(This is something I have been trying to compose to submit to a certain Catholic magazine that we all like to read. It's not a draft, but some ideas. I have been having a hard time even getting them down. So hard that it has sort of blocked me from writing anything else for months. But I would like to request your input. Again, this is not a draft, but an attempt at an argument).
The Republicans are going after Obamacare again with another attempt to gut its foundations and kill it by poisoning it, since they have been unable to get the votes to shoot it in the head. This time they are trying to repeal the ban on denying coverage to people with pre-existing conditions. They are doing this in a particularly cynical way via a lawsuit by 18 Red State administrations to repeal the ACA regulations about coverage requirements. While the lawsuit would still forbid people being denied coverage because of pre-existing conditions, it would allow insurers to deny coverage for illnesses arising from those pre-existing conditions. (Yes, you have read this correctly).
Without going into a lot of detail, if this were passed, what would happen is that new reduced benefit policies could be constructed and sold to the healthy and the sick would be pushed into more expensive policies built on top of sicker risk pools. The separation of the sick from the healthy is part of the Republican end game of "insurance reform". They have suggested at various times that they want to construct high risk pools at the state level and that these would be somehow subsidized by the state. There are all kinds of problems with this aside from the fact that whenever this has been tried it hasn't worked. What the Republicans are trying to do is to segment the insured population into haves and have nots to gain the political support of the former and garner just enough votes to remain in power. They want to create cheaper insurance for some, but not all, and to divide the electorate over price.
From our Catholic point of view, this whole question can be discussed in terms of compassion. The ACA, as flawed as it is, was an attempt to insure millions more people. Uninsured people die too young and it would seem to be the heart of compassion to prevent this.
But the compassion argument is intractable. It's intractable because in the Church there are two competing and irreconcilable theories of compassion.
The theory of compassion that has somehow become associated with the "Left" is that if people can't provide necessities for themselves, it is compassionate for those who can to help provide necessities for them. Healthcare would seem to be a such a necessity.
The theory of compassion that has somehow become associated with the "Right" is that the one needs to support the development of self-sufficiency in others ("Teach a man to fish" etc). Any outside aid provided to a person needs to be balanced against this. While it is exemplary to provide aid to people who cannot provide it for themselves, if one provides aid to someone who could provide it for themselves, one is supporting a dependency that undercuts the recipient's efforts towards self sufficiency. In the case of healthcare, healthcare may in fact be a necessity, but this is irrelevant. Or to put it another way, since it is a necessity, it becomes all the more important that a person's self sufficiency be cultivated to that they can provide themselves with their own necessities.
In this formulation, the kind of compassion proposed by the "Left" is actually destructive since it undermines self sufficient and creates dependence.
The Right does not deny that there are people who cannot provide for themselves and must therefore be aided in the Leftist sense. But the classic method for providing them is charity rather than state support. Not only is charity the appropriate method in this case, but it is the most efficient one. Charity allows the giver to vet each situation individually to determine whether each recipient in fact deserves charity. It allows the vetting to continue until, perhaps, the recipient reaches a point where the Spigot of Blessed Giving needs to be turned off for their own good. It allows the integration of the poor recipients into a more personal community since charity requires direct intervention and interaction (thus strengthening the community).
And it's tax deductible.
Now we are all certainly good Christians, God help us. And it would seem that a question like healthcare should be framed in terms of compassion. But I will argue that it absolutely should not be. The compassion argument gets us nowhere. Worse, it hides another question beneath it for both the Left and the Right. On one hand, the US certainly spends enough on healthcare to adequately and thoroughly cover everyone who lives here. On the other hand, there are massive disparities in who is covered (and how they are covered) and who is not. The underlying issue is not compassion, but inequality. We have the conundrum in the US (if not the world) where we find that as more wealth is created in the country, more inequality is also created. If we look at this in terms of the compassion argument above, we have the Right saying that if there is inequality in the face of so much wealth, it can only mean that the poor are somehow refusing to participate (since the wealth is surely available to them should they want to acquire it). And we have the Left saying that since there is so much wealth, surely some of it can be redistributed to support everyone.
But I think the case can be made that none of this involves compassion at all. If we frame the question of inequality in terms of compassion, we are saying that inequality is simply a given and must be overlain with a system of compassion to rescue people. But I will argue that the system of inequality itself is the problem and the problem isn't one of compassion at all.
