COLUMN: There never really was a 'health care debate' to begin with
The health care debate was recently reignited by the Supreme Court’s decision regarding the Affordable Care Act. Or so it would seem.
The unfortunate truth is that it did not, in fact, “reignite the health care debate” because there was never really such a thing to begin with. There certainly was an Affordable Care Act debate, but calling it “the health care debate” would be sort of like calling arguments about who was the best character in a Harlequin romance novel a “literary debate.”
It seems the primary question of an actual “health care debate” would be, “What is the current state of health care in the United States, and why?” Yes, there were some impressively vague bare assertions back and forth on the health care debate, but they were wholly devoid of substance, and the “why?” remained entirely unaddressed.
Mainline “conservatives” jolting up to defend the American health care system, without qualification, as “the best in the world” hardly constituted thoughtful analysis. Nor did mainline “liberals” giving it the murky evaluation of “bad” without any further details, and proceeding to take on their usual role as the mirror image of conservative reflexes, immediately and uncritically assuming that the problem was a lack of government involvement.
The real answer to this unheard question doesn’t bode particularly well either for those seeing the Affordable Care Act as the death of a perfectly good health care system nor for those celebrating it as the triumphant inauguration of one. That answer is that the United States' health care system is in shambles, collapsed under the weight of countless government involvements, apparently too uninteresting to discuss.
An exhaustive list of all culprits would take much longer than a simple column, but we might do well to note the following for now: laws that prohibit cross-state insurance purchases, tax incentives that link insurance to employment (particularly egregious given current unemployment woes), licensure and approval processes of all sorts and the effects of patents.
In order to be an insurer, one must meet various government standards. In order to be a doctor, one must have a state-issued medical license, and in order to get that, one must attend a medical school that in turn also must be approved. The several layers of licensure radically limit the amount of competition at each level, raising the total price for the patient.
While a myriad of problems existed in the late 19th and early 20th centuries — and referring to that period of robber baron government patronage as “laissez-faire” would be a joke in poor taste — these particular barriers to entry had not yet been fully erected. Without such constraints, the working class did what human beings have always done best: They self-organized from the ground up.
Fraternal societies, formed for the purpose of mutual aid, pooled their resources in order to make the most of what they had. With doctors begging for patients in a way that we can’t fully comprehend today, this actually ended up being quite a bit.
Many doctors engaged in what was known as “lodge practice,” the process of contracting collectively to all the members of a particular fraternal society for an annual fee. Given their decentralized and personal nature, such organizations were able to very effectively police their own against abusing the system. Not only that, they were able to do so without the dehumanizing paternalism and lifestyle regulations that accompany modern government programs with the ostensible aim of helping the poor.
From a contemporary view, the success was staggering. On average, a single day’s wage paid for an entire year of coverage.
The obvious reply, though, is that modern medicine is a different game entirely with all kinds of equipment and drugs that would make things hard for someone trying to work as a lodge doctor in 2012, even without the licensure factors that killed the historical version of the practice. This criticism is fair as far as it goes. But it doesn’t go too far.
Like health care costs in general, it’s worthwhile to ask why these specific costs are so prohibitive. The U.S. Food and Drug Administration and patents both work hard, hand-in-hand, to keep prices far beyond the reach of reasonability.
There are two ways of handling the danger of potentially harmful food and drugs. One is to hold peddlers of dangerous food and drugs responsible by heavy torts when the product damages unknowing consumers. This would not only provide real restitution for victims, but it also would force companies to thoroughly test their products themselves before releasing them into the world and risking the costs of heavy lawsuits.
The other way is to set up a regulatory agency, inevitably held by industry leaders, which makes the costs of doing business for would-be competitors high but low enough for large pharmaceutical companies to go on just fine. This second route is the one we’ve found ourselves taking.
The price of drugs is not only artificially high due to the FDA but also because of government-enforced monopolies over each drug in the form of patents. The moral issues surrounding how odd the idea of holding property in something as inherently non-scarce and intangible as an idea are certainly worth discussing. But for our present purposes, it’s just the economic effect on the health care industry I want to focus on.
Drug patents are particularly insidious, able — through eliminating competition — to increase the costs of medicine by up to 2,000 percent per pill. However, the attack on patients by patents doesn’t end with government-issued rights of monopoly on life-saving medication. Medical equipment itself, too, becomes more expensive due to patents, which means the costs of doing business for doctors must raise to pay for the artificially costly equipment, in turn leaving you scraping to pay for artificially costly visits to those doctors.
The idea of any of these factors being discussed on the major programs of either Fox News or MSNBC is unfortunately laughable. Those loudest voices on the Right, insisting they believe in free markets, have done nothing to expose the ways existing market distortions have shaped a predictably catastrophic healthcare system. Those loudest voices on the Left, insisting they care for the poor, have done nothing to expose how the poor are being robbed of affordable coverage by laws that work to create and maintain an impenetrable system of privilege for powerful drug companies.
Not only have they failed to fully address the implications of their stated values, they have gone against them. Republicans have insisted a health care system that exists as one of the decidedly least free market sectors of the economy is essentially perfect. Democrats have triumphed a bill, forcing people to give money to big drug companies. None of this is discussed, and no real “health care debate” ever actually occurs.
Furthermore, the general form of the fictitious “health care debate” is replicated in the “poverty debate,” the “education debate,” the “unemployment debate” and virtually every other imagined public controversy. Much time is spent going back and forth over whether there’s a problem, no matter how obvious that problem is. Then, varyingly arbitrary, but all very visible, government solutions are raised.
Meanwhile, the much less-visible previous government actions that created the malevolent soil in which the problem grew are met with total silence. All the while, each program — in its own way — contributes to an interlocking system of dominance for the already wealthy, who might fall from their perilously high social position at any moment if not for the steady hand of government.
Yes, “Obamacare” was debated. But the fundamentally cancerous relationship of the system President Barack Obama is a part of — government to the U.S. health care system — has not had been met with the sort of debate that we’d like to imagine.
Jason Byas is a philosophy junior.