Priorities: Where to Spend 42¢

The people's hunger is because those above are eating too much in taxes—
This is why they are hungry.
The people's lack of order is because those above manipulate them—
This is why they are not properly ordered.
And the people's scoffing at death is because those above are exacting so much from life—
This is why they scoff at death,

Dao De Jing: A Philosophical Translation
chapter 75.

On September 13, the CBC radio program Ideas published a podcast entitled “Speaking Truth to Power, Part One”, which was a selection of talks by and interviews of people who had attended the counter-summit held in conjunction with the 36th G8 Summit in Ontario, Canada. One of the speakers made the observation that 42¢ of every dollar that the government on Ontario spends is for health care. In contrast, only 0.3¢ of every dollar is spent on environmental issues. The speaker expressed alarm that such a minuscule part of the budget of Ontario is going into research into and finding possible solutions for the strains being placed on the environment by industrialization, expansion of human habitation and climate change—all of which are bringing alarming changes to the water resources and wildlife habitats, not only in the most populated regions of Canada, but also in areas far from where the human population density is the greatest.

As a citizen of both Canada and the United States, I am interested in the budgetary priorities in both countries. In Canada, health care is the responsibility of the provinces, and Ontario has a provincial health insurance system that provides coverage for everyone. The amount that an insured person pays for health care coverage is determined by the individual's annual income. According to the table of rates published by the Ontario health insurance plan, a person making an annual income of less than CAD$20,000 (about US$19,425) pays nothing. A person earning $75,000 pays $750.00 a year ($62.50 per month). Anyone earning $200,600 and over per year pays $900.00 a year for medical insurance ($75.00 per month). Someone earning in Canada the Canadian equivalent of what I earn in the United States would pay CAD$600 (about US$585) a year for health insurance. In contrast, I pay US$3,791.52 per year, and my employer pays another $5,687.52. So the insurance company that covers me receives $9479.04 a year. Whenever I visit my primary care physician, I pay $20 for a co-payment; the balance is covered by my insurance plan. During the thirty-six years I lived in Canada, I never paid anything to a doctor or a hospital, even when I had two complex surgeries. When I first returned to the United States and was asked to pay a co-payment, I had to ask “What's a co-payment?” and the receptionist looked at me as if I had just come from outer space. She explained a co-pay is the patient's share of the cost of a medical procedure. I couldn't believe it. I was paying about ten times for medical insurance what I had paid in Canada, and I still had to pay more at the doctor's office, and at the pharmacy; it was beyond my wildest imagination. Welcome back to America, my home and native land.

A friend of mine has been diagnosed with pancreatic cancer. Cancer is one of the many conditions that causes blood clots, so he must take an anti-coagulant. The anti-coagulant he has been prescribed costs $8,800 per month in the United States, 80% of which is covered by his health insurance plan. Exactly the same treatment costs about US$2000 in Canada, and about €120 (US$160) in the Netherlands. Those differences in price reflect the difference between health care as a profit-making free-market business (the US and to a much lesser extent Canada) and health care as a public service (most of Europe and Japan). It costs a lot of money to become ill in a society that is more committed to keeping wealthy people wealthy than to keeping everyone healthy. Health care in the United States costs a lot more than many people can afford, which may have something to do with the the number of people who die for lack of medical attention or go bankgrupt getting medical attention they cannot afford.

According to an article in the Washington Post, the recent census in the United States shows that one person in seven in the United States lives in poverty. In my state, New Mexico, the figure is closer to one in five. Only Mississipi and Arizona have a larger percentage of their populations living in poverty. The New Mexico state legislature has recently made budget cuts across the board, resulting in a dramatic reduction in the amount of medical coverage available to the those living in poverty.

Part of what makes health care so expensive in the United States is the conviction, shared by many of the very people who are most disadvantaged by the polices they believe in, that freedom is valuable and that people are most free when the wealthy are neither heavily taxed nor restrained in their pursuit of further wealth. And part of what makes so many people poor is the conviction that what keeps people free is a robust military that has bases in more than 130 countries around the world and is almost constantly involved in military campaigns on foreign soil. Both of those convictions are at the very best questionable. At the worst they are tragically false.

As mentioned above, the government of Ontario, spends about 42¢ of every dollar it spends on health care. In the United States, about 20¢ of every dollar spent is on health care. About 42¢ of every dollar the federal government spends is on the military. About 20¢ of every dollar spent every year goes directly to standing military defense expenditures, which does not count special appropriations for the wars in Iraq and Afghanistan; the other 22¢ in that 42¢ figure goes to taking care of veterans of military service, and paying interest on the money borrowed in past years to wage wars—we are still paying for the long, wasteful, unnecessary and illegal war in Vietnam, a war waged before many of the people now living in the United States were born. Details of how the budget is broken down can be seen on a website put up by the Center on Budget and Policy Priorities.)

Increasingly, it is simply false to describe American government as government of the people, by the people, for the people, the kind of government that Abraham Lincoln said “shall not perish from the Earth.” The kind of government that now prevails in the United States is so diametrically opposed to the well-being of those who are governed that it is sure to perish from the earth. It cannot last. We are watching it die at this very moment. All that remains to be seen is how much of the earth the perishing American government will take along with it when it falls.