There are now charitable organizations to help DVOUW, Disabled Veterans of Unnecessary Wars. I don't feel compassion for these guys, I feel anger that they are considered charity cases. They are OWED! And tax dollars should be adequately applied. In the meantime, the existence of charitable organizations support the delusion that SOMEHOW these vets ARE being cared for and they are probably not. Similarly, there are many people working their asses off who don't have adequate medical coverage. I feel angry. It's not fair.
ReplyDeletePatrick, as usual you lay out insurance complexities in an understandable manner. I agree that if you come at it from a standpoint of compassion you are up against the different ways the left and right define compassion. (I dislike the binary of "left" and "right", I actually think most people are a mixture of both. But I don't know of another way to describe the situation in shorthand, so I will plead guilty to using the despised terms.)
ReplyDeleteThe trouble with coming at it from a standpoint of "inequality" is that the right doesn't recognize inequality as a bad thing. They recognize that people being without necessities is a bad thing, but they don't accept inequality as a cause of this. Even though it's an elephant in the living room, to name it is to go against capitalist orthodoxy. And since we have gotten so used to thinking in binaries, anything that goes against capitalist orthodoxy is by definition, "socialism". Or worse, "totalitarianism".
One thing in the debate over inequality that seems to me to mirror what I have said about compassion is the question of "redistribution". For the Right, providing aid for people is a form of "socialistic" redistribution. For the Left, "redistribution" is necessary. For me, this formulation of redistribution reifies the system.
ReplyDeleteWhat if the redistribution has already taken place before the taxes are collected. We know that in the US wages have been flat starting with the days of St Reagan There is a strong correlation between the flattening of wages and the gradual destruction of the unionization movement. I have a very nice graph that I don't know how to paste here that shows that in the late seventies or so wages and productivity stopped trending together and productivity increased while wages did not. The split in the lines of the graph is very clear.
When I have shown the graph to people on the Right, they say that all it shows is that productivity has increased because of "mechanization", as though there is no particular reason for productivity to be related to wages. But what unions used to do was to demand wage increases to track with productivity increases, for a the good reason that the productivity increases came from the workers in the first place. This was based on a good old formerly conservative principle that if one works harder, one should get more.
What has happened since St Reagan (and I have worked long enough in management to have seen it happen in my industry) is that worker productivity became detached from wage growth. A smaller segment of management began to garner the rewards of the increased productivity of the workers. Managers are typically rewarded for getting their workers to do more with less pay. The top executives in turn get rewarded for getting their managers to extract more for less pay. In the end, the senior managers (who are really just a subset of the employees) take the productivity rewards for themselves. They get the big pay increases. The workers get almost nothing (in comparison). Wages stay flat, because even when individual workers get personally rewarded for their better productivity (or productivity innovations) they are rewarded from the pool of wages that has been allocated to all of the workers, which then allows the total wage pool to stay flat.
Do this over the course of several decades, and the national wage pool stays flat for all workers except for the executives, whose wages alone actually track with productivity improvements. It seems clear to me that this is where the redistribution has actually taken place.
I could make many points here, but I will limit myself to one. We actually have an American tradition about the relationship of work to wealth. We still believe in this. But as the workplace has transformed into benefiting just a subset of the workers, the theory of how work benefits wealth has changed by being re-theorized by people supporting the rich. The new ideology is that if you think you are not being rewarded for your work, it's your own damn fault. Quit and find a job that rewards you the way that you think you should be. (I refer to this with a principle "If you don't like being a slave, start your own plantation!"). There are jobs out there that might give you access to the Golden Fountain of Executive Compensation. If you don't access this, you are lazy, stupid, or both. Your choice.
Random response points:
ReplyDeleteCreating a cheaper low risk pool essentially creates a more expensive high risk pool, which is what many ACA opponents have wanted, but high risk looks uncompassionate, hence the emphasis on thrift and low risk instead. It's a very canny move. Terrible policy, but smart politix.
I think Katherine makes good points about inequality. Compassion need not = equality. compassion frequently factors in some.idea of "fairness." For example: Yes, we want poor people to have shoes, but second-hand shoes from Goodwill are good enough for the poor. If they receive charity such that they can save up for a pair of Ferragamos, fairness is offended.
Our friend Jim Pauwels once asked me years ago on the old blog whether I didn't feel I ought to pay more in premiums because my cardiac and cancer treatment would require me to access more health care.
I'm sure Jim doesn't want me to die because I can't get care, nor do I think he believes I am undeserving of care. And perhaps his thinking on this has changed. But he did seem to believe at the time that sick old people should pay some kind of "fair" share, certainly more than a 23 year old who is in good shape.
