life liberty and the pursuit of happiness

Step Two: Lift Up

Getting right into it.

America spends proportionally more on healthcare than any other developed country. Bizarrely, the quality of care is also much lower than it is in countries that spend less than we do.

This discrepancy is reportedly a result of “higher health-sector prices.” This shouldn’t be a surprise, since the multifarious insurance companies dominating the US medical market are specifically designed to maximize profit from peoples’ poor/health.

That such a malicious, misanthropic practice is permitted at all is appalling, to me. What happened to the life in “life, liberty, and the pursuit of happiness?”

On top of this are malpractice and tort reform. Tort reform has reform in big quotes because it is a widely used name which has nothing at all to do with reform, and in fact is pretty thoroughly corrupt. The argument behind tort “reform” comes from the medical establishment, and boils down to this:

So like, you know how sometimes our doctors and surgeons inadvertently cause irreparable damage or death to their patients? And the patients or their families like… wanna sue? Well, if they do sue, and they win… we don’t wanna pay that much. Like one, two hundred thou, tops. Anything more would be, um, like, a total burden or whatever. KTHXBYE

Let’s look at a fairly common case of medical malpractice. Erb’s Palsy. Erb’s Palsy is often a result of nerve damage caused to an infant while they are being delivered. It can result in permanent loss of muscle and motor function in one arm for the rest of that person’s life.

Erb’s Palsy is completely preventable. It is only likely to happen when good medical care is not being provided. In other words, it happens if a doctor fucks up.

How much money is required to treat such an injury with surgeries (sometimes multiple attempts at surgical repair still fail) and rehabilitation? Considering it can cost tens, if not hundreds of thousands of dollars through any given year, multiplied by the rest of the person’s life, we’re looking at potentially millions of dollars spent on medical costs to repair completely avoidable damage.

In one case, a woman was awarded almost thirteen million dollars by a jury when her baby was incompetently delivered, resulting in Erb’s Palsy. However, thanks to local tort “reform” laws, her payout was capped to four million. From that four million comes the lawyer fees (usually a flat one third of the settlement payed out), so we’re probably looking at closer to three million.

Keep in mind that a few days in the ICU can cost almost five hundred thousand dollars.

If doctors maintain attitudes like this to people in need of medical care, imagine insurance companies, third party middle-men who monetize peoples’ suffering. These practices are practically dystopian.

Instead of looking at Switzerland, let’s look at the UK, now. Specifically, let’s look at the UK’s NHS (National Health Service, not the National Honor Society [which I happened to be a member of back in the day]). Again, according to the data, the UK spends roughly 5% less of its GPD on healthcare, yet in terms of performance, it is on top of the list.

The NHS is essentially a tax-funded, government-run healthcare system provided to everyone in the UK. There are still private practices and small clinics, often also subsidized by the NHS, but predominantly NHS halthcare workers and hospitals work directly for the government.

Let’s wax a little philosophical and address the complaint many Americans have: GET THAT DERN GUVURMENT OUTTA AUR PRIVATE B’NISS. I AIN’T PAYIN’ NO TAXES TA SUM DERN BYURACRACY GONNA MESS EVERTHANG UP LIKE THE GUVURMENT ALWAYS DUHS!

There is absolutely an opportunity for the government to engage in invasive practices and abuse wherever it exists as a literal bureaucracy, managing peoples’ lives, especially their health. Our government engages in these practices. A lot. However, I would contend that as bad as the government is, it at least ostensibly works for the common good, even if politicians are willing to play broadly with the definition of that term.

Corporations, on the other hand, exist for one thing: profit.

We have no problem with government-run firehouses or government-run police. Why is there so much mistrust for government-run healthcare? Imagine if, instead of the percentage of a dollar you pay in taxes to the local firehouse, you paid rates comparable to medical insurance for the right to have immediate fire response teams. Considering how much a fucking ambulance costs, you’re looking at much more than you pay in taxes. Additionally, if you don’t experience a fire, your money went straight into someone’s pocket.

However, when necessary fire response is pulled from a limited pool of tax revenue, it’s much more frugal. The system is clearly more ideal.

Why on earth do we tolerate a system like this for fire response, but not for medical care? Why is it an unnecessary tax burden to pay a small amount towards care that someone, somewhere needs, and that you might one day need, but very few people complain about paying the salaries of local cops?

Granted, those cops might be murdering people in the streets, but while that’s certainly an issue, not many people go so far as to say, “You know what? It’s better to not have any local or federal cops at all.”

(Incidentally, societies where cops have been privatized are prominent in dystopian fiction or satire, like the Shadowrun universe or this sketch from Fry and Laurie.)

Ultimately it comes down to, what is the job of government? Why does government exist, and who for?

I would argue that the government exists to ensure the greatest possible measure of safety and quality of life for the maximum number of citizens who honor its laws. This definition is commensurate with the enlightenment philosophy that spawned the American independence movement and informed its constitution and Bill of Rights. It is a definition that has since been validated by other developed countries with high standards of living, and international organizations like the UN.

In opposition to this, companies exist… to make money. They can absolutely scam the hell out of people in order to do this, and if you think they should, I’m not really sure what to say. Rather than any public good, they idealize profit.

Between these two alternatives, which is best suited to ensuring public safety and health? We give the government the power to run police. We give the government the responsibility of ensuring fire safety. We give the government the responsibility of protecting our borders and our skies, of building our roads and bridges, of maintaining courts of law…

So let’s get back to the practical issue, here. The UK has proved that a government-run healthcare system can cost less while performing better. As for tort reform?

In a government-run system, the government is responsible for malpractice. This completely liberates doctors from their own need for insurance (malpractice insurance). The health system is beholden to taxpayers and legislators who like getting elected, rather than insurance companies or private hospitals who might seek to gouge prices for themselves. And because all healthcare is free, if someone does become a victim of malpractice, they aren’t charged for the consequences, and neither are the doctors responsible.

“But wait,” you might say. “What about Obamacare?”

Obamacare is just as inefficient as the preceding system; it just spreads the inefficiency around more. Let’s say someone qualifies for a government subsidy to pay the rates offered by a health insurance company. What funds the government subsidy? Tax revenue. Who pays for tax revenue? We do.

With every subsidized health plan, we all help pay the insurance rate of a company that is probably offering the lowest possible benefits to qualify, and is not legally obligated to use that subsidy for actual implementation of health services. Now, insurance companies are paid not only by people who could ordinarily afford it, but by the taxes subsidizing people who previously couldn’t.

Guess who helped write Obamacare?

Insurance companies.

For a moment, stop imaging things as they are, with widespread poverty, people fully employed at half of a living wage, and expensive, poor-quality healthcare.

Imagine a United States where everyone has the means with which to properly live, and where their right to a healthy life is secured, no matter their financial ability.

If that doesn’t do it for you, try thinking about an America, where a demobilized military and de-privatized health service (oh, and an abolished death penalty while we’re at it) happens to have saved the country something in the ballpark of trillions of dollars annually.

What would we do with all that money? I have some ideas.

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