Dr. Quinn, Medicine Woman Part II

Remember that time your cable company had you on hold for a half hour and routed your call, finally, to someone who was thoroughly unable to assist you with your problem? Let’s back up a step here. If your cable company or ISP is anything like mine you probably had to go through a dozen asinine automated steps where you had to verify your computer was plugged in as well as turn it on and off at the recording’s prompting. Or when that voice helpfully advises you to go to the company website… after you already indicated via the touchtone menu that your Internet is out.

Efficiency at its finest. Or how about the time your credit card company did this to you? Or the time your airline bumped you for little to no reason? Or lost your luggage? How about the time your computer manufacturer charged you hundreds of dollars to pay for their expertise of getting you to open up your own computer and see inside? I’m sure you have your own horror stories of dealing with any number of problems like this. Meditate on them for a good long while. On all the “your call is very important to us” hold messages you’ve sat through or all the times you’ve had to fight to get a few bucks back you’re owed from a return or a promotion.

Then consider what has been said about “government-run healthcare” conjuring up scary images of queues, waiting periods, bureaucrats and service-by-number.

Some GOP lawmakers, taking a sideswipe at the people who deliver their fan mail every day, warned that government healthcare would be “like the Post Office.” Presumably an insult. Perhaps they’ve forgotten what it’s like to be routed to a call centre in India since their servants take care of that? Who knows?

The point is that they’re propagating an idea that exists in the mainstream media and underlies most discussions about things like healthcare: that private interests run things more efficiently than government.

This myth came about in response to the fact that normally governments wield the largest bureaucracies. This is true, without question, in most countries. Because the “government” includes jobs like police officers and firefighters and park rangers and postal workers and any number of secretaries and bookkeepers to handle the paper work of those and scores of other agencies. Lest we forget the military and intelligence services are also “government” jobs and they too require clerical aides who would be considered “government” employees.

Corporations portray themselves as more limber. But of course they would be. If your company only makes, say, lead pipes, you’re going to need far fewer employees than an entire government would. But, they would say, they know how to make the smallest number of employees do the most work.

Exactly; thus “your call is very important to us. Your estimated wait time is 90 minutes.” Efficiency!

Ever noticed when you’re shopping that only two or three registers seem to be open at a time when there are ten total? Efficiency!

Ever noticed that there’s usually only one lone person working the graveyard shift at an isolated 7/11 that wasn’t equipped with bullet proof glass? Efficiency!

Ever wondered how a company thought it was a good idea to put lead in baby milk? Efficiency!

Ever wonder why sweatshop labour exists yet its products still cost a pretty penny? Efficiency!

When looked at this way you begin to realise that the altar of efficiency, upon which so much is sacrificed, is not about helping me or you or even the very employees of a given company. It is only about making the most money possible with the most minimalist expenditure of resources. That money does not trickle down to you or the employees. It stays in the hands of those at the very top, doled out in the form of bonuses to chief executives. After all, they did all the hard work, right?

There is nothing wrong with wanting to profit from your work. From taking in more money on a sold

Remember kids: This is not a bureaucracy because it's privately owned.
Remember kids: This is not a bureaucracy because it's privately owned.

product than you spent making it. The problem is that many corporations long ago began pushing this idea further and further to its breaking point and logical conclusion: sacrificing as much quality as possible to make the absolute highest profit possible. There is a happy medium where you can profit and produce quality products and service at the same time. Greed is what compels executives to go well beyond those boundaries to squeeze that extra million out of the profit margins.

If you’ve ever worked at a retail outlet and seen your break time diminish or benefits scaled back or wondered why the bathroom is cleaned only once every year, this is precisely why.

Back to healthcare. We are told that corporations’ propensity to do this sort of thing is exactly what makes them wicked awesome at running healthcare.

But consider the examples I gave at the top of the article. Corporations are inefficient when it comes to handling our concerns and needs, regardless of whether or not we are paying customers. They are very efficient at separating you from your money, however. That’s the point. Where corporations create efficiency and “cut costs” is with you. Less quality for you, less service for you.

So again, consider healthcare. This is how they run it.

Even if you’ve paid your insurance premiums they will do everything in their power to save a hundred here and a hundred there. While that’s nothing to them, it could be everything to you. Like, say, a needed part of your rent payment. Not that they notice or care about this.