In truth, my ACA policy limits my ability to access certain treatment options by refusing to cover more than one type of chemo that controls the cancer. Fortunately this works OK for me, but it doesn't for a significant percentage of patients with the same disease. So many of them end up sick from taking higher doses of what their insurance WILL pay for. They have the Goodwill drugs. Would receiving the Ferragamo drugs be fair? Do the same standards of fairness apply to health care that we apply to shoes? These are not meant to be flippant questions. Perhaps there should/must be limits.I'm compassion. No one is expected to beggar himself in helping beggars. Should the nation be expected to beggar its defense, education, or public safety in order to pay for a huge number of aging Boomers?
Also: ACA opponents often overlook the fact that the ACA jacks up your premiums based on two factors: age and tobacco use. I receive a subsidy, but my premiums are also about 10x higher than the one we paid for for The Boy. So some "fairness" is built into the system by requiring older people who have higher morbidity rates to pay more.
In other words, fairness is often used as an argument that limits compassion. Heard this in Al-Anon a lot, where a feeling of compassion for alcoholic family members is encouraged, but is always tempered by the notion that it's not fair to you or the alcoholic to let your compassion turn into enabling.
Delete"Our friend Jim Pauwels once asked me years ago on the old blog whether I didn't feel I ought to pay more in premiums because my cardiac and cancer treatment would require me to access more health care. I'm sure Jim doesn't want me to die because I can't get care, nor do I think he believes I am undeserving of care. And perhaps his thinking on this has changed. But he did seem to believe at the time that sick old people should pay some kind of "fair" share, certainly more than a 23 year old who is in good shape."
DeleteHi Jean, I don't remember that conversation, nor writing what you're recalling here, but I don't doubt I did say that or something similar. As for what I think and whether or not my thinking has changed: I truly don't know what to think about what constitutes an equitable way to pay for expensive treatments. I've never known what to think on that score. Sometimes when I write lengthy comments it's because I'm thinking aloud, trying to work through a problem.
Thank you Jean.
ReplyDeleteThe question of healthcare as a consumer good is complex.
Separating people into two pools of the sick and the sound might seem more equitable than having everyone in a single pool that spreads costs among all. But if we scratch it a bit, it brings up all sorts of problems.
Is everyone in the sick pool equally sick? Why should someone be in a risk pool with a hemopheliac if their major illness is a minor heart attack? Does everyone in the sick pool have the same chance of being sick? Two people may have cancer that is in remission. Both are definitely risks in any actuarial calculation. But both will probably not have their cancer appear at the same time or with the same intensity. Is it fair that one subsidize the other?
Then there is the question of the odds of serious illness in the age of DNA testing. Should a person who has genetic markers and a family history of serious cancers be in the "well" pool just because they are not sick at the moment? Because per every proposal I have seen, this person will not join the sick pool until they have become ill. The year they do will be expensive for those people who were wise enough to choose the right parents.
The point is, every possible risk pool or product built on certain inclusions and exclusions is going to be "unfair" in a risk spreading calculation. And supporters seem to forget that each product requires its own separate administration on both the insurer and provider ends. Does patient X have insurance plan 432-A or 431-B. Is the patient covered for the exact disease that they have presented with?
A second problem that I have is on the financing side. When people talk about tax subsidized high risk pools, it might sound like costs will be pushed down for the lower risk pools, but in fact (unless the tax dollars subsidizing the high risk pools are inadequate) the lower cost of the risk pool is simply being transferred to the high risk pool. In other words, one takes the "saved premium" for the lower risk pool, converts the amount into a tax, and transfer it to the high risk pool. Overall the same amount is being spent. Except that the creation of one (or a thousand) additional pools is going to increase administrative costs.
Finally, people don't understand how much risk sharing they do already in their non-ACA private plans. I have mentioned this before on a number of occasions on Commonweal. People with commercial insurance pay about 135 to 145 percent of costs in a hospital visit. Medicare pays about 98 percent of costs. Medicaid pays much less. Everyone is already subsidizing everyone else. This would not change in any Republican proposal. It would be reified.
The "unfairness" of the well paying for the sick only emerges if we play games with time. If we treat healthcare as a commodity like it's an ice cream bar, then yes, it would be unfair if I have to pay for mine and the five that you are eating. But in order to do this, we have to take out all of the other considerations that I have mentioned, and more. So much of healthcare depends on various rates of risks for different people that may or may not kick in at a certain time. Because any insurance system requires that people have the insurance before something happens (as opposed to simple commodity production, where the commodity need only to exist when the need happpens) it really can't be commoditized except by hiding a lot of facts about it.
