One thing I've heard over and over again, in the current debate over health care reform, but in truth all my life, is people griping about how inefficient government is. We seem to take it as a matter of faith, as an unescapable reality that anything the government does it must be inefficient.
Now, I'm not debating that this is the sad state of affairs in many things that the government does. What I take offense at is that we as a people have come to expect this, that this inefficiency is as inescapable and as permanent as the sun rising in the east every morning.
Who ever said that government operations must be inefficient? Why do we accept that so many things the government does are done inefficiently? Why do we not refuse to accept this, and make our government at all levels, federal, state, and local, more efficient? Are we all just stupid? It's our own money that we're talking about, after all.
Now, I work for the government, specifically as a civilian aircraft engine mechanic for the Air Force. It's a good job, and I'm very glad to have it. And I do what I can to do my best every single day I'm at work; I do try to give an honest day's work for an honest day's pay, which is fair all around. And I'd say that most of my co-workers do the same.
Previously, I worked in the commercial airline industry, at a couple of third-party maintenance providers. I will say that some of the procedures the government uses are bewildering, and would make absolutely no sense on the outside, i.e., for companies that actually have to turn a profit, or go out of business. It would be a good thing if the government would hold itself to 'best commercial practices' standards in all things; the government does not have to turn a profit, but it should act as if it did. If government at all levels had that commercial 'be profitable or die' mentality in it's operations, I know we'd save untold billions every single year.
But the main thing is that all of us need to demand better accountability and better efficiency from our government.
Sunday, March 21, 2010
Universal Health Care
OK, so it's been a while since my last post. I've been busy.
I think I can make a pretty persuasive case for universal health care here in the United States based on, of all things, the Declaration of Independence.
The Declaration of Independence is sort of a strange document, in that we Americans just love to refer to it all the time, yet it's not a legal document. It's not a law; it was never enacted as a binding requirement on what our government is supposed to do. Rather, as Jefferson wrote in the first few introductory sentences, (and I'm paraphrasing here) when the time comes for a people to break away from another people, a decent respect for the proper relations between all peoples compels those who are breaking away to announce why they have chosen that course of action.
Jefferson then launches into the immortal words that all American schoolchildren are taught: We hold these truths to be self-evident; that all men are created equal; that all men are endowed with certain inalienable rights; that among these rights are life, liberty, and the pursuit of happiness. (Of course the government-approved curriculum has our students stop there, before Jefferson gets into his more radical ideas, which apparently are a little too radical for general consumption nowadays--that to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed; that when any form of government becomes destructive of these rights, it is the right of the people to alter or abolish it . . . but I digress. Good words, revolutionary concepts, but not exactly germane to my attempt to justify universal health care.)
These are the fundamental principles on which America rests. Despite it's non-legal status, America's courts have for generations looked to the Declaration for guidance, because it so succinctly and clearly displays the intent of the same Founding Fathers who went on to create the Constitution (which is of course a full legal document, ratified and adopted some 223 years ago). 'All men are created equal' is the fundamental statement on which all our civil rights are founded upon, for example, and 'certain inalienable rights' goes even further to state that those equal men have specific rights that cannot be taken from them, and Jefferson was gifted enough to state that 'among those rights are life, liberty, and the pursuit of happiness', meaning that those three are among those rights, but the list of inalienable rights is longer than just those three.
So, among those rights that we as Americans hold dear is the right to life, and liberty, and the pursuit of happiness. The government cannot deprive us of our lives without due process of law, meaning that if we commit a capital crime, and are found guilty by a jury of our peers, the government can put us to death, in such a way that is not cruel nor unusual. Furthermore, we as American citizens cannot be discriminated against based on race, national origin, sex, age, or a number of other things.
But yet the way our health care system is set up, it discriminates against us all on the basis of whether or not we have insurance and to a lesser extent, our income level. I for one cannot see a significant difference, in terms of moral justice, between denial of medical care based on whether or not I have paid for some sort of insurance and denial of the right to vote based on whether or not I own real estate, or whether or not I am descended from someone who was eligible to vote in the 1860 election, or whether or not I can pass some sort of voting test--all of these restrictions on the right to vote having been ruled unconstitutional decades ago.
Health care is fundamentally linked to that first listed inalienable right, the right to life, as to be practically one and the same. Without decent medical care, none of us could expect to live any longer than people did 200 years ago, before all the revolutionary changes that have made modern medical care the wonder that it is. If I am denied medical care because of an inability to pay, or (which is much more likely) if I receive substandard medical care because of an inability to pay, then I am being denied that most fundamental right guaranteed to all Americans.
