National Health

I’m still on the national scene. I’ll have to mix it up with more local color, I know, but for now I’m fixated.

I have been considering the arguments for and against the administration’s – and, somewhat by extension, Congress’s – plans for spending their way out of the recession. A scandal-hobbled and severely weakened Republican party is attempting to rally the conservative faithful to guard against the administration’s incremental “takeover” of the free market, their plan to “socialize” health care, their designs on “dismantling” the Bush tax cuts. I suppose to them, it looks like Armageddon. But to me it just looks sensible. I try very hard not to be partisan on questions of nuts and bolts policy, and maybe that’s impossible, but I just can’t see the problems. Here’s how they look to me, one by one:

Socialism and the end of free markets? Hardly – the economic crisis is certainly more complex than you or I can fully understand, but one thing is pretty clear: if our financial markets collapse, we will have a very much bigger hole to dig ourselves out of than if we can do something to prevent that collapse. And that “something” is a cash infusion to free up capital, loosen credit restrictions, and increase the so-called “velocity of money” to get spending and growth back in the picture. It’s not a long-term solution to our problems (see below), but it’s a way to avoid longer-term problems in the short term, if that makes sense. The short explanation is “Japan” – their “lost decade,” economists agree, was longer than it might have been due to very sluggish action by their federal regulators at the outset of their own economic crisis. Like our domestic free market stalwarts, they were squeamish about intruding on the mysterious mechanisms of the “invisible hand” guiding the financial system. The result was a shut-down of credit availability that slowed their economy to a crawl for many years. The government came in with money and loan guarantees, but late, and the damage took longer to undo. It’s fortunate, in a way, that our crisis occurred on Bush’s watch, and the first massive bailout was planned and conducted under his administration. It quiets the noisemakers a little, as they must acknowledge that this is not a “Democrat” thing. I for one believe Obama when he says he doesn’t “want” to be in the banking business – it’s a necessity for now. As much as we may despise the big financial players for their greed, recklessness and willful ignorance, before we can make any systemic changes we must shore up the system we are currently working under. In fact I agree that we need a second stimulus. The alternative could very likely be chaos.

Nationalized health care – I just can’t see what’s wrong with it. The best way to express this is to look at the preliminary numbers and to note the many examples abroad from which we can learn and plan. I believe it’s safe to say that in the U.S., we waste a lot of money when it comes to health care. How else to explain that among industrialized countries, we are first in spending but only middling in performance (according to many published reports)? That is, we spend – by far – the most per capita on health care, but we receive, in terms of health care access and quality, nowhere near the best product. Why? One obvious reason is middlemen and the exorbitant costs of health care administration, insurance itself, and drugs. It’s no secret health insurance cost is outpacing inflation by a wide margin. Why? Drug costs are also through the roof. Why? Perhaps the why is unimportant. If we can offer a public solution to compete with these monolithic insurance companies and hospital organizations, the very competition we want to protect will be served. Rather than crush competition, a public plan might force a highly consolidated industry to simply take fewer profits and reduce inefficiencies and redundancies. Would it be so bad, for example, if your local hospital didn’t have a two-story atrium, marble floors and an espresso bar? I guess the question comes down to whether health care is a “product” or, at a basic level, a “right.” In a nation as wealthy as this one, it can be both. The cost of the health care plan before Congress is roughly 1.5 trillion dollars over ten years. But if we look at the projections of what we will spend as a nation on health care without the plan – estimated at about 35 trillion over the same period (we spent a verified 2.4 trillion in 2008 and are projected to spend 3.1 trillion in 2012 and 4.4 in 2018) – that “huge” number doesn’t look so big. Furthermore, if such a plan forces private industry to compete, to force efficiencies in the system and to be satisfied with smaller margins, then spending that 1.5 trillion—or even more—may actually end up saving us all money. I for one think it likely. We just have to have the guts to go head to head with the health care giants. As for the giants, I don’t blame them for wanting to protect their golden goose. But I would be very disappointed in our public “leaders” for not going after a few eggs for the rest of us out of fear or, worse, because they are themselves  in the pockets of Big Medicine.

