Tag Archives: Healthcare

Why Advocates Fear Success

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LettingGoWe often see it in parents. Parents expend much of their lives raising their children. More than raising them, passionately advocating for them at every stage. They have built a home around them. They have expended much of their wealth to help them grow. Their emotions and their self-identity are wrapped up in their role as parents. They have done everything possible to help their children to succeed. Yet, allowing them to actually succeed, to fly from the nest and diminish their own role as parents, can be those parents’ most difficult challenge.

Similarly, success is the most fervent hope of advocates, yet it can be the most difficult thing for them to accept. Letting go is often difficult not only for advocates, but even more difficult for advocacy organizations and for an entire advocacy movement. You became impassioned, you rallied, you worked much of your life, your built institutions, you fought many battles, maybe even bled, to advance your cause. It’s understandable that it can be hard to let go. Particularly hard when your advocacy is not only your passion, but all you know how to do. Even harder when your financial livelihood and the financial livelihood of so many others depends upon the continued necessity of those advocacy institutions you have built.

The result is that many advocacy groups have a very difficult time dealing with success or an evolving social situation that has made them increasingly irrelevant. Even when 99% of their mission has been achieved, or when far more important issues arise, they still insist they need more funding, more effort, more time, more dedication, because there is just so much yet to be done. They begin to minimize their own accomplishments and exaggerate the remaining problems, so as to justify their continued relevancy as activists.

All movements go through a life cycle, and retirement is not easy for any of them. But I’m not going to name names. I’ll leave that to you to consider. I will say that I myself have long been passionately active in the atheist movement. However, as greater acceptance of atheists has been achieved (although very far from sufficient), as Trump has emerged as an existential threat to Democracy in America, and as climate change has emerged as an existential threat to the planet, I gradually let go of atheism as my primary issue. It wasn’t easy. I did go through a stage where I insisted that atheism was still a vital cause because religion is so much a foundational issue enabling all these other problems. But even that argument, while valid, sounds clingy and desperate to me now compared to so many other immediate threats, like healthcare.

Speaking of healthcare, I do feel compelled to point out one specific case in point, Culinary Union Local 226 in Nevada. They strongly oppose Bernie Sanders because of his proposed Universal Healthcare Plan (see here). They have reportedly gone so far and to pressure and intimidate members who support Sanders.

By the light being shone in this article, it should be easy to see why they would so vehemently oppose Sanders. Let’s face it, while Unions advocate for their members on a wide range of issues, healthcare is their clear raison d’être. Since healthcare in America is so prohibitively expensive, and since while other abuses still exist these are no longer the days of Upton Sinclair, people are driven to unions largely for assistance with healthcare. If Sanders were to eliminate healthcare as a major problem, those unions would lose their major point of leverage. They would no longer be desperately needed by members to advocate for their healthcare.

In my opinion, Culinary Union Local 226 and others are not unlike parents who would rather undermine a daughter’s impending marriage than allow her to leave their nest for a better life. Even if you accept their argument that they are only advocating as best as they can for their members, they are shortsighted because their current “gold” healthcare plan is always at risk. Of course, from their perspective, the risk of losing it is why their members need to continue to support and fund them. And from a more principled perspective, their “we got ours” attitude is simply unconscionable for the good of our nation overall.

 

Healthcare is a Limited Right

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PrivilegeIt is obscenely immoral when Conservatives argue that healthcare is a privilege reserved only for the privileged few who deserve it, especially when the only criteria that determines whether the privileged few deserve healthcare is whether they happen to be rich enough to afford it. For Conservatives, wealth is the only measure of merit and the wealthy are the only ones meriting healthcare.

Conservatives have a wide range of specious logical arguments and appeals to emotion that they invoke with great fervor to support their petty shortsighted selfishness. Here is just one horrible article in the Washington Times that regurgitates much of this vomitous bile (see here). Among these arguments are 1) the Constitution does not explicitly enumerate any such right, 2) why should others pay for your healthcare, 3) this right to healthcare would have no limits, 4) it would lead to government death panels, 5) it would ration healthcare and slow it down, 6) it would stop all new research, 7) the free market is the best solution, 7) healthcare is a commodity like any other, 8) free healthcare would disincentivize work, and 9) we don’t consider food, shelter, or clothing to be rights, so why should healthcare be one?

Of course these all have relatively simple and well-known rebuttals so I won’t go into them all here. I won’t repeat the overall cost savings or make further appeals to basic humanity and decency. I will only point out that Conservative claims that healthcare as a right cannot work are all empirically proven wrong by the fact that every other civilized country in the world manages to make it work. And their claims that national healthcare in those nations leads to worse outcomes is empiracally proven wrong by actual metrics of healthcare outcomes.

The most popular recent argument worth singling out is “why should young people pay for the healthcare of older people?” Well, not ONLY because when today’s younger generation gets old, tomorrow’s younger generation will subsidize THEIR healthcare, but also because today’s older generation helps to pay for the colossal medical bills incurred when young people break their neck while skate-boarding or bungee-jumping.

Religion does not help us out much in this debate. As with pretty much every issue, religion only rationalizes and provides justification for whatever position one wishes to take. For progressive Christians, the Bible demands universal healthcare. But conservative Christians manage to find passages to justify their healthcare Darwinism. Representative Jodey C. Arrington, Republican of Texas, defended work mandates at a Congressional hearing for food stamps by quoting the Bible: “If a man will not work, he shall not eat.” This “Bible logic” has been applied to healthcare as well (see here).

