| Number 113 | April 6, 2001 |
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This Week:
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Greetings, I believe that access to health care is a right, not a privilege. That's why it shouldn't be left to the market to manage. The private market – and capitalism itself – is organized around the principles of competition and individual gain. This is impossible to reconcile with a society's need for a healthy population. This week's issue gives some specific information to illustrate this point, and a little theory to go along with it. The little bit of theory ("Left, Right, Center, or...?") has to do with naming things. I'm not interested in identifying the "good guys" and the "bad guys." I don't think that way. What I am interested in is developing language that helps to identify the obstacles and opportunities in the struggle for social justice. All I know so far is that "left, right, and center" don't do the job. Next week's conclusion to this piece is not entirely written yet, so I would appreciate feedback from readers, telling me what you think so far. Again, welcome to the new readers this week. I look forward to your comments! Nygaard |
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Tom Faschingbauer resigned last week. Tom was the director of human services in Ramsey County, Minnesota's second-largest county, which includes the city of St. Paul. The county human services department overseas the numerous programs that are run by the county which have to do with human welfare, such as child protection, mental health programs, and the program actually known as "welfare." Despite the ongoing debate about exactly how big a tax cut and/or tax rebate Minnesotans should get this year, Tom Faschingbauer sees things from a different perspective. He is going to work in the private world of non-profits where he "can be creative about giving money away." (We'll see how "creative" he can be as the economy tightens and private non-profits have less money to give away.) In the public sector that Tom is leaving, meanwhile, "the county budget is stretched thin because of a near-stagnant tax base in Ramsey County and a political push to keep tax increases low," according to the story in the Star Tribune (Newspaper of the Twin Cities!) of March 31st. Faschingbauer said as he announced his retirement from serving the public after 35 years, "I can't remember a time when we had money to plan for new programs." When asked about being forced to confront tough choices between growing needs and limited resources, Tom said, "It's very, very hard because you know you have to cut good programs. But the reality is the money isn't there. You know you will be cutting programs that can help people, including children who might not have a home for a night or families who need day care so they can work." |
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There's a scandal afoot in Minnesota. The attorney general in our state, Mike Hatch, has accused mega-health care company Allina Health Systems of gross inefficiency bordering on the criminal. Hatch charged last month that Allina has been spending an outrageous percentage of their revenues on administrative costs instead of on the actual provision of health care. It's a fascinating story, and well worth paying attention to, for several reasons. The story broke on the front page of the Star Tribune (Newspaper of the Twin Cities!) on March 22nd, in a story entitled "Hatch Attacks Allina's Perks." It seems that the Attorney General has conducted an extensive investigation which found that Allina's HMO, called Medica, spends 47 percent of its premium revenues on "administrative costs," including such things as image consultants, golfing trips, gift certificates, liquor, and spas.In Allina's defense "industry leaders say spending 10 to 12 percent of revenues on administrative costs is ideal." And, as you might imagine, that's exactly what Allina claims they have been spending. In the March 22nd Star Trib, Allina claims that it only spends 10 percent on overhead. That figure had morphed by the next day's follow-up story into 12 percent. Then again, in the March 31st Star Trib that same figure was reported as both 10 percent and 12 percent, in two separate articles by two separate reporters. By April 4th Allina had seemed to settle on 12 percent. Whatever they said, the local daily seemed willing to report. Note that, whichever figure you choose to believe (if either), they both fall within the "ideal" range. Lest readers think I am nit-picking here, let me point out that Medica's premium revenues come to about $1.2 billion, meaning that the difference between the reported claims is around $20 million per year. Context? $20 million per year would pay for all the medical care for more than 4,000 of the low-income Minnesotans who are currently without insurance. The March 22nd story dutifully mentions other "critics" of Minnesota's HMO industry, including a group called the Minnesota Physician-Patient Alliance, who "challenge" the ideal number of 10 percent. These critics insist that, rather than 10 percent, in the HMO industry as a whole "40 cents of every health care dollar pays for the cost of managing health care." Keep this 10 percent figure in mind. Remember, this is the number held up as "ideal" and – true or not – is the number given in defense of the private HMO system in the United States. 47 Percent, 10 Percent, 1 Percent When contrasted with the Attorney General's charge of 47 percent, a figure of 10 or 12 percent certainly looks pretty good, which no doubt explains why Allina and the rest of the industry keep repeating it in their defense. However, there are some other numbers that should be included for the purpose of judging the appropriateness of Allina's system. Such as the overhead costs of almost any publicly-administered program you can find, anywhere. Unfortunately, the article never mentions any public systems, not even the most obvious and easy-to-research ones such as the Canadian single-payer system, or the U.S. Medicare and Medicaid systems. So, just for the record: United States Medicaid is the most complicated of the three programs. For one thing, it is administered by 50 different states rather than the federal government. Also, it has the strictest eligibility requirements, meaning that applicants have to be tested and policed to keep out