Posted by: Carl Magruder | May 19, 2009

True Health: Musings of an Arrant (with an “a”) Conservative

AMERICAN BAPTIST

RESOLUTION ON HEALTH CARE FOR ALL

Healing is a significant sign and metaphor of biblical faith. The prophets of the Old Testament and Jesus himself were healers. Physical well-being was valued for its own sake as well as a sign of hope for the day when everyone would share equally in the blessings of shalom.

Many of Jesus’ miracles were miracles of healing. He touched and healed lepers, restored sight, caused the lame to walk and renewed the life of the woman who had suffered for years with a flow of blood. Christ’s example (Mark6:53-56) has inspired countless Christian health care workers including those serving as missionaries. Clearly, we have understood Jesus’ concern for physical well-being as a commission to carry on that work of healing.

ABC 11/91

In a recent political discussion, I was referred to as a liberal.  It kind of surprised me, since I consider myself solidly conservative religiously, socially, and politically.  Take the issue of health care, for instance.

The United States is the last “developed” nation to step up to the challenge of providing health care to all of its citizens, and the country is actually well behind numerous “global south” nations that have nonetheless risen to the challenge as resources permit.  Cuba in particular trumps us in health care, literacy, advanced educational degrees, and infant mortality statistics.  I’m not sure that the lack of health in the U.S. care is entirely unrelated to the fact that we incarcerate a larger portion of our population than any other industrialized democracy (disproportionately poor people of color), and that we have one of the few criminal justice systems that still endorses capital punishment.  (A prerequisite for participation in the European Union is that a nation must have abolished the death penalty—they consider it barbaric.  Oh, and they have much lower violent crime rates.  Hmmm…)  I don’t know if it is because we spend more on our military than the next 25 nations combined?  Is our lack of health care and basic concern for the well being of our “all created equal” citizenry related to our willingness to torture people?  When Bush and Obama say that “the American way of life is non-negotiable” do they primarily mean that as a nation we intend to continue to be 5% of the world’s population using 30% of the resources no matter what?  Are we undeterred in this commitment even while the climate is destabilized, we’re in the midst of the sixth great extinction, and 29,000 children starve or die of preventable diseases on the planet every day?  At least nobody tries to claim that we are a nation based on Christian principles.  That would be embarrassing!  Jesus wept…

As for health care reform, there are several places for legislators to go seriously wrong on this one.  I will point out three pertinent issues, all related to environmental health.

First, allow me to offer a simple comparison.  Consider the public transportation in cities where nearly EVERYONE uses the system: New York, Chicago, San Francisco, Washington D.C., etc.  The transport systems in these cities work pretty well.  We kvetch about how they could be better (while chronically underfunding them), but they work fairly well, and they retain ridership.  Now consider cities where the public transportation is primarily used by the poor, the elderly, kids, and those who don’t have a driver’s license because of immigration status, DUI, etc.  These are cities like Las Vegas, Los Angeles, Indianapolis, Phoenix, Jacksonville.  The public transportation in these cities stinks, which creates a self fulfilling reality—anyone who doesn’t HAVE to use it doesn’t, and it continues to decline in a vicious cycle.

A public health program that is designed not for all citizens, but only for those who do not otherwise have access to adequate health care will be like the public transportation in Indianapolis.  It will be slow, ugly, confusing, inadequate, and still cost taxpayers money without providing adequate services.  A system for everyone is the way to go.  Then everyone is invested in its being good, and nobody resents paying for it.  If it slips, there will be accountability. (Let the very elite fly to Sweden for their varicose vein surgeries if they want to—as long as they are still paying taxes in the U.S, and not stashing their money in off shore accounts.)

This leads to the second big mistake that legislators could (and almost certainly will) make.  This is structuring the health care program to utilize private insurance corporations.  You didn’t seriously think that Nancy-Ann DeParle would go any other way, did you?  Although President Obama advocates cutting private lenders right out of the Federal Student Loan program, saving $48 billion over ten years and enabling more folks to get a quality education, the idea that we would cut private insurance industry right out of a national health plan is apparently extreme.  Since private corporations have the legal protection of corporate personhood, and are accountable only to shareholders and therefore driven primarily by profit, they will provide good care to patients only to the extent that this is profitable.  Corporations are amoral.  Because of their massive political influence, they will make every effort at the time of the initial legislation and in all subsequent revisions to favor their own profit margins, often at the expense of patients.

We have a dominant myth in our culture, propagated by some irresponsible liberals, which claims that free market economics will result in the greatest good for the largest number of people.  When Adam Smith proposed this notion, which he called “the invisible hand in the marketplace,” corporations had various kinds of serious limitations on them:  They could only operate in one state, they could only operate in one industry, their charters could be easily revoked, and often their charters had a built in end date.  Also, trees were felled with axes in those days.  We still managed to deforest nearly all of North America in less than 100 years, but technologies were less dangerous than they are now, and more labor intensive.  Using highly sophisticated three dimensional holographic imagery, modern economists concerned with ecological sustainability and a just distribution of resources to all of humankind have recently caught a glimpse of the “invisible hand in the marketplace.”  They report that the “hand” has put on a sock puppet which appears to be laughing hysterically at working people and ecosystems…

Is there any truth to the Private Good/Public Bad mythos?  Let’s consider Social Security.  Oh, they are constantly trying to scare you that it won’t be there after the Baby Boom generation sucks it all up, and it is true that the system is in some trouble, but it continues to work fairly well after seven decades.  It is administered with a very small percentage of its monies, making it quite efficient in terms of overhead.  The idea of privatizing Social Security has been another attempt to favor the private interests of financial entities over the good of the people.  Can you imagine what would have happened if Social Security money had been in hedge funds last year?  Fuggeddaboutit.  What’s the easiest way to make Social Security work forever?  Remove the proviso that says that after about the $102,000 annual income mark, you don’t have to pay more social security.  Why not tax it right up to the maximum income?  The richest 5% of Americans could probably social security the rest of us right into a secure retirement for all time, and they’d have a little less money to make mischief with.

