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When I was a Mississippi teacher in a school that was half black and half white, nearly all of my black students and half of my white students qualified for free lunches. In a school where no one was rich, picture one quarter of the student population having to buy that which the other three-quarters get for free. Now, picture the parents of that one-quarter having to pay for their own children’s lunches and, through their taxes, for the lunches of the other students. Such situations build resentment. When I asked in a previous post why it might be that the very parts of the country that have the poorest people are also the parts that so vehemently oppose a national health care system, no one answered. I think that one reason is just such resentment. The South contains a lot of seriously pissed-off people, and I can’t bring myself to put them down too harshly because I’ve seen the world through their eyes.I support national health care because I also see how miserable and hopeless my own precarious health situation would be if I were to lose my private insurance in a state that has a waiting list for Medicaid. If you become too sick to work, you lose your job, and when you lose your job, you lose your insurance. You can’t buy more insurance because you’re sick and you have no job. What is the message in this? That your life is worthless aside from your ability to earn money with which to buy insurance? I would be astounded if you could find a single person who is desperately ill and can't afford treatment who opposes national health care. If I am right, what you have here is a situation in which those who have their own needs met simply don’t care a whole hell of lot about those who don’t. Perhaps, they blame them for having the problem.
I have been corresponding with a man named Aaron who opposes national health care, and I promised him that I would address the issue here for the simple reason that I feel better about spending inordinate amounts of time writing for my blog than I do writing letters. Aaron’s argument is that private charities should take on the problem. When I pointed out that they’re already unable to do this, his response was that government is to blame, not just for their failure, but for the soaring cost of medical care. He offered two primary reasons for this. First, by pumping taxpayer money into Medicaid and Medicare the government guarantees healthcare providers an income. This stifles competition, and no competition means higher prices. Second, government sets standards for medical facilities, procedures, personnel, and so forth; and the necessity of meeting these standards also runs prices up.
I spent five hours in McKenzie Willamette Medical Center last March for outpatient surgery, and I was comforted to know that my caregivers met government standards. Those five hours cost $18,695, and that didn’t include the surgeon’s bill, the anesthesiologist’s bill, or anything else. When medications, x-rays, blood tests, follow up doctor’s visits, physical therapy appointments, three MRIs ($1,300 each), and so forth, were included, that one outpatient procedure cost more than $40,000, and the bills are still coming in because I’m still needing follow-up care.
Let’s say that Aaron is right, and that if government stopped paying for any medical care for anyone and got out of the business of setting standards for doctors, drugs, procedures, and facilities; health care costs would drop. He didn’t give a percentage, but for sake of argument, let’s imagine that they would drop by two-thirds. Instead of $40,000, my bill would have been $13,333. If I were among the many who work a 40-hour week for the minimum wage of $7.25 an hour, I would have to work almost a year (46 weeks) to pay for that one surgery. Since I’m in worse shape now than I was before the surgery, I would be unable to work at all if I were a manual laborer, and no work would mean no income and no income would mean no insurance.
Under Aaron’s proposal, I would be obliged to appeal to private charity for help. This would mean filling out applications for one or more charities and going through what would surely be an extensive screening process. Would I go to one charity for health care assistance and other charities for food, heating oil, and help with the mortgage? And if approved, would I be approved for whatever was necessary, or would I have to have every procedure, every drug, and every office visit to every specialist approved separately and in advance? Would the charity then comb through every bill and negotiate a lower price with the provider as insurance companies do? Would there be a yearly—or a lifetime—maximum that they would—or could—spend?
Now, let’s multiply my problem by the millions who would need help, and let’s imagine that instead of being sixty and needing shoulder surgery, I’m eighty and suffering from dementia and kidney failure and need round the clock nursing care and weekly dialysis. Talk about health care rationing! Talk about death panels! How else could it play out? Private charities could no more pick up the tab for health care than they could pay for building roads or maintaining the military.
Just think of the millions of people who are chronically ill or aging, thousands of them unable to even seek help on their own behalf, and tell me that a network of charities could work. A fundraiser was recently held at a pizza joint here for a little boy who was severely injured when a drunk driver hit the car he was in, killing everyone but that child. $10,000 was raised. Think of it. $10,000 for a severely injured child who might need a lifetime of care. How many pizza feeds would Aaron propose and for how many children? And what would become of people like the old man with dementia if no one wanted to hold fundraisers for them? Under Aaron’s plan, they would die. Those who were on top in our society would still drive their Lexus’s and live in their 5,000 square foot hillside mini-mansions with the five car garages, while those who were less fortunate would be left to suffer and perish, literally by the roadside. When we Americans talk about how much a person is worth when what we mean is how much money does he have, we’re not speaking metaphorically.
Yet, I do not think believe that my friend Aaron is heartless, or else I would not call him my friend. I actually think he is an idealist who sincerely believes that laissez faire capitalism would lead to a better world for everyone. I also suspect that he is a bit of an ideologue, but maybe I project. I was once a devotee of Ayn Rand because she made it all look so good on paper. In her books, the capitalists were creative and hardworking visionaries of uncompromising virtue; the socialists self-aggrandizing manipulators devoid of integrity; and there was no middle ground. Then I read about the Industrial Revolution, a time that came nearer to her vision of unrestrained capitalism than any other era. And what happened? The very few got very rich upon the backs of the very many. Human beings were treated like machine parts that were so cheap and plentiful that their welfare was not worthy of consideration.
Children were chained to work stations twelve hours a day seven days a week. Their emaciated bodies shivered wretchedly in thin rags in the winter and dropped from heat exhaustion in the summer. They became stooped from overwork; they got rickets from bread and water diets; they lost fingers, hands, and sometimes their lives to noisy and dangerous machinery. They died from breathing noxious chemicals or absorbing them through their skins. Laissez faire capitalism meant no fire codes, so they perished by the hundreds in burning factories. And when workers died because of the negligence of their employers, their families got NOTHING but poorer, sadder, and more desperate. Meanwhile, the children of the rich partied before moving from their city mansions in winter to their country—or European—mansions in summer, all while gaily dressed in the furs of slaughtered animals and the plumages of endangered birds. They might as well have gone all out like those Nazis who made handicrafts from the skins of laborers who died of exposure and exhaustion.
America then was like many of the so-called “Developing Nations” are today, and it would take a stretch of the imagination to imagine anything more cruel. But that’s what unrestrained capitalism looks like; a few ruthless men (mostly men) making more money before lunch than hundreds of their employees will earn in their short miserable lives. Whatever the evils of socialism, in theory at least, it holds human life as more valuable than limitless wealth amassed without regard for how many people are ground to dust in the process. Ayn Rand was wrong. There is a middle ground, and it starts with insuring that people aren’t left to die because they can’t afford to be treated.
