Monday, March 8, 2010

Why is health care a problem that needs repair?

Health care is a business. It includes giant pharmaceutical companies that develop and market drugs, large hospitals that employ thousands of professional staff and house costly equipment, long-term care facilities, and physicians working as individuals or in group practices. Costs of investment and development have to be covered, payrolls have to be met, and profits have to be made. All of this is understandable. The problem, however, is that the cost of health care has escalated to the point that normal people cannot pay for it. For example, several years ago, my wife had to go to an emergency room and spent about twelve hours in the hospital. The cost was $13,000. How many people in America can afford to pay out $13,000 for something other than food, clothing, transportation, and shelter?

The solution to health care is insurance. An insurance agency collects a certain amount from an individual within a year and gambles that it will be able to pay all the medical bills for which it is liable. After all, not all people will need expensive health care in a given period of time. Unfortunately, the health insurance business is yet another ring in the total business complex that dominates health care and, in this case, it seems purely motivated as a profit-taking activity with no real interest in health or general welfare. The health insurance business is, in effect, an enormous gambling casino.

Insurance companies have several strategies for maximizing profits and minimizing costs. First, they can charge increasing amounts for their coverage. Second, they can restrict their coverage liability. Third, they can deny claims. Virtually all of them exercise all three options.

The American public faces three options in health care. First, the system can be allowed to continue freely, and it looks like the end result of that would be health care for the fortunate few who are able to pay. The rest must suffer and, ultimately, die. Second, the health care industry could regulate itself so as to offer care to everyone who needs it. It would be absolutely astonishing if that were to happen. Hence, third, under the general concept of controlling utilities, the health care industry could be regulated. Between the three options, this is the only option that could offer Americans real welfare. When we look around the world, we find every other First World country in possession of a well regulated health care system. What prevents that from realization in America is the greed of those who dominate our system today, the very corporations and individuals who own Congress and have bought enough votes to prevent any real change.

Saturday, March 6, 2010

Most Americans consider Capitalism to be the core of their society. They frequently confuse Capitalism with democracy because they also consider themselves a democratic society. They are not the same, of course.

Capitalism is an organization of economy in a society; that is, it is a way in which the people meet all of the needs for survival, indeed, more hopefully for their general welfare. Capitalism assumes private ownership of real property, which can be used for production of goods. This could be land, which can be used to grow crops; but it can also be machinery, which can be used to manufacture consumer goods. Typically, in a modern Capitalist society, only a small percent of the people are fortunate enough to own real property of this kind. Other people, indeed the majority of people, must exchange their labor with the Capitalists for the benefit of wages.

Jeffersonian democracy was considered to be harmonious with Capitalism because agricultural land was the principal form of real property and the great majority of citizens were land owners. [Saying this somewhat ignores the fact that citizenship belonged to land holders and that even early American economy was already becoming industrialized, especially in the North.] The concept was that the majority of citizens would share common interests and be able to function effectively as a democracy. But the Founding Fathers did not foresee the social revolution that would unfold in the 19th Century. Putting it very simplistically, population rapidly out-stripped the availability of agricultural land so that the majority of Americans became wage-laborers living in cities rather than becoming landed democrats. From 1900 to 2000, farm population fell from about 80% of Americans to less than 1% (so insignificant that the Bureau of Census ceased keeping records). This means that a great majority of Americans have no stake in real property or the Capitalist system except for being wage laborers.

The classic analysis of Capitalism is Marx's, and the classic proposition is that Capitalists will always strive to make as much money as possible by selling their products at as high a price as possible and paying for the resources of production as little as possible. Since one of the chief resources of production is labor, this implies that Capitalists will always pay as little as possible for labor. Marx added to his analysis the fact that Capitalists use their productive capacity to create new real property which can expand their ability to produce, and he called this "alienated labor" because it is something produced by the labor force but not owned by them. Hence, in Marx's view, the Capitalist class becomes always increasingly powerful while the laboring class becomes increasingly poor, indeed, becoming what he called the Proletariat. Since wealth can quickly acquire political power, democracy has faded into oligarchy, the rule of wealth.

Marx, of course, believed that the Proletariat would eventually revolt and bring about a utopian society. In America, in spite of tremendous oppression of laborers in the late 19th Century, often enforced by police and militias, an ingenious system of Imperialism successfully elevated the working class into a comfortable MIddle Class. The system was based on importation of resources from what became called the Third World. Since resources abroad could be bought at extremely low prices, Capitalists could afford to provide better wages to people back home. In effect, as Lenin pointed out, American and other First World economies were able to guard against rebellion by exporting the proletarian condition to the Third World. All of this was achieved through the international operation of government, applied in the interest of American business. A key tool in this operation was the stabilization of regimes in Third World countries that would sympathetically cooperate with development of resources and provision of cheep labor.

What is the situation today? Colonialism and Imperialism began to collapse after the Second World War. Interestingly enough, Marx's predictions of rebellion against the Capitalists turned true enough in the Third World where there was a genuine proletariat. This, of course, lead to the American panic that Communism was taking over the world. Indeed, many of the factions fighting for the proletariat in Central and South America are Communist. All of this has, needless to say, put a lot of pressure on American business operations around the world.