Look, the answer is not that complicated. It is only made complicated by Conservatives who strive to make it seem murky and fraught with practical and ethical problems. The answer is simply reasonable moderation. No one suggests that a “right” to healthcare would not be a limited right. No right is unlimited. We should and could provide basic public healthcare that would do immesurable good. Just as we should provide a minimum wage and, yes, a minimum amount of food, clothes, and shelter to our fellow humans.

Rich people could still buy whatever elective or costly life-extending healthcare they like, just as they can still buy all the expensive food, clothes, or homes they can afford. But Conservatives won’t abide even reasonable moderation. They don’t want those good for nothing, undeserving poor people to have one penny “handed out” to them, whether it be food, clothes, shelter – or healthcare.

The false choice that Conservatives try to force us to accept is either to provide no base level of public healthcare whatsoever – like mindless animals – or to grant everyone an unlimited right to medical care. That is an intentionally paralyzing false choice. We can provide reasonable healthcare and retain an elective healthcare market and retain all the advantages of a private market with a public safety net. No one would turn up their nose at life-saving healthcare because it will not pay for their boob job.

We should not let Conservatives engage us in this false choice arguement, rather insist upon a sane and humane universal public system that ensures reasonable basic healthcare for all. The only debate should concern the extent and limits of healthcare that is covered under the public system. But that debate should not endlessly paralyze us either. Tweaks to specifics can be made at any time as needed.

And as to paying for all this… I say what I say about all social funding. Cut the military to a fraction of its current budget and tax the rich far more progressively, then we can talk about how much, if any, we still need to limit social programs.

Competition Improves Healthcare?

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MedicalMoneyI really, really wanted to get to my backlog of scientific blog topics today, but was distracted once again by Shawn Spicer at his daily press briefing. In defending “Trump/Ryan Care,” he repeated perhaps a hundred times that “It is an economic certainty that increased competition unquestionably brings down costs.”

(Note that he uses the word “costs” but he presumably intends this to mean “prices.” Cost is really the cost of manufacturing a product. Price is the cost to the consumer. Price minus cost equals profit. I will use these words consistently in this way to eliminate ambiguity and confusion.)

Shawn’s assertion is a meme that is almost universally accepted in America as a fundamental principle, a given, but it is simply untrue. It is part of the falsely simplistic “Economics 101” nonsense that has been repeated so often that it feels like perfectly sound common sense (see here).

Our acceptance of false arguments like this manipulates us into adopting “free market” solutions that harm our own self-interest and shovels money from poor Americans to rich Corporations.

The reality is that the “free market” does not give a hoot about low costs or even about high quality and there is nothing inherently forcing it to provide the highest possible quality at the lowest possible price. Quite the opposite. Businesses in unregulated free markets will minimize cost (quality) and maximize price to realize the highest possible profit.

If their manufacturing costs are reduced through deregulation, they will not lower their prices to the consumer, they will enjoy higher profits. If they are forced to lower prices through regulation, they will lower their costs (quality) before lowering their profits.

But wait you say. Of course that is true and that is why competition works! If there is competition then if a business wants to survive they must deliver higher quality at lower prices than their competitors. Eventually we reach an optimum for the consumer.

Except that rarely works in the real world, and works least well in providing essential services that really matter, things we must have to live and work and even survive.

The example that is invariably given in idiotic Economics 101 courses is the lemonade stand. If Sally sets up a stand in her yard and charges $1 per cup, but then Billy across the street sees her making money and sets up his own competing stand charging $.95 for the same lemonade, then Sally must either increase her quality or lower her prices or accept less profit if she wishes to stay in business.

But in the real world, Sally and Billy would both quickly understand that getting into a price war is a lose-lose scenario in game theory. If they both just keep their prices the same, they both enjoy higher profits than if they compete. If Jimmy were to open up a stand in his yard and sell lemonade for $.50 at no profit, Sally and Billy would quickly buy him out and return prices to $1. Further, they would both lower the quality of their lemonade, thereby increasing their profits, right up to the point at which they lose sufficient customers to cause a net loss.

In reality, the free market optimizes for the lowest quality at the highest price the market will bear to maximize profits.

When I lived in India, I often had to use a rickshaw to get around. The rickshaw wallahs would see that I was a Westerner and smarmily quote me exorbitant prices for a ride. Now, there were at least 100 wallahs waiting around with nothing to do, all perfectly able to take me. But if I went from one to another they would all give me the same inflated prices. Even if I simply left and walked the 5 miles, none would budge. In that free market, like most, businessmen would rather lose customers than lower their prices. The wallahs all knew as big corporations well know, that I would eventually have to pay their high fees to someone and that benefitted them all much more than undercutting each other.

The last people who should be fooled into believing that competition lowers prices are Walmart customers.  Walmart literally destroys all competition and then, as essentially monopolies in their markets, they provide the lowest prices to their customers. Where is the “free market competition” argument here? Monopolies clearly can do way better. They have huge purchasing power and don’t have to pay advertising overhead.

So it is with essential services like healthcare in America. Free market competition will not force healthcare companies to lower their prices, improve their quality, and sacrifice any of their profits. Competition inherently segregates risk pools which particularly damages this industry. Deregulation will only allow insurers to work together to maximize profits by lowering their costs and raising prices to the highest level the market will bear, which in the case of essential healthcare is cripplingly high.

What we need in healthcare is not deceitful free-market snake oil, but a healthcare monopoly like Walmart. We need public healthcare that can create the largest possible nation-wide risk pool, negotiate the best costs, and take all profit out of the equation. Our free-market system has a vested interest in maximizing profits over patient health. These interests are simply not compatible and never can be (further reading).