Furthermore, with either a lack of medical care or a lack of adequate medical care, that's going to impact that other right, the pursuit of happiness. That great 'American dream', of self-sufficiency and of being able to own a home and be at least somewhat financially secure, is never going to happen if you have the misfortune of having a significant illness or injury, and not have adequate health insurance; you can count on being significantly in debt for at least a major portion of your life. So, without adequate insurance (or being fortunate enough to have been born to very wealthy parents), your ability to exercise your right to the pursuit of happiness is going to be severely constrained.
Now, the truly poor have Medicaid, enacted in the 60's, to alleviate some of this injustice (for that is what it is, truly named). The problem is that, first, those who make too much for Medicaid and don't have affordable insurance available to them are extremely vulnerable to financial disaster, if not an outright inability to pay for adequate medical care; secondly, Medicaid is subject to the same budgetary whims and shortfalls as road maintenance and state parks. Without that adequate medical care, Americans inalienable right to life is being denied. In fact, the National Academy of Sciences estimated in 2004, six years ago, that 'lack of health care causes roughly 18,000 deaths every year in the United States.' Since there have been no significant changes to our health care system since then, we've lost more than 100,000 American citizens to inadequate health care over the last 6 years--enough to fill a small city with our fellow Americans whose basic, fundamental right to life, set forth in the Declaration of Independence, has been denied. Here's a good example, and another, and another.
In fact, other studies suggest that the National Academy of Sciences estimate may be far too low. The Harvard Medical School found in 2009 that 45,000 Americans die every year due to inadequate health insurance. If the Harvard folks are correct, over 6 years, that's well over a quarter million unnecessary deaths.
I think I can make a pretty persuasive case for universal health care here in the United States based on, of all things, the Declaration of Independence.
The Declaration of Independence is sort of a strange document, in that we Americans just love to refer to it all the time, yet it's not a legal document. It's not a law; it was never enacted as a binding requirement on what our government is supposed to do. Rather, as Jefferson wrote in the first few introductory sentences, (and I'm paraphrasing here) when the time comes for a people to break away from another people, a decent respect for the proper relations between all peoples compels those who are breaking away to announce why they have chosen that course of action.
Jefferson then launches into the immortal words that all American schoolchildren are taught: We hold these truths to be self-evident; that all men are created equal; that all men are endowed with certain inalienable rights; that among these rights are life, liberty, and the pursuit of happiness. (Of course the government-approved curriculum has our students stop there, before Jefferson gets into his more radical ideas, which apparently are a little too radical for general consumption nowadays--that to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed; that when any form of government becomes destructive of these rights, it is the right of the people to alter or abolish it . . . but I digress. Good words, revolutionary concepts, but not exactly germane to my attempt to justify universal health care.)
These are the fundamental principles on which America rests. Despite it's non-legal status, America's courts have for generations looked to the Declaration for guidance, because it so succinctly and clearly displays the intent of the same Founding Fathers who went on to create the Constitution (which is of course a full legal document, ratified and adopted some 223 years ago). 'All men are created equal' is the fundamental statement on which all our civil rights are founded upon, for example, and 'certain inalienable rights' goes even further to state that those equal men have specific rights that cannot be taken from them, and Jefferson was gifted enough to state that 'among those rights are life, liberty, and the pursuit of happiness', meaning that those three are among those rights, but the list of inalienable rights is longer than just those three.
So, among those rights that we as Americans hold dear is the right to life, and liberty, and the pursuit of happiness. The government cannot deprive us of our lives without due process of law, meaning that if we commit a capital crime, and are found guilty by a jury of our peers, the government can put us to death, in such a way that is not cruel nor unusual. Furthermore, we as American citizens cannot be discriminated against based on race, national origin, sex, age, or a number of other things.
But yet the way our health care system is set up, it discriminates against us all on the basis of whether or not we have insurance and to a lesser extent, our income level. I for one cannot see a significant difference, in terms of moral justice, between denial of medical care based on whether or not I have paid for some sort of insurance and denial of the right to vote based on whether or not I own real estate, or whether or not I am descended from someone who was eligible to vote in the 1860 election, or whether or not I can pass some sort of voting test--all of these restrictions on the right to vote having been ruled unconstitutional decades ago.
Health care is fundamentally linked to that first listed inalienable right, the right to life, as to be practically one and the same. Without decent medical care, none of us could expect to live any longer than people did 200 years ago, before all the revolutionary changes that have made modern medical care the wonder that it is. If I am denied medical care because of an inability to pay, or (which is much more likely) if I receive substandard medical care because of an inability to pay, then I am being denied that most fundamental right guaranteed to all Americans.