Is it fair that the well have to subsidize the sick? Is it fair that cities subsidize the roads, electricity, postage, internet service, etc of the country? Is it fair that the wealthier states subsidize the social services of the less wealthy states? Is it fair that people without children have to pay school taxes? Etc.
One of the complexities of predicting who will cost a lot and who won't lies in the Brave New World of genetic testing. We like to think it's "fair" for people who have healthier habits to pay less (never mind that the whole point of insurance is to share out the risks evenly).
DeleteBut what's lurking in the genetic make-up of outwardly healthy people may put them at higher risk than someone like me with a chronic but indolent blood cancer.
Many cancer patients I know are getting 23 and Me tests (at their own expense, cha-ching for 23 and Me), so they can keep track of how new scientific discoveries might change their prognoses.
However, spontaneous mutations can occur at any time, so unless you have your 23 and Me tests at frequent intervals, you're relying on info that might have changed.
I have resisted this testing because a) I'd rather live my life than be constantly combing medical journals for new discoveries and scrambling through the alphabet soup of a genetic test to find out if I have Factor B or CALR with deletion, or whatever; and b) I don't want that info out there without any control over how 23 and Me might eventually use it.
Supposedly 23 and Me sells your genetic tests with non-identifying info to researchers (so they're making a lot of money every time they sell your tests).
My guess is that a lot of actuaries would love to get their hands on these tests WITH identifying info so they can raise premiums accordingly. Once we get to that point, the for-profit health insurance biz will change dramatically.
I just got back from visiting my brother in law in the hospital. He is 13 years into a battle with cancer and isn't doing the greatest at present, though he has had several remissions with intermittent good quality of life. He has worked through most of it, but now has had to take early retirement. He is nowhere near being old enough for Medicare. However he was fortunate enough to have worked for a public utility which is unionized. They negotiated really good coverage, where if someone has to retire early they can keep their coverage. I am sure that his treatment by now has to have cost well over a million dollars. If they didn't have good insurance they probably would have lost their house by now. He may lose his batt!e, but at least my sister won't be out on the street afterwards. The Democrats need to to push on the right to unionize. And yes, we need a national health system. People in Canada don't have to worry about losing their homes and savings because they get a life threatening disease.
DeleteI am really sorry for your family, Katherine, but glad your bil has had good years and that health care costs are not among their burdens.
DeleteCanada seems to have a good system. Specialist care and second opinions are built in. The idea is that having two specialists consulting in a rare or tricky disease leads to fewer misdiagnoses, and doctors share info so everyone is up to speed.
The point that I really wanted to make here, and that I didn't make very clearly, is that putting the discussion in terms of compassion locks in the idea that the underlying wealth of the system (that people without insurance don't have access to) has already been distributed fairly and equitably. If the wealth has been properly distributed in terms of just desserts, then anything beyond that is a redistribution from people who deserve it to people who either do deserve it or don't deserve it under the terms of the definition of compassion.
ReplyDeleteBut I think that we have to drop the notion of compassion in this case and get to a more fundamental question of distribution. As I tried to outline above, the nature of distribution has clearly changed, beginning with the seventies. Workers have become excluded from sharing in the benefits of their own hard work. They are now simply another asset of the company. Any increases in productivity, including increases in the amount of work done, are captured by management. Some they keep and some they add to the physical assets of the company.
We can see this in an evolution from the idea that the economy should work to provide good jobs to the idea that the economy should just provide jobs. Part of this has been a movement from the idea that one should work harder (and more efficiently) at their job and be rewarded to one where if one is dissatisfied with what one gets at one job they should move to another. Capital always gets a free pass in this. But that's another story.
I think that in terms of Catholic Social Thinking, we need to focus on the fact that as the production of wealth has increased, the general population is somehow getting less. They key is to ask the question "if there is more wealth, why is there more inequality"?
Patrick: "I think that in terms of Catholic Social Thinking, we need to focus on the fact that as the production of wealth has increased, the general population is somehow getting less. They key is to ask the question "if there is more wealth, why is there more inequality"?"
DeleteHow about this question: When did employees/workers become capitalists like their bosses? And how much did this contribute to inequality?
When health insurance was part of the employment agreement so were pension plans. Don't know any numbers here, but all those good jobs had employer-paid pensions and what a worker got for that was a defined-pension plan that paid out when they retired. In general (very general!) the worker had to put in so many years for it to be vested, that is for him/her to collect on retirement. That probably left a residue in the plan for workers who left before they were vested.
