Wednesday, August 19, 2009

Crimes and Misdemeanors and Other Thoughts

I have been following, off and on, the increasingly raucous debate over whether the government should be involved in health care. Interestingly, I think, the loudest opposition comes from people who have no need of a public option for health care and from those who fear that such an option will kill their goose that laid the golden egg. Perhaps it should.

Frankly, I believe insurance company decisions regarding whether to pay benefits or not are based all too often on the impact to their bottom line or to the value of shareholders' stock instead of the impact on a person's life or even survival. My own feeling is that if insurance companies must exist, they should do so to provide supplemental insurance to cover more voluntary things such as plastic surgery.

Opponents on the Right complain that any government involvement in health care takes us another step down the road to socialism. I'm all for private enterprise - in areas that do not hold the potential of a life or death decision: buying a car, dining out, clothing stores, and the like. However, I also believe there are places where the for-profit economic model has no place, and health care is one of them.

Some have suggested that reform, such as a law to prevent denial of benefits for a preexisting condition is a better approach. At one time, I might have agreed. But no more. I no longer believe a piecemeal approach can work. Nor do I think the health insurance industry will sit still for such changes to their cash cow. If they can kill such a massive reform effort as the one currently underway, individual changes stand no chance of success.

I think it is a travesty, even a crime that the richest nation in the world ranks 33rd in the world in infant mortality rate, according to a 2006 United Nations report. (A 2007 report from the CDC puts that death rate even higher.) By the way, that is five spots worse than lowly and impoverished Cuba. (The U.S. ranks 34th in the rate of child deaths within the first five years of life. Cuba ranks 26th in that regard.) The 2009 estimates from the CIA World Factbook rank the United States even lower at 46th in the world. That bastion of wealth, Slovenia, ranks 19th, with two fewer infant deaths per 1,000 live births than the U.S.

Simply put, capitalism has no place in health care. Maybe, though, this debate can serve as a catalyst to review and rethink capitalism, not with the goal of replacing it but with the goal of restoring some balance. For instance, in 1970, a company CEO made, on average 25 times the salary on one of his workers. In 2009, that figure was by some estimates 700 times the average worker's income. Even as jobs are lost or shipped overseas, CEO salaries continue to rise. Perhaps this is what Reagan meant when he talked about trickle-down economics. The top tier skims off the cream and allows whatever is left to trickle down to the rest of us.

I work for a company that a few years back had a CEO who nearly ran the company into the ground. He managed to unload the company, saddling the new buyers with billions of dollars in debt in the process, then drove off into the sunset with his $150 million golden parachute. In the meantime, several hundred of the rank and file workers he left behind had their jobs eliminated or shipped overseas.

I don't think the original proponents of capitalism ever had this in mind. This is no longer your father's capitalism, where small businesses served as the backbone of the economy. That model has been replaced by an oligarchy in which CEOs hold most of the wealth and the power that comes with it.

Is this really what the Founding Fathers had in mind?

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