In honor of the 50th anniversary of the March on Washington and Dr. Martin Luther King Jr.’s “I Have a Dream” speech, Dan Munro wrote a wonderful column on Forbes reminding us that King saw healthcare as a civil right. Sadly, we have made little progress on healthcare inequality, with roughly 50 million Americans without health insurance and another 40 million under-insured.
The Affordable Care Act (Obamacare) is poised to relieve some of that, with the individual mandate to buy healthcare insurance and subsidies for low-income Americans. But individual states are still allowed to choose whether or not to support and fund a key component of the ACA – Medicaid expansion. Many will, but some won’t.
Many doctors have walked away from taking Medicaid patients, and some have abandoned Medicare patients too.
Every other industrialized country adopted some form of “universal coverage” as the very foundation of their healthcare system, recognizing it as a civil right. So why haven’t we?
In a single word: FEAR. That seems to be based on three strong beliefs:
- The false assumption that universal coverage is Government run healthcare and thus bureaucratic and wasteful. It’s neither.
- An attitude of American “Exceptionalism” that assumes no other nation can teach us anything.
- The myth that anyone can rise out of poverty to become rich and prosperous through hard work and determination. We praise all who do but scorn those who don’t, labeling them losers who don’t deserve free healthcare provided by others.
The article prompted an online discussion in one of my LinkedIn groups, and I thought my response was worth sharing.
I think Fear of Helping Losers is a smoke screen – part of an intentional misinformation campaign among those with a lot to lose from a universal healthcare system. The real fear in my view is the loss of revenue if such disruptive ideas are implemented and successful. My response to another LinkedIn group on The Future of Healthcare seems to apply here too. (excuse the length) …
CORPORATIONS measure success in business terms like Profit, ROI, and Payback Period and thus look at relatively short-term investments that show strong shareholder returns. Corporations, by their very nature and even their legal mandate, have a primary objective of serving the interests of shareholders, not the interests of society. That’s why, if viewed as a person and evaluated based on personality profile testing, they generally behave as sociopaths. (See www.mhealthtalk.com/2012/07/corporate-behavior-and-rising-health-care-costs/.)
GOVERNMENTS in place to serve society measure success from investments differently and generally over much longer time periods. That’s why infrastructure investments (highways & bridges, sea and airports, public utilities, public education, basic research, etc.) often make more sense for governments – both to benefit all of society and to promote competition, which again serves all of society. If FedEx built the roads and charged tolls, for example, could they price out their competition: UPS & US Postal? If American Airlines built the airports, would Delta even be allowed to land there?
There obviously are pros & cons of the different incentives of public & private organizations, and an ideal healthcare system would recognize that and work to maximize the strengths of both. (See www.mhealthtalk.com/2012/08/hybrid-model/.) If a hybrid public/private model actually reduced our $2.7 trillion/year of healthcare expenses by half, to match what other industrial nations pay, then over $1 trillion could go into the economy elsewhere. But how likely is that?
Disruptive health reform is unlikely since SOMEBODY will no longer get their part of the $1 trillion, and they’ll scream bloody murder. The incumbents will naturally and fiercely defend their current positions and oppose any public health care initiatives. They’ll fight to keep their profits and argue that much of it will trickle down to others somehow. Yeah, right.
Ideally, government would work to serve all of society by developing a skilled, healthy and productive workforce that adapts easily to tech innovation and skills obsolescence. It would also promote wellness and healthy lifestyles to minimize the need for medical care, provide equal opportunities, and drive economic development across all social and socioeconomic sectors. But instead of that, our government subsidizes agribusiness and processed foods, big oil and the resulting environmental contamination, and Wall Street, all of which contribute to rising healthcare costs (profits).
When was the last time our government undertook a major infrastructure project or actually served society instead of plutocracy? Today’s politics, and the corrupting influence of powerful special interest lobbying, has divided our nation to the point that creating the ideal healthcare system, or the ideal government, seems impossible.