treatment for a wide variety of conditions today. The current cost of treatment with one of these miracle drugs is roughly five dollars, practically a pittance—unless you are poor.

Now, suppose a very poor person, a person who can never afford even the luxury of a cup of brewed coffee at a café, came to a medical facility with a seriously infected cut on his leg. If this infection is not treated, there is a chance it will cost this person his foot, and maybe his life. Yet the essential Republican position is that this person does not deserve treatment with the inexpensive life saver that’s been readily available for over 80 years because he is black and lazy. Needless to say, this position is amoral and thoroughly un-Christian, not to mention that statistically this person is not likely to be black or lazy. Regardless, the social cost of not treating this person is far higher than the five bucks or more it would cost to cure him, even if he should require hospitalization.

In places like Haiti and many of the poorest African nations, people contact common diseases that are easily and inexpensively treated, but they die because they cannot afford even a treatment costing pennies. The US is the only advanced nation in which it is possible for a poor person to die from a simple but untreated condition because even basic medical treatment is unaffordable and unobtainable.

Serious conditions are a death sentence to the uninsured, who will either be unable to get treatment, or their treatment is so delayed that the condition is worsened. Deaths have in the recent past been estimated at over a hundred daily because of lack of medical insurance, each of which costs the country a substantial amount in dollars and lost production and costs the family and community much more in lost wellbeing.

The success of the Affordable Care Act (ACA, “Obamacare”) provides resounding proof of the need for affordable care. There is simply no rational reason to believe that health care should not be available to all. It costs more to not provide it than to provide it.

The success of  “Obamacare”
provides resounding proof
of the need for affordable care.

Moreover, the conservative belief that our system of private care is not only adequate but “the best in the world” is nonsense no matter how you look at it. It costs nearly twice as much as the best systems in the world. A comparison of costs in several countries puts US prices at the very top, costing significantly more for virtually every service. Nor is our medical demography any better. We lag behind in life expectancy, have far too high a rate of problem births, and have very high rates of diabetes, heart disease, certain cancers, and a number of other things. We are definitely not Number One.

The conservative Republican fear is that national health care will somehow “march us straight into Socialism”. Conservatives have been claiming that we are “marching straight into Socialism” every year since 1856, yet somehow, after 158 years of marching, Socialism is not even on the horizon. It simply is not “Socialism” to provide universal medical care, no matter how many times Republicans claim it is. Socialism is a system in which the government owns everything, including the medical structure. Think Cuba, the USSR, China. That definition does not remotely apply to the advanced nations that have national medical insurance, all of which are regularly judged to be better than our system.

Some Republicans have said that the poor don’t need health insurance because they can always go to the Emergency Room. It should not be necessary to inform them that the Emergency Room treats emergencies, but apparently it is. ER is not health care. Moreover, treatment of emergencies requires 24/7 services of highly trained medical personnel, an expensive physical plant, and trained transportation crews with specialized vehicles to bring in the patients. A sore throat would cost to treat as much as a compound fracture.

It should not be necessary to
inform Republicans that
the Emergency Room
treats emergencies.

Why national health care? Because it’s the most effective and efficient system possible. Nearly a third of our medical costs are paid to insurance companies, and have nothing whatever to do with health care. Costs where doctors are paid per service have the highest costs in the world.

Failure to protect the health of all citizens does not save money. Huge sums are pointlessly lost when workers’ untreated illnesses keep them from working, spread contagion, cause long-lasting changes to their health, and maybe cause them to lose their jobs or become chronically ill and unable to work. The malaise affects the whole family, and can easily burn through all their savings and cost them everything they own. Among the poor, a single serious medical condition can destroy the future of the entire family for at least a generation.

Medical bankruptcy is the most common kind of family financial disaster in the US, but medical bankruptcy does not exist in first world countries with a good national health care system. It only happens in the US.

The alternative to national health care is the highly expensive and uneconomical system we have now, a system in some ways no better than the non-system of a Third World nation. If we are to have a nation with any semblance of equality, health care for all citizens must be an essential part of it.

So It’s Serfdom, Again

You remember the English serfs, right? Serfs worked for extremely wealthy landowners with titles like baron or duke, for almost no pay at all. When all the wealth goes to a very few extremely wealthy people with titles, that’s called an extractive economy. Feudal England was just such an extractive economy.

After major political changes in 18th century England, a socio-political condition emerged in which workers did actually get paid. Eventually their children even got to go to school and all the rest. The American Revolution came along and abolished all inherited feudal establishments in the new nation. But conservatives’ thinking is still trapped in that feudal era, and they like the idea. The proof of this is the strong support of the enormous increase in wealth of the very rich by conservative Republicans, with no concomitant improvements for anyone else.

Conservatives’ central beliefs today
were formed at an earlier time,
when all wealth went to the wealthy.

Call me a peasant, but I take offense at the conservative belief in the importance of a very wealthy elite, the 0.01%, who control the other 99.99% of us, particularly in a country where all that was supposed to have been banished in 1787. These people aren’t “job creators”. They don’t actually “earn” their money. They are not at the top of a meritocracy. The whole conservative faith makes even less sense now that we have proven that diminished equality decreases the wealth and wellbeing of everyone, the rich included.

Now, do not conclude that I think we are on the verge of re-establishing the social setting of 1300 England. Nor am I against wealth, per se. But look at the direction conservatives would lead us. We already have vast wealth concentrated in the hands of a very few, who are working hard to build an extractive economy that serves only them, very much like feudal England. Only our enlightened laws prevent them from getting it at once.

It is among the poor where freedom is defined.

But it is among the poor where freedom is defined, not among the rich, and freedom is definitely on the decline for the poor. It should not be possible to work a full time job and be forever trapped in poverty, but that’s what we have. Millions of people work at common jobs, which are essential for the smooth functioning of society, but need a second job to make ends meet. This is the sign of a modern semi-serfdom, not freedom, not democracy.

When I have expressed my belief to conservative friends that everyone should earn a Living Wage, their response has been to ask why I want to seize the wealth of others. News for them: fair pay for honest work is not money seized from anyone; it is fair pay honestly earned. If paying a Living Wage would, in fact, be the same as stealing, it could only prove that this money was extractive wealth that should have been theirs to begin with. Nor could it devalue those who are reasonably paid. Living Wage laws have worked well in Australia, where they have been in place for a century. A fair social setting hasn’t hurt the poor in sound European nations, where an illness never creates a family bankruptcy, as is frequent here, and the low-wage worker isn’t automatically poor when age forces retirement.

Conservatives who say they don’t support
Living Wage laws actually support keeping
the poor forever in modern semi-serfdom.

Those at the bottom of the US labor market have become the permanent poor. The ever-worsening pay for the poor is approved of by conservatives, thus supporting the destruction of opportunity that is supposedly the hallmark of the country. In spite of their honest labor, any modest setback for a poor family can easily destroy their entire wealth and all hopes for a better future for at least a generation, often two or three.

The belief of conservatives is that this is the way it should be. If this were not their belief, they would fiercely support Living Wage laws, single-payer health care, and good retirement plans, all of which, ironically, would also benefit them. They do no such thing. I believe that conservative beliefs are hypocritical, and move us in the direction of serfdom, which is something we were supposed to have overcome with the Constitution.

[Edited from a post on 2012/04/16]