(I notice in the Sears' bankruptcy stories that the new owners ended the pension plan and the stock sharing.) Right there an introduction of a new inequality.
Sometime (don't know exactly when '70s?) 401-Ks/Bs... came into existence. Workers could put their own money into their pension and companies could add to that (don't know if that was a requirement in the law).
That seemed to solve the problem of getting vested (your contribution was always yours), but it required you/workers/employees to make choices across a variety of offerings: stocks/bonds/real estate/etc. And because the money and its accumulations were yours, you could borrow against it, take it out, etc. So what may have seemed a fairer, more democratic, more individualistic system taught workers and employers lessons. Is that when workers became capitalists?
Here is one lesson I have thought about. When workers put their retirement savings into stock funds, did that have the effect of making them more attentive to the stock market? And paying attention to the ups and downs of that, did it make them/us less attentive to the employee/employer contract, and to those who aren't in the labor market that comes with benefits.
Hence more prosperity has led to more inequality, because the job market is compartmentalized into capitalist attentive workers (who have 401s) and workers who aren't part of the 401K world....?
In brief, the whole worker/company contract shifted with the end of defined-benefit plan and the labor market has been segmented so that fewer workers get pensions and health insurance and job security, etc. That makes workers who get all of that capitalists, and workers who don't get all of that some level or proletarians.
DeleteCapitalists can create lots of jobs, but keeping people on contract or part-time in order to duck benefits became a trend. Generally part-time jobs never had benefits, so not offering them didn't seem unfair--even as the number of full-time jobs dwindled.
DeleteIn 1968, 13 percent of all jobs were part time; the high point was 20 percent in 2013. We're down to 17 percent part-time now, according to BLS.
Unemployment has fallen by half, from about 8 percent in 2013 to about 4 percent now. But the full to part-time job ratio is not falling proportionately.
There are actually some people who want part time jobs, for one reason or another. But some of the ones who have them need full time, especially those who have to cobble together more than one part -time to make it.
DeleteI think the Golden Age of the destruction of defined benefit pensions was in the 1980's. Companies had to and did accumulate large reserves to pay them off, and these were prime targets of the takeover specialists and the first assets that were looted. From the point of view of the capitalist, the need to provide for these pensions was a drag on future earnings, since it was an expense that could be eliminated. It was replaced with the 401K, where the company would match some percentage of employee money for a stock market contribution. It was this that made most people "capitalists" since they were now told that they were "investors" (insofar as stock speculation is investment). There was a double ideological benefit here, because it was also the age of the promotion of the new idea that stockholders were the "owners" of a company for whom management "worked".
DeleteBack at the ranch, St Reagan embraces another neo-religious religious concept called deregulation. Regulations, being enforced by the government, gives it more power and therefore regulations must be nothing more than arbitrary means for the government to increase its power, since the unregulated market will produce all that's good if only people would get out of the way. Thus sayeth the Lord. The first big regulations that St Reagan kills are the ones designed to protect labor in certain ways. This in turn allows wages to be forced down at which point capitalists discover that "unecessary" regulations had been "artificially" inflating wages and "distorting" the market. The reward for other workers whose own wages had not yet gone through this grinder was to be lower prices. While we are told to believe that prices emerge somehow from the free market, in fact they are part of the political process of pitting one group whose wages are being cut against others whose wages have not yet been cut. After a while, however, a sort of chain reaction occurs. So many people have seen their wages depressed that they NEED lower prices. I have even read some numbnut economists who claim that wages should NEVER be raised (because inflation oh my god!) and that the world should consist basically of set wages and capitalism only working its magic to lower prices, thus creating prosperity for all. (Never noting, of course, that cutting wages is the best way to cut prices and creating a situation where wages don't go up, but they definitely do go down).
DeleteI am not saying you are wrong here, Margaret. The destruction of pension plans did indicate the beginning of the cultural shift in the direction of capitalist accounts of what constitutes fairness, fairness being defined as what creates the maximum benefits for them (because for them the one and only function of capitalism is to create and accumulate capital).