In certain respects, the solution to the collapse of raw Imperialism is what we now call "globalization." By developing property outside of America in the former Third World, Capitalists can achieve a new system of production. Wage labor in other countries can be increased comfortably above Imperialist levels, hence, satisfying local communities; yet wages are well under those demanded by laborers in America and resource costs remain low. As a consequence of globalization, America's productive capacity is moving off-shore and there are fewer employment opportunities for Americans at home. Worse yet, America is allowing itself to become dependent upon the rest of the world for manufacture of important goods. In America, the Middle Class is disappearing and will continue to disappear. If you want to take Marx literally, you have to ask how long this can continue before there is a well-defined Proletariat in America that can do nothing but rebel in order to salvage a minimal standard of life.

But our future is not my point. My point is the relationship between Capitalism and government, or would-be democracy. That America is now an oligarchy should be obvious. It takes millions of dollars to run a successful campaign for political office. The recent Supreme Court decision to legitimize corporate spending in political campaigns will soon make this situation even worse. Americans naively continue to believe in their democracy because, after all, they continue to have the right of voting. But what is the right to vote when the choices offered voters are thoroughly orchestrated by corporate wealth. In 2008 Americans voted for Obama with the hope that he would effect numerous reforms. But examine just the issue of health care reform. Obama alone has little or no power. Real power is vested in Congress, and Congress is dominated by lobbyists from all the major corporate interests, in this case, insurance carriers and the medical profession. This is no democracy. It is, in fact, the wealthy who determine our future under the plan of protecting and enhancing their own wealth.

Conservatives, today, seem to believe, as they always have, that good business sense is the best (and only) tonic for democracy. Government should promote and protect business. Property-poor people are unfortunate but have basically not worked hard enough to acquire wealth. Their situation, in other words, is their own fault. This situation is a natural product of human nature and government should not be used to change that which is natural. What we have to ask is whether this point of view can be applied to our national politics consistently and whether it will lead to the kind of stable society envisioned by our Constitution. In particular, will this society achieve the "general welfare" of all people?

The answer, it seems to me, is a loud "no" unless Conservatives can tell us what is wrong with the account of Capitalism above and, hence, how a Capitalist society is actually able to promote the general welfare of all. Liberals, I believe, must argue that government (indeed, strong Federal government) is required in order to achieve these ends.

Thursday, March 4, 2010

Instead of conservatives and liberals continuing to hack away at each other, it would be interesting to see the dialog move to a more constructive level. Namely, what is it, really, that we would like to see as a vision of our society and what role should government play in realizing that vision.

I think that liberals have a pretty consistent vision of what our society should be like. It begins with an idea of community in which people care about one another. Thus, children should have the benefits of good nutrition, healthy surroundings, and education. They should not have to go to work in factories in order to support their struggling families. Older citizens should not be dropped into a human dustbin just because they are no longer valuable to industry. So there should be ways in which they can live out their lives honorably and in some comfort. People in the middle should have some voice in their destiny, meaning that they should not simply live as victims to a wealthy aristocracy that treats them as a primitive "labor force." While wealth will never be distributed equitably, it should not be distributed so inequitably that the majority of people in our community live in poverty with little or no expectation of being able to better their condition.

Liberals have historically seen the Federal government as an avenue to achieving their visions because State governments are often dominated by conservative factions that do not agree. Hence, the tension between Federal and State concepts of governance revolves around these visions. [Having grown up in a suburb of Chicago, I can attest to this. The majority of people lived in the greater Chicago area, but politics was effectively dominated by the rural population of the state. As a result, the majority of people in Illinois needed the Federal government to produce programs suitable to their social needs.] Hence, liberals take literally the goals expressed in our Constitution --- especially the "general welfare" and the "blessings of liberty" --- and seek to secure these through Federal action. One way or another, government is necessary to achievement of liberal values since history makes it clear that liberal values are ignored by oligarchic and aristocratic societies.

Liberals also believe that business should be regulated so as to protect consumers. The Interstate Commerce clause gives the Federal government the power to do this. Regulation should not be abusive or lead to harassment. But people ought to know what is in the food they eat, ought to know that a car they buy is safe, ought to know that a toy they purchase won't endanger the life of their child, and ought to know that maintenance of the airplane they board is held up to a standard for safe flying.

Now, I will leave it for you to fill me in on the conservative vision of what our society should be like. Because it seems to me that it would not include child-labor laws, would rely on private education for the fortunate few, would care less for how the majority of children are raised, would certainly not allow unions and collective bargaining, indeed would probably prefer to see police forces used to beat up rebellious laborers (like in the 19th Century), and would prefer to see older citizens dying of health issues they couldn't possibly afford to deal with and otherwise put up in "poor houses" with minimal care and nutrition. What boggles my mind is that the people who benefit from this remarkable vision are something like 5% of the population who are well enough disposed with personal fortunes to actually live happily in such a society. Yet, when you look at the breakdown of liberal vs. conservative politics in this country, that 5% is joined by another 45% of the population that has nothing to gain by such an attitude and everything to lose. I'd appreciate it if you can explain that to me as well.

Personally, I paid into Social Security all my life and I am unblushing about receiving my SS check each month. Medicare is a fine benefit for older people and about $2500/year is deducted from my SS benefit for my Medicare coverage. Between my Blue Cross supplemental and prescription insurance and my Medicare I pay about $5000/year for health care. It's not like I'm on the dole!

Seriously, I'd like to know what you think the conservative vision is --- and how effectively that would play out.