Furthermore, with either a lack of medical care or a lack of adequate medical care, that's going to impact that other right, the pursuit of happiness. That great 'American dream', of self-sufficiency and of being able to own a home and be at least somewhat financially secure, is never going to happen if you have the misfortune of having a significant illness or injury, and not have adequate health insurance; you can count on being significantly in debt for at least a major portion of your life. So, without adequate insurance (or being fortunate enough to have been born to very wealthy parents), your ability to exercise your right to the pursuit of happiness is going to be severely constrained.
Now, the truly poor have Medicaid, enacted in the 60's, to alleviate some of this injustice (for that is what it is, truly named). The problem is that, first, those who make too much for Medicaid and don't have affordable insurance available to them are extremely vulnerable to financial disaster, if not an outright inability to pay for adequate medical care; secondly, Medicaid is subject to the same budgetary whims and shortfalls as road maintenance and state parks. Without that adequate medical care, Americans inalienable right to life is being denied. In fact, the National Academy of Sciences estimated in 2004, six years ago, that 'lack of health care causes roughly 18,000 deaths every year in the United States.' Since there have been no significant changes to our health care system since then, we've lost more than 100,000 American citizens to inadequate health care over the last 6 years--enough to fill a small city with our fellow Americans whose basic, fundamental right to life, set forth in the Declaration of Independence, has been denied. Here's a good example, and another, and another.
In fact, other studies suggest that the National Academy of Sciences estimate may be far too low. The Harvard Medical School found in 2009 that 45,000 Americans die every year due to inadequate health insurance. If the Harvard folks are correct, over 6 years, that's well over a quarter million unnecessary deaths.
Another nice little figure is that in 2008, four times as many US Army veterans died as a result of a lack of health insurance as were killed in Operations Iraqi Freedom and Enduring Freedom (Iraq and Afghanistan, respectively)--that's 2,266 veterans who died, men and women who had volunteered to go into harm's way to do their duty to our country, every single one of whom once took an oath 'to preserve, protect, and defend the Constitution of the United States against all enemies, both foreign and domestic; to bear true faith and allegiance to the same . . .' There are many who still, to this day, wear POW bracelets and fly the POW 'You are not forgotten' flags, to keep alive the memories of the POW/MIA servicemen and women we left behind in Southeast Asia, and it is 'altogether fitting and proper' that they should do this, as Lincoln said in his most famous address. But no one seems to want to remember these other veterans who also did their duty. But again I digress.
So, returning to the subject at hand, the only truly right, morally just, way to provide health care is to make it available to all people, to all Americans, regardless of income, skin color, race, national origin, age, sexual orientation, or any other means of discrimination.
Now, we do have, on a limited basis, universal health care for a few (relatively speaking). About 3% of Americans are covered by the military's TRICARE system. At one point, my family and I were covered by this system (my wife was injured on active duty and was placed on the TDRL-Temporary Retired Disabled List--while she recovered, and so we were eligible for TRICARE). Now, I will admit that TRICARE can be pretty spotty, and the quality of the coverage can vary greatly from one location to another. But where we were (in Jacksonville, FL) it was pretty good, primarily (I think) due to the presence of a full military treatment facility (MTF), the Naval Hospital at NAS Jacksonville.
There, we found a system unlike anything I had seen in the civilian world. There was no profit motive, so there was no need to order unnecessary tests; conversely, if a test was needed, there was no delay in getting authorization--you just went and had the test done. All the equipment was there and available; it might as well be used. The doctors there did not receive kickbacks (calling a spade a spade; a kickback is defined as a percentage of income given to a person in a position of power or influence as a payment for having made that income possible) from the drug companies for prescribing the latest and greatest drug with a multimillion dollar ad campaign, so they prescribed what worked, and what was necessary--not what would help the doctor writing the prescription make their car, boat, and house payments. All medical records were stored digitally on a computer network; there were even checklists that the doctors and other health care providers used to ensure that nothing was missed. Truly an extraordinary system, at least when it's at its best, as it was there. And I'd really like to point out that this was a quintessentially government-run health care system, of the type that it seems everyone on TV wants to lambaste. (You know, that's a good topic for another post . . .)
The care was timely, it was accurate, it was effective, and it was good. And it was cheap-$115 per quarter for our whole family. Now, that pittance of a premium didn't cover much of the total cost, which was in the neighborhood of $41 billion for FY2009, covering around 9 million people (active duty, guard & reservists on active duty, their dependents, and retirees and their dependents). That works out to a cost of between $4500 and $5000 per person, or around $400 a month. Extrapolating that out to cover all 300 million Americans, that would work out to about $1.5 trillion a year, if TRICARE was expanded to cover all Americans.