One thing that strikes me is how the role of the executive has changed, both practically and in the public mind. Capitalism has gradually seen the separation of ownership and control, beginning with stock trading. But now the executives, who generally do not own a company, are seen as capitalists themselves and deserving of the capitalist share. Before, however highly paid, they were employees. Now they act as owners as well. They claim that they "work" for the stockholders, but they don't really. The idea that stockholders can fire the executives is only theoretical. Most of the stockholders, since their stocks are part of portfolios that are managed by others, don't even know what companies they hold stock in. And stock holding is so dispersed that it is impossible for stockholders to organize to have any effect on management. Since board members are usually selected by the executives themselves, we have a situation where they can do whatever they want. And they get to do it in a complete moral vacuum, since they claim that whatever they do must be the will of the "owners" (stockholders) who, because they didn't object to anything, must therefore actively approve it. I saw a discussion on the web-page of First Things recently where some idiot was defending outrageous executive pay by saying the it was definitely deserved because the owner-stockholders don't object. It seemed a strange position for a magazine the pretends to promote direct moral responsibility to claim that something must be good because no one has said it is wrong. As a former stock holder myself, I would be more inclined to say that outrageous executive salaries take away from that would could be distributed to the stockholders. Or, I might say that the idea that the stockholder-owners are actually decision makers in this salary process would and could ONLY make sense if the stockholders had themselves made a demand for high salaries in the first place.
Sorry. Rambling here.
There are, in fact, many ways that workers could get an actual piece of productivity improvements without resorting to "communism". They could, for example, be given stock options too. Why only the workers called executives should get them is a mystery. If options incent executives, they should also incent the other workers. And the workers should have representatives on the boards, as they do in Germany and Japan. Both of these could be done without even unionizing the shop. After all, if ownership has been separated from control, it really doesn't matter who has ownership, does it?
DeleteCompassion has no purchase among 42% of the country, obviously, when the Consoler-in-Chief mentions bomb threats against "high-profile individuals" whom he doesn't name, bemoans the fact that the threats interrupted his effort to make a threat of a bunch of women and children a 1,000 miles away, and then names the unnamed high-profile individuals when it's time to start the "lock them up" chant.
ReplyDeleteNo, there is no balm in Gilead. It's a winners-and-losers place.
But istm that reason does not work with people who have no idea of how insurance works. I've seen it argued that healthy people don't need it. A healthy guy called this morning and asked me to pick him up at the hospital. He was hit by a car last week, had two skull fractures and a broken knee and says his back hurts. The guy is in his 40s and worked out regularly until last week. He has no insurance beyond VA, and he was not helicoptered to the VA hospital, so I suspect the Delray Medical Center is going to be out-of-pocket. He had no pre-existing condition, and now he is going have a lot of them. You never know. But istm the 42% is pretty certain that they do know.
The AP story about Tiny's (empty) promise to force down drug costs says the plan relies on part of the Affordable Care Act, which he tried and continues to try to repeal. (The story probably moved Friday; it was in our paper yesterday.) Once again, if tomorrow is going to be like today, only better, there is no need to think about health care. But if you are going to be hit by a car tomorrow, you have to think about it today. Too many people don't seem to know that.
Tom, glad you were there to give him a ride home. I hope the driver of the car that hit him carried liability, that would give him at least some help.
DeleteI've never understood why the VA maintains a completely separate healthcare system. It seems like it would be better to give veterans a card similar to Medicare that they could use anywhere.
Oh, Katherine. What a day. They are not letting him out. His call was based on the fact that they told him they were taking him out of Trauma and moving him to a room. He thought that meant he could go home. He is still a huge mess. He is still there. I'll get him when they turn him loose, but after talking to him and his nurse, I don't think it will be tomorrow.
DeleteAs for the VA, they have a lot of specialized problems -- like Agent Orange exposure -- and attitudes -- suck it up, soldier!-- that your ordinary GP might not understand. Makes a lot of sense, if the VA wasn't one of the places Congress goes to "find" money for tax cuts and if Congress and the White House didn't leave goldbricks in place rather than replace them with hard chargers who would melt down the goldbricks AND scream when Congress "finds" money for tax cuts in the VA budget. A serious study of the VA would, I suspect, prove democracy can never work. At the same time, I know a lot of vets who swear by it.
Until and unless Healthcare is seen by the majority of people in this country as a RIGHT, not a gift from "the government," then we'll continue to have this problem. Get employers and insurance companies out of the business of health except (possibly) as instruments of administration and ensure that the all fund the all when it comes to healthcare. We do it with social security, Medicare and VA benefits. (I have VA benefits and I have had NOTHING by excellent care and service from them.)
ReplyDeleteI guess I don't see it as a right which is an individualistic concept but a matter of solidarity. But there is no solidarity in this country. I remember reading that the British instituted their national health care after enduring WWII together. Even war doesn't bring us together. We have a mercenary army to take care of that.
Delete