Well, it’s finally happened. Health reform is staring down the barrel of the cost shotgun. It’s inevitable that someone will get “hurt” in the process if Congress finds the courage to pull the trigger. Of course many more will be helped as a result, but that brings us back to the problem of changing the status quo. The folks who stand to gain the most from reform are in no position to support it politically. They are poorer, less educated, and far less organized than they need to be if they hope to have a voice in Washington. On the other hand, those who would be “harmed” by health reform–I’m looking at you, Mr. Hedgefundmanager–are wealthy, educated, and tied-in to politics through the well-established and well-heeled operations of organized interest groups (i.e., lobbyists). The opposition is armed, while the potential beneficiaries stand empty-handed. It’s not a very fair fight. Of course, these are the rules we live by in this country. Money is the successful result of hard work, and it just happens to confer benefits from one generation to the next, leading to the entrenched powers-that-be.
Now, I might be cynical, but I don’t think that we’re going to change that. It’s part of the very fabric of what makes America what it is. We’ve gone through the tech bubble, the housing bubble, the banking bubble–ultimately the deep recession–without learning or changing much at all. In fact, there is a lot of talk that the healthcare bubble is next. But, should we be surprised? After all, we are the nation that produced Gordon Gecko’s mantra “Greed is good” in the hit movie Wall Street. We’re all just chasing the (rather superficial) dream.
One of the best ways to maximize profits is to avoid paying for things, be they costs, responsibilities, or tough decisions. That’s why we have trade deficits, bloated credit card balances, and phrases like “passing the buck.” In healthcare, the result has been a devotion to rationing on the ability to pay, turning a rather blind eye to the tens of millions for whom such a system of rationing results in little to no care at all. Our American culture of self-interest permits that to work well. I don’t see that changing either.
What we need is a system that accepts the uniquely American aspects of our national character. Rather than talking about whether or not to adopt a Canadian, British, or German style health care system, we should be upfront about our strengths and weaknesses as a people. Then a system can be designed that fits with who we are–builds on the strengths and works with the weaknesses.
Taxing the wealthy to pay for the poor isn’t going to fly in this country unless a valid appeal can be made to the wealthy as to why such a move is actually in their best interests. When it come to footing the bill, we love to pass the buck. Yet, there’s no such thing as a free lunch. Someone always has to pay the bill. It’s time that we acknowledge that we’re all involved here. If nothing else, our basic tendency towards greed unites us. The question is: How can Congress re-frame the horribly unpopular idea (at least to the wealthy) of a “success tax” as a lower-cost version of the already existing “hidden tax” the rest of us pay to carry the uninsured along? Because ultimately, a little bit of individual sacrifice has the potential to benefit not just the “poor” but the collective public–including those who make the initial sacrifice. Like they say: “No pain, no gain.”