Now, that's an overly simplistic estimate. But I honestly believe that if someone were to do an 'apples to apples' comparison of our current health care system to a universal 'single-payer' government-run health care system, we will find that there would be significant savings from switching to a universal health care system. Oh, initially, there would be a big surge, as tens of millions of Americans currently without adequate access to health care got 'caught up', so to speak, but after a few years, you'd see a downward trend. Why? Reduced administrative costs for one reason, and economies of scale for another.
And there's another reason for universal health care--a healthier workforce is going to be more efficient and more productive than an unhealthy (or only partially healthy) workforce.
But regardless of the financial and economic reasons, universal health care is simply the right thing to do. Dr. Martin Luther King once said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane"; this from a man who grew up in the Old South, where 'white only' and 'no colored' signs were common, 'separate but equal' was the law of the land, and hundreds of black men were lynched every year--he felt that despite all that, unequal access to health care was far, far worse. And he was right. The time to end this particular inequality, this particular injustice, was ages ago, and it didn't happen then. It is past time that we right this particular wrong. To not do so is to continue to betray the noble, honorable, and just principles on which our great nation was founded.
So, returning to the subject at hand, the only truly right, morally just, way to provide health care is to make it available to all people, to all Americans, regardless of income, skin color, race, national origin, age, sexual orientation, or any other means of discrimination.
Now, we do have, on a limited basis, universal health care for a few (relatively speaking). About 3% of Americans are covered by the military's TRICARE system. At one point, my family and I were covered by this system (my wife was injured on active duty and was placed on the TDRL-Temporary Retired Disabled List--while she recovered, and so we were eligible for TRICARE). Now, I will admit that TRICARE can be pretty spotty, and the quality of the coverage can vary greatly from one location to another. But where we were (in Jacksonville, FL) it was pretty good, primarily (I think) due to the presence of a full military treatment facility (MTF), the Naval Hospital at NAS Jacksonville.
There, we found a system unlike anything I had seen in the civilian world. There was no profit motive, so there was no need to order unnecessary tests; conversely, if a test was needed, there was no delay in getting authorization--you just went and had the test done. All the equipment was there and available; it might as well be used. The doctors there did not receive kickbacks (calling a spade a spade; a kickback is defined as a percentage of income given to a person in a position of power or influence as a payment for having made that income possible) from the drug companies for prescribing the latest and greatest drug with a multimillion dollar ad campaign, so they prescribed what worked, and what was necessary--not what would help the doctor writing the prescription make their car, boat, and house payments. All medical records were stored digitally on a computer network; there were even checklists that the doctors and other health care providers used to ensure that nothing was missed. Truly an extraordinary system, at least when it's at its best, as it was there. And I'd really like to point out that this was a quintessentially government-run health care system, of the type that it seems everyone on TV wants to lambaste. (You know, that's a good topic for another post . . .)
The care was timely, it was accurate, it was effective, and it was good. And it was cheap-$115 per quarter for our whole family. Now, that pittance of a premium didn't cover much of the total cost, which was in the neighborhood of $41 billion for FY2009, covering around 9 million people (active duty, guard & reservists on active duty, their dependents, and retirees and their dependents). That works out to a cost of between $4500 and $5000 per person, or around $400 a month. Extrapolating that out to cover all 300 million Americans, that would work out to about $1.5 trillion a year, if TRICARE was expanded to cover all Americans.
Now, that's an overly simplistic estimate. But I honestly believe that if someone were to do an 'apples to apples' comparison of our current health care system to a universal 'single-payer' government-run health care system, we will find that there would be significant savings from switching to a universal health care system. Oh, initially, there would be a big surge, as tens of millions of Americans currently without adequate access to health care got 'caught up', so to speak, but after a few years, you'd see a downward trend. Why? Reduced administrative costs for one reason, and economies of scale for another.
And there's another reason for universal health care--a healthier workforce is going to be more efficient and more productive than an unhealthy (or only partially healthy) workforce.
But regardless of the financial and economic reasons, universal health care is simply the right thing to do. Dr. Martin Luther King once said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane"; this from a man who grew up in the Old South, where 'white only' and 'no colored' signs were common, 'separate but equal' was the law of the land, and hundreds of black men were lynched every year--he felt that despite all that, unequal access to health care was far, far worse. And he was right. The time to end this particular inequality, this particular injustice, was ages ago, and it didn't happen then. It is past time that we right this particular wrong. To not do so is to continue to betray the noble, honorable, and just principles on which our great nation was founded.
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