Should health care be controlled by the government or by patients?

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by Shane Busby

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Healthcare and Social Success

The success of a society is ultimately determined by how well its population lives, dies, and looks after its most vulnerable. The level of success attained by any one individual is comparatively unimportant to how well the population, in its entirety, lives. It is important to note that both individual and population wellness need to be met in order for a society to be deemed successful. Healthcare is an integral aspect to societal success.

Health is only missed when one loses it. If one does not have his/her health, then all of the financial success in the world is meaningless. Therefore, the question of whether healthcare is government run or patient run creates a false dichotomy, which is really quite outside of the main issue of whether or not the society is successful - both now and in the future. In fact, in order for societal success to occur, it is essential that wellness be available to everyone, irrespective of financial status. Limiting the opportunity for wellness on the basis of whether one can afford it or not is not reflective of a fair and just society.

The link between societal success and healthcare is well understood, even by capitalist mavens like Bill Gates, who in 2000, along with his wife Melinda, created the world's largest charity - the Bill & Melinda Gates Foundation. The mandate of the Foundation is to improve healthcare and reduce extreme poverty worldwide. The foundation doubled in size in 2006 due to a contribution from financial guru Warren Buffet, CEO of Berkshire Hathaway.

While some might argue that capitalism is essential to facilitating healthcare and reducing poverty worldwide, they would be missing the point. The point is this: in America there are millions of people whose level of income prevents them from accessing the healthcare they need and thus precluding them from participating exercising their opportunities to create success for themselves. Thousands of children go without basic healthcare every year in the United States. These facts alone are deplorable, and should not occur in such an affluent society.

So, how is it then that in the richest country in the world, people are dying only because they are unable to afford healthcare? First, let me say that the rugged individualism which forms the basis of American society and which affords the opportunity to amass wealth does work, and works well. However, the idea that maintaining and promoting a democratic political and a free market system is mutually exclusive to providing healthcare to its citizenry, is both baffling and tragic. A capitalist system does not require exclusion of good ideas irrespective of where they originate, nor does a social healthcare model inevitably result in, or open the door to a slippery slope toward communism (economically) or socialism (politically). To suggest that a socialized healthcare system would indeed ruin or infect, as it were, the American politico-economic system is absurd and has no basis in reality or sound thinking.

One need only look at the success of social healthcare systems operating in free market economies to understand this. Michael Moore, in his revealing movie, Sicko, provided a snapshot of the French, British, and Canadian systems and demonstrated how well these systems work in harmony with free market economies. For those who continue to perpetuate the myth that socialized healthcare will lead to the collapse of the American way of life, these arguments are often grounded in economic elitism or ignorance; or both. There is an irony that the richest (and most healthy) segment of society decries socialized healthcare because they can afford to purchase as much as they want at any time. It does not matter one way or another to this advantaged group and yet the fear-mongering continues. Yet, there is even more of an irony that some of the poorest citizens decry socialized healthcare. I can only surmise that this is due to the repetition of a romanticized view of freedom and opportunity (perpetuated by the elite) which is strategically linked to the idea of free enterprise and democracy - in a nutshell, brainwashing. These concepts are all quite separate and occur individually without the existence of the others. Yet they are all mixed into the pot and inextricably linked in the minds of those who want to associate socialized healthcare with Soviet style communism - this is pure and utter hogwash.

On the other hand, it makes good sense for ever individual to control his/her healthcare. Secondly, government should not intercede in the private healthcare of individuals delivered in physicians' offices. These services should rightly be paid for by individuals accessing those services. Virtually everyone can afford the cost of a visit to the doctor. For those very unfortunate individuals who cannot due to extreme poverty, mental illness, mental handicap, or the like, then society should provide them with a means to access services. On the other hand, if you get into a car accident and require significant healthcare diagnostics and interventions, how do you pay? Well, if you are fortunate enough to belong to a health plan through your employer or can afford your own insurance, then good for you, if not, then God help you.

Where individuals are in an accident or are stricken with seriously acute or chronic illnesses which would result in extraordinary high costs due to hospitalization or ongoing treatment and diagnostics, it makes good sense to have a system in place to be able to address these costs for everyone irrespective of their ability to pay. Withholding healthcare in these instances and based on an individual's ability to pay, borders on criminal.

Since corporatism is the rule in America these days, you can rest assured that even if you have healthcare insurance, there are huge economic pressures on insurers to limit the amount of service offered or to de-list you entirely should a serious illness or accident befall you. In a society where profit is revered more than the collective health of the population, imbalances are bound to occur. However, writing off a large segment of society who cannot afford healthcare, and predicating it on whether or not they are advantaged or disadvantaged is not the answer.

The elderly consume the vast majority of healthcare services some estimates are up to 85% of all costs. As the population of America continues to age and as people retire and leave the workforce, there will be an ever-increasing need to address the healthcare costs and pressures that come along with these shifts. If you have amassed wealth over your career, you will likely need it to cover your healthcare costs by the time you reach old age (or sooner). If you have not, then under the present system, you will not be able to afford treatment. A population of senior citizens poses challenges never before experienced by any Administration. Perhaps the sheer volume of the baby-boom cohort will create revolutionary change once again, but this time in healthcare.

Paradoxic ally, while there has never been more of a need to reform healthcare, by its very nature it is contentious and a bona fide deal-breaker for career politicians. Therefore, it is highly doubtful that any seriously electable politician will take this issue head on in 2008, or at least not until there is a legitimate crisis (not the one currently trumped up by the media). As the head of healthcare reform during her husband's presidency, Hillary Clinton discovered what a politically hot potato healthcare is. So, despite the increasing urgency of this topic and the need to strategically map out a better way, politicians and corporate America, led by health insurers and pharmaceutical companies, will remain content with the status quo.

So returning to the question of "who should control healthcare"? In fact, both individuals and government have a role to play. I remain doubtful of the efficacy of large insurance companies and pharmaceutical companies to do the "right thing", as they are hoist on their own petard of being fiscally responsible to their shareholders. I suspect these shareholders are largely the same individuals who are most vocally opposed to social healthcare.

Clearly, evangelizing capitalism to the detriment of social progress has no place in a successful society. To succeed, we must marry self-interest with the goal of creating a successful society. Societal success will not necessarily result from the existence of a democracy and free market economy. You have to plan for itand to quote an old adage: "if you fail to plan, then you've planned to fail".

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