For you see, while conservatives are trying to pit you against an imaginary, archetypal welfare cheat and building you up as “John Q ResponsibleCitizen”, they’re making you ignore the fact that despite your responsibility corporations begin cutting costs with you, as they raise your insurance premiums. They do not care about you or your health, even if you pay. If they can get away with it they will deny you a lifesaving procedure and walk away with your money. It is only your insistence working the phones and making your way through their switchboards that ensures an insurer doesn’t ‘forget’ to cover you.

Every American has had some rough brush with cost cutting measures and dispassionate corporations, just as surely as they’ve grumbled at the DMV. So why are we being told to be so enthusiastic about their ability to run healthcare plans when evidence from every other wealthy nation suggests there’s a better alternative? Does the fact that these companies make billions in profits and pay millions of that to politicians have any relevance to this fact, perhaps?

This is the bureaucrat between you and your doctor *now*
This is the bureaucrat between you and your doctor *now*

Lest we forget, as those ads with the annoying duck may remind you, healthcare companies have a large advertising presence in our media. Furthermore, could you imagine television without at least a few minutes of your day being spent hearing about how Miracle Drug X has been shown in rare cases to cause thoughts of suicide, heartburn, depression, athletes foot, high blood pressure, sore throat, headache, nausea, and yeast infections?

So let’s stop this right now.

We need to stop pretending the private sector runs things more efficiently. Lest we forget, they too have bureaucracies. Bureaucracy has become a dirty word when it’s merely a descriptor of the network required to support a complex enterprise. It is not an intrinsically terrible thing. But we need to stop pretending only public employers have them. They exist everywhere. It’d be like berating a company for using computers. They’re simply how business gets done.

Don’t be fooled. Not only do countries around the world put lie to the notion that government cannot be involved in healthcare, but our own experiences should tell you that the private sector cannot be left to its own devices in this field. Corporations can do a lot of good, but they must be supervised. Without being steered towards doing what is right they will do what is wrong simply because it saves them money. We don’t necessarily have to give up privately run insurance if we like it so much- just ask Switzerland and Japan.

All the governments there do is control costs, provide a safety net for those who cannot afford premiums, and mandate that no one can be denied insurance on the basis of their health.

So why not here?

Dr. Quinn, Medicine Woman Part I

I have a knack for being snarkily dispassionate about politics, taking a leaf from George Carlin’s playbook about being a disinterested observer with no investment or stake in political horsetrading. The current debate about healthcare, however, is one time where I have to trip and stumble back into the abyss of giving a shit.

It’s too personal for me not to. My own personal stake in the healthcare crisis as an uninsured woman is irrelevant. It’s the people I know personally who lack insurance despite health problems that are eminently treatable but for want of money that drive my feelings on the matter. I’ve been told that I’m unusually passionate about this issue. Well, so be it. If I’m going to be vitriolic and passionate about anything it might as well be this.

When you know someone who is being slowly murdered to support a wealthy business interest or an ideological point of discussion that tends to get one’s dander up just a wee bit.

So let’s get started. This week Democratic lawmakers have acted as the vanguard in President Obama’s new healthcare reform strategy, selling his proposals in town hall meetings nationwide. I won’t mince words, I detest this reform plan. It’s too much compromise and too little solution. But it’s worlds better than what we currently and laughably call a healthcare system. Anything that can get at least some stopgap relief to the armies of men, women, and children who are uninsured or underinsured is at least something.

The fact that a red squiggly line appears under the word ‘underinsured’ reminds one of how often we don’t hear about this, certainly. While the near 50m people without some form of insurance are bad enough, the millions more whose health insurance will not protect them from catastrophic healthcare problems are just as alarming. If you get a cold you’re covered, if you get cancer you’re SoL. That’s not a healthcare system.

Here’s why:

1) Healthcare for Profit is not Healthcare.

One basic thing you will learn in macroeconomics is that most decent economists agree there are some things a complex society needs that market forces cannot produce or maintain in sufficient quantity or quality. These include lots of taxpayer funded services that we take for granted; everything from the armed forces to the police and fire departments to various municipal EMS services to public parks and green spaces.

America is the only industrialised country where we seem to think healthcare should not be included in that list, despite all the economic alarm bells that should be going off when one turns healthcare into a business.

To put it quickly and dirtily when you move from seeing users of the system as patients to seeing them as dollar signs, you’re going to start rationing care to turn a profit.

