Freethought San Marcos: A column
by LAMAR W. HANKINS
I begin with a simple proposition: If the marketplace cannot or will not provide a good or service needed by the people, the people have the right to satisfy that need through their own cooperative efforts, whether through private cooperation or through cooperative government action.
If you believe that only private markets should be allowed to provide goods and services, then nothing I write will persuade you otherwise. However, the private market model does not represent how the American economy has worked throughout our history. The following examples of failed markets that have been improved by both private and public cooperation illustrate this economic history.
Credit unions are an example of private cooperation to create a financial system that encourages savings and meets the basic need of most families to borrow money for homes, cars, vacations, and other consumer purchases. Other consumer cooperatives provide housing, water, electricity, telecommunications services, child care, health care, food, books, and funeral services.
Producer cooperatives are owned by people who produce similar products, such as farm crops, cattle. milk, crafts and other artistic products. Worker cooperatives are businesses owned by workers, including employee-owned food stores, bakeries, restaurants, taxicab companies, sewing companies, timber processors, and other industrial manufacturers.
Some businesses, cities, and state governments have banded together to purchase goods and services that they need in order to lower costs, improve services, and increase competitiveness.
While all of these kinds of cooperatives are vital to the economic health of the nation, they exist alongside profit-making businesses that offer the same or similar goods and services. Cooperatives usually exist where the private market has failed to provide people something they need, at a price they can afford, and on terms they find acceptable.
Government is another type of cooperative venture that operates under different rules and structures from those followed by either the private, market-driven sector or the cooperatives sector. Government usually provides streets, roads, and highways; fire and police protection; schools; libraries; recreational facilities; airports; sewer services, garbage collection, and recycling services; water, electrical, and gas utilities; low-income housing and a range of social services, including health care and health care insurance for the elderly, children, the disabled, and the military (TRICARE and VA).
According to recent polling, nearly 75% of Americans now realize that the private health insurance industry, driven by market forces, has been unable to provide adequate health insurance to meet the health care needs of nearly 50 million Americans and costs far more than it should for another 50 million Americans who have some coverage.
Something similar happened with fire insurance companies. If you had a fire insurance policy in the early 1800s, a private fire brigade would respond to a fire alarm at your home. The system did not work well because not everyone was covered by insurance and conflicts often arose between competing companies with different customers who were affected by a common fire. Governments gradually assumed fire-fighting functions in most communities. Today, even volunteer fire departments are controlled by government laws and regulations, and such departments perform an admirable service.
While many for-profit companies provide utility services, build and operate roadways, build and manage prisons and jails, and provide private security services, most such functions are done directly by governments at all levels.
The mixture of government, for-profit, and not-for-profit entities providing goods and services to the public indicates that there is a role for all of these business models in our economy. When one model fails to perform adequately, usually some other model is developed or expanded to meet the unmet needs. With health care insurance, we have come to such a point.
The private health care insurance system is not adequately meeting the needs of about one-third of all Americans, either those who cannot afford any health care insurance or those whose premiums and co-payments have reached the point that they have to forego other necessities to meet the increased costs or go without the health care. Given the government’s experience providing health care and health care insurance through the military and through Medicare and Medicaid, it is clear that the government is capable of making affordable health care available to all Americans, especially those who are not served by the present for-profit system and those who can afford only inadequate coverage.
What is now standing in the way of a Medicare-like option for those Americans who cannot afford private health insurance is the insurance system itself. According to Consumers Union, “the giant drug companies, insurance companies and medical conglomerates are spending $1.4 million each day” on lobbyists to make sure that whatever health insurance bill is passed by Congress “benefits them, not you.” (Emphasis added.) These corporate entities have “even hired 350 former members of Congress and staff to push their agenda of getting more money in their pockets, and less in yours.”
The only reason the insurance companies oppose a public option for health insurance coverage, which would guarantee health care for those who can’t afford insurance now, is that they don’t want to risk that the government option will be so popular that their customers will move by the millions away from expensive private insurance to the more reasonable coverage that could be provided by a Medicare-like option.
Between them, my parents enjoyed over 45 years of Medicare coverage, without the hassles that my wife and I have endured in the private sector. They never needed to get approval to see a specialist. They never needed pre-approval for a medical procedure. They never had to worry that the co-pays would be beyond their means. They never had to worry that their health care coverage would be canceled by some corporate bureaucrat concerned more about the company’s profitability than with their health care needs. They never had to worry that a medical procedure would be disallowed by one of those same corporate bureaucrats. And they always were able to receive health care services from the doctor, specialty clinic, laboratory, rehab facility, hospice, and hospital of their choice.
Health care should not be just another commodity bought and sold in the marketplace. When it is, far too many people do not receive the care they need. The result is needless suffering, financial hardship, and premature death. The primary concern of the for-profit health insurance companies is their bottom lines. It is the nature of companies owned by stock-holders to serve the financial interests of those stock-holders above all else. An example of serving such interests to the detriment of policyholders was given recently in testimony before the Senate by former CIGNA Health Insurance executive Wendell Potter: “Insurers routinely dump policyholders who are less profitable or who get sick. They look carefully to see if a sick policyholder may have omitted a minor illness, a preexisting condition, when applying for coverage, and then they use that as a justification to cancel the policy, even if the enrollee has never missed a premium payment.”
There are alternatives to the present despicable system, but they will be created only if our elected representatives serve the interests of the people, rather than the interests of the corporations or the dictates of a rigid private market ideology, an ideology manifested recently in the efforts of menacing protesters who have interrupted and shouted down some of our elected representatives, including Congressman Lloyd Doggett. These include some of the same people who claim that the plan now being considered by the Congress will force euthanasia on the elderly–a loathsome and false charge.
A group of Oregon doctors pushing for universal health insurance have concluded that “there is only one way to control costs, one way to remove profiteering from the system, one way to reclaim the care of our patients, and one way to be sure everyone is covered: we must replace our current pay-or-die system with a comprehensive, publicly financed, privately delivered, Single Payer system that puts people first.”
We need a better health insurance system. The only kind that will fix our current broken, dysfunctional, excessively expensive system is a single-payer system, something like Medicare-for-all. If we cannot have a single-payer system for all Americans that saves billions of dollars each year in administrative costs and profiteering, and assures that health coverage will not be canceled at the whim of some corporate bureaucrat, then we should at least have a system that covers everyone in the most economical way possible, while prohibiting the private-sector health insurance companies from dumping any of their customers.
The way to do this is to have the government collect the premiums and pay the private medical providers of our choice if we can’t find affordable health insurance in the private sector. The private, profit-driven system will either figure out how to be more competitive or it will cease to exist. Such change is nothing new. It has been going on for the last 300 years in North America. It is not socialism. It is the American way.
© Freethought San Marcos, Lamar W. HankinsEmail | Print