Currently, 25% of medical costs go to overhead costs.  A single-payer plan would save $380 billion a year, to say nothing of the $150 billion a year in lost productivity due to treatable health issues that currently go untreated for lack of access.  What’s inefficient again?  Conservatives conserve, rather than waste.  That’s why we’re called conservatives!

My third point about the snatching-defeat-from-the-jaws-of-victory health care plan that will likely be shoe horned through Congress this year is that there are real benefits to having a single entity handle something as broad as health care.  Besides efficiency, another benefit is in data collection and analysis.  There is a dearth of good medical information out there that could direct policy decisions.  Because there is not a centralized system, when we want to know something , we do a research project.  These research projects tend to be small in scale, and are often funded by the pharmaceutical or medical technology industries.  Naturally, these industries only research things with profit making potential.

Here’s two real world small examples of what we could do with a larger data base.  By using medical records from Kaiser Permanente, a large HMO that operates in southern California, researchers were able to discover that people who have early childhood trauma suffer more alcoholism, broken bones, diabetes, divorce, and die earlier than those who do not.  They also discovered that weight loss programs for long term morbidly obese patients that lack a psychological component are almost certain to fail to produce permanent weight loss in most patients, since the overweight person needs to address underlying issues not medically related to carrying extra pounds.  Are you smart enough to think of how this information might be used to help people be healthier?  Of course you are.  Do any of your solutions include an easy, obvious way for Eli Lilly and Company to make obscene profits?  I didn’t think so…

A centralized health care system would paint a different picture of our nations’ health than we currently get.  One of the first things that would happen would be a massive shift to real preventative medicine.  Preventative medicine has gotten a boost in recent years, but consider this:  A person who takes three years to die of lung cancer is a cash cow to the medical industry, and a boon to the Gross Domestic Product, which is how we measure our nation’s overall economic “progress.”  A person who is healthy as a horse and dies quietly in their sleep at a ripe old age is much less of an economic benefit, other factors being equal.  Therefore, market driven entities are not interested in true health.  If the nation is covering the health of all citizens, the focus on preventative medicine would be more pronounced, and it would start to look at systemic health issues, such as exposure to toxics.

If you go to your doctor because you are overweight or have cancer, she will likely talk to you about your lifestyle choices—smoking, drinking, eating food that tastes good (like bacon).  If you don’t have these health complications yet, they will tell you to avoid cancer and obesity by your individual lifestyle choices—eating rabbit food, sweating on purpose, having a prayer life (all good things to do).  But the data and motivation to look at the fact that cancer rates went up 48% in the fifty years after the Second World War is not part of the thinking.  That U.S. residents have become the most overweight people on the planet is not analyzed on a scale larger than the individual, though there is evidence that exposure to toxic chemicals contributes to weight gain.  To really do preventative care, we would have to acknowledge that we have a runaway unregulated chemical industry manufacturing synthetic chemicals for profit that are destroying human health from the genetic level on up.  Real policy changes would be much more likely if we did not have to go through the laborious process of proving the toxicity of each individual substance while industry funds lobbyists to promote deregulation.  The invisible hand in the market loves deregulation, but it loves putting more money into the pockets of the rich, so that incomes in America have skewed towards the rich in the last four decades to a greater extent than ever before.

In conclusion, it is clear to me that the guy who instructed me to feed, give drink to, clothe, visit, and otherwise comfort “the least of these” would favor an effective health care system that said “No” to greed and yes to the rest of us.  That’s why I consider myself a die-hard, or arrant, conservative, perhaps even a fundamentalist.  What could be more fundamental than health?

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Responses

  1. Provocative, as always, Mr. Magruder. Yesterday I caught just a snippet of an Minnesota Public Radio interview with a VP at UnitedHealth, and he said, among other things, that he views health care as a public ministry (I believe those were his words) similar to education, and that presently-operating health-care companies are the natural fit for taking this country into the next phase of health care. I can see his point as regards efficiency and pragmatism (for that would surely be easier and make more sense than throwing away what we have and starting over from scratch), although I have trouble imagining the vast, fundamental changes that would have to be implemented internally (not least, perhaps, inside the minds and hearts of those who run such companies). Nevertheless, I believe in the conversion power of the true gospel of Jesus Christ, and that with God nothing is impossible. Can we trade our love of following a profit with an “f” for a prophet with a “ph”? As Christ did it—one person at a time—such a miracle is indeed possible.

  2. I think that the paradox of the necessity of individual conversion and also the necessity of transformed systems is one of the great riddles of the human condition. We will need a lot of individual transformation, but hopefully that quickly reaches a critical mass that allows systemic transformation. There are systems that we currently are completely imbedded in, like the Industrial Growth Economy, that need to be transformed in a very core way. I am quite skeptical that the current, for profit health care industry will be up to the job. There are some things too basic to human and environmental well being to be left to the market. Health care has been considered one of those things by most industrialized nations since shortly after WWII. Indeed, the only other industrialized nation that used to not have Universal health care was South Africa, but then Apartheid went away and democracy advanced.


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