Draconian ideas begin to creep into the system. Looking at patients as “risks” instead of, say, “people who need treatment” is what these ideas have engendered.

2) Capitalism Rations Healthcare.

You heard it here first, folks. But really this is easily visible on its face when examined the right way: what else do you call tens of millions of people unwillingly uninsured but ‘rationing’? We’ve heard this term used as a far right scare tactic over and over again in this battle, yet it seems to ignore the fact that the health insurance companies’ lust for profits have rationed millions out of the system.

The reason for this is simple. If your source of income (i.e. profit) is very finite, you will not render goods and services to just anyone. Only those who can pay. When it comes to selling, say, cars or computers or laundry detergent, this suits us all just fine. When it comes to healthcare, it starts killing people.

The reason the concept of “risk” exists in healthcare is because the insurers are for-profit.

3) America has 50 million (and counting) horror stories.

The much vaunted “horror stories” from “socialised” healthcare systems in Canada and the UK are designed to convince Americans that any sort of government-run healthcare plan is going to lead to endless tragedies. This would be all well and good except…

It neglects the countless times insurance-payers have been denied treatment because insurance companies saw them as too big a risk to support. Mind, these were cases where the patients had faithfully paid their insurance premiums. The company found a way to get out of meeting their end of the bargain when the moment of truth came. Only a private corporation could justify this using notions of risk versus reward. Only a private corporation could or would put some 25,000 dollars of its profit margin ahead of someone’s life. Even if we’re supposed to get what we pay for.

This doesn’t even begin to discuss the countless people who have no insurance at all. Where are the dreary television ads warning us using their personal tragedies?

4) Public Healthcare is Preventative (read: Cheaper).

It’s worth keeping in mind the simple psychology behind all of this. If you have coverage of some sort you are more likely to go to the doctor at the first sign of trouble rather than, say, wait five weeks for the symptoms to hopefully go away since you sure as hell can’t afford a useless doctor’s appointment.

If, however, you don’t have to worry about paying for even an intake visit you can catch a serious medical condition early and treat it for far less pain and lucre than you would otherwise be able to. For all those who complain so vociferously about paying for others, the simple reality is that they already are in one way or another. When a person who is hospitalised with a serious illness, insured, underinsured, or not, is checked in and treated they are absorbing resources and quite possibly contributing indirectly to increasing your insurance premiums.

One way or another, you pay. Would you rather pay far less through taxes for preventative treatment or far more through your already onerous premiums for people who’ve been conditioned to wait until it’s almost too late?

5) Public Healthcare is quite American, thank you very much.

In the usual rhetorical shell game oft played by politicians in this country we have been pooh poohed and told that we need to find a “uniquely American” solution to our healthcare woes. This is often in a response to questions about high user satisfaction in other countries that have universal coverage.

It’s, as is often the case with such things, a smokescreen.

Between the highly successful programs of Medicaid, Medicare, and military/VA care, we have proven that public plans are as American as apple pie. This by itself puts lie to those condescending dodges.

But the other reason they exist is in part because of American arrogance. Pride goeth before a fall (yet another Biblical idea that religious conservatives love to ignore). In the mid 1980s Taiwan was emerging from poverty and set about building a national healthcare system. They commissioned a blue ribbon panel to go around the world and study other healthcare networks, including America’s. They rejected ours mostly out of hand and instead put together ideas from a welter of other nations to bring about the highly successful, low-premium, smart-card based system every Taiwanese citizen now enjoys.

Are we too proud to examine what ideas can be borrowed from other countries?


There will, of course, be more to come. This is a broad overview of a rather complex subject. One that unscrupulous power brokers have taken it upon themselves to simplify in a dangerous way.

As I leaf through various media outlets and read political cartoons (rant forthcoming on that medium) I find that the debate on healthcare, particularly from the right, has been reduced to encouraging selfishness and fearmongering. Literally dozens of cartoons show President Obama as a surgeon ‘extracting’ a taxpayer’s wallet. A more interesting sub-genre shows him as a doctor snapping a long rubber glove on and a generic white male representing The Taxpayer bent over before him in a gown.

This continues the long running conservative obsession with anal sex, of course.

But more importantly it shows how right wingers are trying to frame this. Protect your own wealth and screw everyone else. They seem to forget that idea, and how it dominated policymaking over the last two decades, is why taxpayers’ wallets are hurting in the first place.