Tuesday, March 14, 2017
What The Healthcare Debate Is Really, Really, About
In a nutshell? It is about the question: How do we create, and distribute fairly, critical human needs?
Unfortunately, I have to start this with what is essentially an offshoot of economics 101.
The talk of insurance companies, and insurance coverage hides the fact that what is being attempted here is to, first and foremost, create an investment fund. The point of that investment fund is to make as much money as is possible by investing.
Since there are already a good number of investment funds, offering various kinds of return on what you invest, ordinary rates of return aren't always the best incentive to attract investors with. Another incentive is therefore called for. And in this instance it is the promise to pay medical costs, to various degrees, in the event that illness, of one form or another, suddenly befalls you.
As you can plainly see in this arrangement paying out more in fulfilling the indicated promise above is not in the fund's interest profit wise. This is why these companies pay close attention to health actuary tables to keep track of statistical probabilities so that they can price the contribution to the fund according to the risk potential of the contributor. This is also why the pundits talk so much about getting as many healthy people paying into the system as possible, because more of them means more contribution with less risk of withdrawal.
And therein lies the tradeoff. The young pay a little more now, so the old, or the not generally healthy to begin with, don't have to pay way beyond what they could ever hope to afford; which is something the young ought to be mindful of because they will be facing it quite soon enough.
A lot of the opposition to "sharing" like this, of course, comes from the Libertarian mindset that wants to demand: "I shouldn't have to pay for the poor choices of others." An attitude one can certainly understand, even if it is recognized that it is, at the very least, quite shortsighted, and superficial.
What we have to remember here is that shit happens whether you make good choices or not. The good choices certainly increase the odds of better outcomes, but they hardly remove the occurrence of the bad ones.
Obviously, then, problems of health, and staying healthy are a good deal more complex than just "poor choices," though those do certainly enter into the equation. On the one hand, all of us make some of those, on a recurring, semi regular basis; all of which varies constantly. So where do you draw the line on where there's too many bad ones made or not. And, as already stated, it can't be based on just the mere fact of getting sick. That happens for so many interrelated biological factors, inherited or not, and other environmental stress factors over time, as well as what I choose to eat on a daily basis, or drink, or smoke, or ingest generally. And also, quite importantly, the tradition of healthcare I have already enjoyed, or not, from the lineage of my socio-economic strata, matters greatly.
And in that vein it is also important to remember that in some communities there are no choices other than bad ones, all the way around, with populations who have made cycling through that limited arena a matter of a generational legacy. And whether an area gets red lined because of race, or because the general income level just doesn't support anybody trying to come in and make any further investments, the result is the same; desperate people with no choices but bad ones (so you get the dichotomies of drug lords being investors, offering jobs, and a product that, if it weren't so expensive, would keep users completely satisfied, and docile; juxtaposed with other unsavory, and/or poison based, industries also there to take advantage of things... As in, say, for profit prisons. Oil refineries. Waste dumps of various sorts, etc, all offering jobs that don't pay a living wage, and only help to continue a negative investment environment).
The real issue we face now. The issue that so few are willing to confront, and acknowledge, is that money, and income, and narrowly defined jobs, doing one specific thing, can no longer be relied on to create or distribute basic human needs fairly. Partly because jobs, as a commodity item, can no longer be relied on for fair valuation in a supposedly competitive environment. And also because information itself is now gold, and to be hoarded, or stolen, or distributed only at the profit of the original holder; which then puts Democracy into the hole we now find it in.
To often these days what is competitive, or not, is left up to the holders of large accumulations of capital counters; setting up situations where it is competitive for everyone but those in the market they play in because they've either bought full control, or they've colluded to gain full control. And to make matters worse for the holder of a skill commodity, not only can machines now dampen your competitive aspirations (as if third world workers weren't already), being allowed to organize at all, so as to bargain for price with more collective authority, gets propagandized into all sorts of negative connotations, even as they put most of the blame for inflation on the ratio between wages, and the cost of what is being produced in total; taking little regard for all of the new ways investment can happen now, with huge sums returned, but little notice of true social costs, or the amount of money thus injected into the system to pursue purchases with.
This is why Capitalism is not only obsolete, it is broken, and unfixable. There is no way for it now to be able to be fair for the majority of people who it is supposed be operating for, and not the other way around. We have to become our own producers, managers, and investors of effort. We have to organize into city states of like minded people, decide how we will share the workload, how we'll organize the physical plant of the community, and then how we will divvy up what the physical plant can produce. Everybody gets one vote, and a share of what's produced because they participated with everybody else. And no matter how hard transitioning to this might seem now, it is nevertheless what must be done.