Tax increases!!! – I believe, if memory serves, that the decade or so of massive tax cuts for the wealthiest Americans was offered up by the Bush administration and defended by a sycophantic Federal Reserve as a “solution” to our economic “problems”. Well, here we are. Can we try something else now? The interesting thing is that as the economy has cratered under this philosophy, the very rich are getting – you guessed it – richer. In constant dollars, the gap between rich and poor in this country continues to grow. And the concentration of wealth in the upper echelons continues to concentrate as labor and the middle class absorb more and more of the tax burden. At last report, the richest 1% of Americans controlled 20% of the country’s wealth. We all know this. It’s not necessary to point out that these ultra-rich pay “more taxes” than the local McDonald’s manager (in terms of percentage and dollars). Of course they do, because they can afford it. Paying 46% of a 100 million dollar income still leaves you with 54 million, you know. And I don’t need to be reminded that they “risk” their capital to start businesses, create jobs, etc. Of course they do – because with risk comes reward. And – a very important point – they have the capital to risk in the first place. Do you? You work hard, don’t you? You “invest” as much as you can – in the market, your 401, Beanie Babies, whatever, knowing your investment is at risk. And yet – gosh – you are still taxed. How come? The answer is pretty clear – because you (and I) don’t write the tax laws. It should be crystal clear by now that trickle-down economics is at best a fantasy and at worst a form of theft. Give the super-rich more money, and they put it in the bank. They don’t spend it (because they don’t need it). Or, worse, they lend it back to the government at attractive interest rates to allow the government to pay its debt – debt it has incurred because it does not collect enough taxes. Which creates ever more debt. This really happens. It’s not the rich people’s fault – they’re programmed to make money, they really can’t help it. And within reason that’s a good thing. But the cycle we’re in is not good for the rest of us. So it’s up to government to equalize the tax code already – and by equalize, I mean ask those who reap the greatest rewards from this economy to contribute the greater share toward its maintenance, until we have equilibrium. Heck, some of them (notably Warren Buffet) are themselves asking to be taxed more.

But what it really all comes down to, I and many others have been thinking, is what we value as a people. The familiar refrain during this recession is that the only way out of it is if Americans “start spending again,” as if only the working and middle classes can save us by buying a new TV. I can see how this helps the TV manufacturer and Wal-Mart – but how does it help the rest of us? Americans, it seems, are going exactly the opposite way. They are buying less expensive things, and fewer things, and smaller houses, and “staycations”. They have started thinking about what they buy, rather than buying out of habit or from advertised coercion. They are, in a simple word, simplifying. They may even find they like it. I have found, even though I like the possessions I have, that too many possessions is not a blessing but a burden. They just weigh you down.

So how do we save the economy? Maybe by spending – but not on TVs. Maybe we spend on better health care access for everybody (a net savings due to increased wellness), better roads and bridges (which will need building anyway), more efficient energy systems and factories and appliances and cars and homes (also a net savings and a balm for our abused environment). We should spend on outreach and assistance to Africa and to our so-called “enemies,” spend on alternative energy research to reduce our consuming addiction to their natural resources (which is how they became “enemies” in the first place) and in so doing de-fuse their own leaders’ anti-American rhetoric. In short, instead of buying a TV, let’s buy a sustainable future. We can simplify our material life and invest instead in our national and global health – in every sense of that term. It is a short-term asceticism that may well bring forth a long-term flowering of our nation and culture into what it always had the potential to become: a nation of progressive, fair-minded, egalitarian individuals working both for ourselves and for the common good of our fellow citizens and the world. It’s not impossible if we just decide to do it. The only obstacles I can see are greed, paranoia and cynicism. I don’t know about you, but I’ve had enough of that.

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