Is Anybody There? Does Anybody Care...?

…“Does anybody see what I see?” Those are lines in a song from the 1969 Broadway musical 1776. The actor playing John Adams sings this soliloquy lamenting why members of the Continental Congress can’t see what is so obvious to him, namely the need for independence from Great Britain. There are times when any of us might arrive at a conclusion that seems both obviously correct and contrarian at the same time. Later, more often than not, additional information can have us viewing things differently, perhaps even causing a touch of chagrin. Don’t you hate that, when things appeared so certain?

I currently find myself burdened by such a view and have seriously struggled to find reasons why that view might not be correct. I haven’t found any…at least not yet. I’m talking about Health Care in America. I have written about it previously, but, frankly, it cannot be brought up enough. It is the single most import issue in the United States today, because it impacts so many aspects of life simultaneously.

It is the single biggest expenditure for the Nation’s people, dwarfing Defense. It’s the single biggest hindrance for freedom to seek employment. It is possibly the most inefficient system of any kind (based on size) in the history of modern man. It’s the single biggest inhibitor for small business expansion. It is a major cause of disabling anxiety for the middle class. It is the single biggest transfer of wealth in the history of this Country…or any other country. I’m not making this up. Currently $1.8 trillion annually comes out of your pocket (directly, in taxes, public debt – which is only deferred taxes - or for you by your employer) and ends up…well, somewhere else.

Yet the negative nature of this system in its entirety is nearly oblivious to large segments of our population. More amazingly, there are segments which have been convinced to actively support this System against their own best interest.

The wealthy can self-insure and since they are (unwittingly or not) the beneficiaries of the transfer they are hardly inclined to admit what is happening. Their surrogates in Congress will repeat that we have the best health care system in the world, over and over. The employed insured are annoyed but at the same time blinded by not being able to understand the true cost of what they’re paying. The poor have little incentive, because they can tap into existing welfare and have little (materially) to lose. The elderly actively resist change because they already receive universal coverage and are frightened by those who say change will take that away. The young (those say 18 to 30) for the most part are comatose on the subject, primarily kept unconscious by their natural good health.

The opinion of the wealthy will not change; moreover they will do whatever it takes to retain the status quo. The employed insured, most notably working Conservatives, will not challenge the System, unable to recognize their own deleterious behavior, even as they unload every bullet they have into their own feet. They are too malleable by use of fear. It is for the youth of America that I’m writing this piece. They are the only ones who can effect change and they are ones paying the price right now, by the accumulation of extraordinary debt and lost opportunities. They should be shouting from the roof tops or stampeding in the streets. Is anybody there?

The universal dispensation of health care cannot exist in a large modern economy today as a for-profit, free enterprise system…period. It might appear to work if you’re willing to give up the universality. You’d have to let a segment of your economy go without health care regardless of their desire to get it. More metaphorically, you have to let people die in the streets, so to speak.0

Yet even then it wouldn’t work effectively or efficiently. There is nothing in a for-profit health care system that can control the cost because, in economic terms, there is almost no elasticity in demand. That means individual demand for health care services does not drop no matter how high the price goes up. Total demand might drop simply because people can no longer afford health care, fall out of the system and die, but for those paying with their remaining assets the costs would continue to spiral up. The whole concept is not self-sustaining and it is ripping apart the fabric of our nation. Does anybody care?

A young person might ask what is so different now compared to decades past…a lot actually. First and most critical, the population of the United States has more than tripled in the last 100 years. Modern medicine as we know it now is relatively new. The technological changes that have transformed medicine (micro biology, pharmaceuticals, genetics, and numerous others, for example) have mostly occurred during the lives of living generations.

Further, historically through most of the 20th century, the practice of medicine was mostly non-profit. Most doctors worked independently in conjunction with hospitals that were publicly or charitably owned. The massive change toward capitalization of health care with the rise of professional corporations and huge hospital corporations has taken place mostly over the past 30 years. The bones of the beast became the medical insurance corporations, and the life blood of the beast is debt, public and private.

No other large advanced economy in the world has had this experience. Universal public health care in Europe and Asia is as old as the medical industrial complex is in the United States, most originating in their current form just after World War 2. Canada tried the American approach but soon realized the obvious and converted to universal public health care in the early 60s. 

Now Americans pay multiples of what other modern economies pay, on a per capita basis, for health care that barely rates above third world countries for the nation as a whole. And even with all these resources spent, the fear of being turned out on the streets by the insurance companies due to a job change, or contracting a disease, or having an accident, and end up running out of assets pervades the middle class like a perpetual black cloud. Can anybody see what I see?

There should be a revolution between the young people of American against those who are on the receiving end of that annual $1.8 trillion transfer. When Mitch McConnell, John Boehner, and Eric Cantor endlessly repeat the phrase “government takeover of health care” to describe the recent health care law (that only modestly modified the health care insurance industry) they are using fear to maintain the status quo. 

Such should be heard as clarion call for American youth to demonstrate against the hypocrisy. Young people did it during the Vietnam War because they felt personally at risk. Well…they’re at risk now, as we all are. But the youth of America will bear the brunt of the disaster, the longer they wait to show up and open their eyes.