A Fairness Doctrine for Healthcare?

I have been following the healthcare reform debate with increasing fear that this opportunity to produce meaningful change in the way healthcare is paid for in this country will be squandered.  Considering that this is the first real chance of making serious change since Harry Truman was President, it would be reasonable to guess that if we pass this one up, it will be decades before we have another such chance.  


To be clear, I favor single payor, but support a strong, public option, an extension of Medicare open to all, and fixing Medicare in the process.  Anything that does less than this - and it looks like we will get considerably less - is a continuation of the status quo, and therefore a failure.


I have been appalled to watch our hopes being shattered as the writing of a reform bill is left to those beholden to the healthcare industry.  The only objections to a strong public plan come from the politicians we have entrusted with this task.  Three quarters of Americans (including half of Republicans) favor such a plan.


But the discussion has been co-opted by the insurance industry, so we hear such absurdities as "a public plan will compete unfairly with private insurance companies."  


Well, as far as I can tell, no one is saying that the present system (and I use that word loosely) is not fair to the insurance companies, so this is not something to be fixed.  The problem is that the system is fair to them at the expense of the rest of us.  


And the insurers are not evil.  They are doing a fine job of meeting their mission, which is to earn profits for their investors.  That is the legal mandate for all profit-making corporations.  We all know that sometimes corporations cut corners to make profits.  When this leads to an inferior product, common wisdom says that people will find a better product, and profits will go down until the company improves the quality of their product.  


With many products, this works.  Those who produce better products do better than those producing poorer products.  The American automobile industry is perhaps an extreme example of this principle.  I once heard it said that in the 1970's, when the oil crisis made it seem inevitable that the auto industry would have to make major changes, the Japanese hired engineers, and the Americans hired lawyers.  


The deregulation that began with Ronald Reagan relieved this for some time, but eventually ran its course, landing our economy in the worst recession since the Great Depression, and our automakers could no longer escape the result of their decisions, leading to bankruptcy for two of the big three.  This shows how the market works.


But can this apply to health insurance?  


There are states with small populations that support only one or two insurance companies.  In fact, many of those members of Congress working against meaningful change come from such states.  But even in larger states, options are often limited by employers who tend to rate cost as the most important factor.  In fact, when John McCain, in answser to an e-mail from me, said he respected my views, but wanted to make sure Americans still could choose the plan that worked best for them, he was saying that they could choose the plan they could afford.  


But insurance corporations are not considering the overall cost of providing healthcare.  They are not in the business of providing healthcare.  They are in the business of shifting as much of the cost to the consumer (a ridiculous word in this instance) and others as possible so they can meet their mandate.  


And so the result is millions of people uninsured or having outlays so high that they cannot use the insurance they have.


Healthcare in this country is rationed in this way.  As for those who have good insurance, they often have more healthcare than they need.  We have a system where some Americans receive more healthcare than they need, and most receive much less.  


The problem of course is that we are not talking about cars or computers or widgets.  We are talking about matters of life and death.


So we are left with another kind of fairness doctrine.  Listen well, lawmakers:  you can be fair to the health insurance companies, or you can be fair to the American people.  You can be fair to the industry or you can be fair to your constituents.  You can be fair to the corporations that financed your campaigns, or you can be fair to the people who will vote either for you or against you in the next election.


And your constituents are watching.

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