the ineligibles. Finally, it serves a population (poor people) that tends to be sicker than the average for a variety of reasons, including their lack of access to preventive health care. Despite the complexity of Medicaid, states administer the program for about 4 percent of total costs, or roughly one-third as much as the "ideal" level in the private sector. The next simplest publicly-administered program is the United States Medicare program, which covers a much larger population. Most Americans over age 65 and many younger Americans with disabilities are in the U.S. Medicare program. U.S. Medicare spends between 2 and 3 percent of its revenues on administrative expenses, or about 70-80 percent less than the best the private system can do. The simplest program among these three is the Canadian single-payer plan. It's also called Medicare, but it's quite a bit different from U.S. program with that name. There is one main reason why a single-payer system is so different: it is universal. This eliminates the need for all eligibility tests, most fraud protection (you can't sneak into something that is universal), and most billing costs. And, of course, the huge costs of advertising and sales that are necessary in a competitive private system are irrelevant in a universal public system. The Canadian system spends about 1 percent of program revenues on overhead, about 10 times better than the private-market "ideal." The reporting on the Allina scandal has been voluminous. I spent some time reading over a dozen major articles on the subject over the past two weeks, and not once did I see any reference to Canadian health care, to U.S. Medicare, or to U.S. Medicaid. I even looked for any reference to any publicly-administered health program anywhere in the world, and found not a single one. To summarize: It takes one penny out of every dollar to run the universal public health care system in Canada. The private U.S. system considers a cost 10 to 12 times that high to be "ideal." How can you judge the merits of the health care industry's defense if you don't know this fact? One of the things Allina says in its defense is that "Many examples of lavish expenses cited by [Attorney General Mike] Hatch either contain errors or were taken out of context." To report on the enormous disparity between the cost of administering a private health care system and a public one would put the whole Allina story in a different context. That context might lead people to question the very idea of trusting private corporations to guard the public health. And that is something which the private corporations that are our mass media will always be reluctant to discuss. |
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I have spent the past two weeks arguing that we should forget about using the tired old political labels "left," "right," and "center." Likewise with "liberal" and "conservative. But, if we throw those out, what are we left with? In order to begin to answer that, I have to talk about two competing philosophies. When I say "philosophies," I mean overall sets of beliefs about "how the world is." Although I don't have a name for the dominant philosophy in the United States right now, it is fundamentally individualistic and competitive. This philosophy says that humans are self-centered and will always act to maximize their own interests, narrowly defined. The philosophy of people like me, on the other hand, is fundamentally social, or collective, and cooperative. (Not exactly the dominant philosophy in the air these days.)This philosophy says that humans are interested in the welfare of all of the various groups and natural systems of which we are a part, and will always act to maximize the interests of those groups and systems (i.e., the planet). We do this not because we are better people than "they" are, but because our philosophy brings us to understand that our individual welfare is inextricable from the welfare of the context in which we exist. The thing about a philosophy is that it cannot be "proven" in any literal sense. It is a set of beliefs. Whether a philosophy is a "good" or a "bad" one is an interesting question, but I'll leave that alone for now. For now I want to talk about how to label these philosophies. I don't have the labels yet, but I think it is important to at least attempt to find some language for these things. And I always look for language that will hopefully resonate not only with those who are already engaged in the struggle for social justice, but also with those who are not yet engaged, and those who have hardly brought these things to consciousness. Not Exactly "Conservative..." What to call the "other side?" If you think about it, the perfect manifestation of the individualistic and competitive philosophy is capitalism. This makes it tempting to refer to its adherents as "capitalists." And sometimes, with my closest anti-capitalist friends, I do. The unfortunate thing, in the current propaganda environment, is that as soon as you use the word "capitalist," most people think you are some kind of Marxist or sectarian politico or otherwise try to put you into a small box. Then they think they already know what you are going to say, and they've already put all sorts of words in your mouth that you now have to prove you were not going to say. Besides, there is already a dictionary definition of the word, and it doesn't fit what I'm talking about. Other than "capitalist," I don't yet have a good word in mind for "them." Maybe there isn't one... Not Exactly "Liberal..." There's a similar problem with trying to label people like myself. "Liberal" certainly won't do. Collectivist? That won't work, sounds too Bolshevik. Co-operators? Makes you think of granola and tofu, doesn't it? There's always the option of defining ourselves as the negation of our opponents – i.e., anti-capitalists – but you don't build a movement around what you DON'T want to be. Again, I don't have a good word in mind here. I've been talking about philosophy or, as Spanish speakers say, cosmovisión. Next week I will continue to develop this line of thought by exploring how these contrasting philosophies translate into ideology, or sets of principles and doctrines, and finally into policy, or practical action. Along the way I hope to come up with some useful language to help us more clearly understand our enemies and, perhaps more importantly, our true allies. |