12 July 2007

Compared to what?

Two of the rhetorical razors that I gained from my ancient background as a political scientist, and that I have often found useful since then, are "Who benefits?" and "Compared to what?"

I was glad to see both of them employed in Michael Moore's documentary SiCKO. For as long as I can remember, I've wondered why people didn't challenge the unfair comparisons between our "best in the world" health care system, as we were apparently supposed to believe as a matter of patriotism, and the systems I'd experienced in Canada, the UK, and elsewhere. Now, thanks to Moore's film, perhaps when we hear that "Americans get the world's best care," more of us will ask, which Americans, compared to which others?

Generally, I'd agree with Moore that a transparent single-payer system operated by the government makes the most sense, but my biggest concern is not the payment mechanism. It's the basic philosophy that funding the medical system is carried out by extracting money from patients--directly from their pockets or indirectly from their insurance companies. This basic philosophy puts money directly in the path of the medical decisionmaking process. Here's what should happen:
1. Society as a whole supports the health care system through taxes, with spending carefully monitored and audited, and wastage spotted through familiar processes of oversight and the political system of checks and balances.
2. Sick person goes to doctor or hospital.
3. Sick person gets the treatment that is actually needed, based entirely on medical criteria. No more, no less.
4. They get well, hopefully, and go back to their jobs and pay their taxes to support the system, unencumbered by new worries about bankruptcy.
Instead, what we have is:
1. Society relies on the market to support the health care system, with an incredibly complex and wasteful and expensive patchwork of public and private funding, and most people have to make their own anticipatory arrangements to gain access to health care. Instead of paying a known amount of formal taxes, insured people are taxed huge amounts (in our case, almost as much as one person's minimum-wage income) to support this free market spectacle, with its amazing profits and high-paid executives--and yet they may still face a blizzard of supplementary billings when they get home from treatment.
2. Sick person goes to the doctor or hospital permitted by whatever arrangement they've made (not "your choice" as claimed by defenders of the current "system") or risk paying 100% of the costs, which can rarely be known in advance.
3. Sick person may get the treatment needed to survive a trauma or critical situation, but then all bets are off. Every incentive in the system is to pay as little as possible, and to take as many medical options as possible off the menu so that the insurance company can maximize profits.
4. After (hopefully) recovering, the insured patient is trapped in their present insurance plan or, if in a group plan, a continuing chain of uninterrupted coverage, because the very fact that they've received medical care may make it impossible to get new insurance. (Uninsured patients may never be able to get private insurance.) If their coverage turned out to be inadequate, they may face ruinous new financial burdens.
What is so humane and attractive about this system that it can be defended against the single-payer systems in place in so many other democracies? And what combination of fear, passivity, and redirection (all inconsistent with the behavior of a truly free people) keeps Americans from demanding change?

Salute to Woodland Friends Church: I wondered what in the world I'd taken on last weekend: a 16-hour round trip by car for the sake of a 25-minute speaking opportunity on Sunday morning. The reality was so much more than that: first of all, wonderful hospitality with members of the meeting. Thank you! A new experience for me was the family's four favorite horses following us around the farm like happy dogs, oblivious to the effect of their huge size as they clung to us, eager to keep company with their humans.

Second, getting to know a unique Friends meeting--miles away from any others, located in Woodland, Idaho, twelve hairpin miles uphill from the nearest post office in a farming community of maybe 300. I loved Sunday school--I went to the Adult Friend-based class and found the freedom of discussion and range of outlooks that one might find in any thoughtful Quaker group.

Third, a chance to speak to a whole congregation without a microphone. I'd almost forgotten what it is like to be an announced speaker, standing in front of a full (if small) meetinghouse untethered by electronic devices, and able to be as mobile as I wanted to be.

Fourth, receiving warm affirmation and support for Judy's and my Russia plans, which were the occasion of our invitation to visit Woodland Friends.

And finally, the sixteen hours of travel, via Umatilla, Walla Walla, and Lewiston, turned out to be a blessing. Along with the spectacular sections of highway, such as Route 12 along the Clearwater River, I listened to whole CDs of Vladimir Horowitz (The Last Romantic), a cathedral choir in St. Petersburg, a Taize choir, Muddy Waters (Hard Again), Junior Wells and Buddy Guy (Coming At You), and several others. And at times I just drove in silence, unable to believe how fortunate I was to see the vistas and skies that unfolded before me.

Righteous links: Brent Bill on theological hospitality. ~~~ Events expose the Iraqi "benchmarks" for the stalling device they've always been. ~~~ "Putin's Generation:" Sean's Russia Blog comments on the New York Times article about officially-supported Russian youth movements. ~~~ A treat for Quaker purists: some unexpected comments about music in worship, from such ancient worthies as Martin Luther and Calvin, via mondaymorninginsight.com.

Buddy Guy live: "Slippin' In":


Contemplative Scholar said...

I very much appreciate your thoughts about the health care system in the U.S. I am really troubled that insurance companies and drug companies are profit-driven. This creates incentives in competition with the incentive we would all hope would be primary: health.

Sometimes I fantasize about a world that is economically run entirely by non-profit organizations. Those organizations that make extra money then would send their extra money to those providing much-needed goods or services that do not always generate quite enough money.

Johan Maurer said...

I loved the comments from the British doctor on the bonuses that he and his colleagues might get for persuading people to stop smoking or make other healthy changes in lifestyle. That bonus system contrasted sharply with American insurance company staffers who were, in effect, put in competition with each other and rewarded for having high denial rates.