Wednesday, May 21, 2008

Thy saving health among all nations

Harry Emerson Fosdick (1878–1969) wrote “I would rather live in a world where my life is surrounded by mystery than live in a world so small that my mind would comprehend it.” While I am inclined to subscribe to that sentiment, there are mysteries that I would not at all mind having unraveled. One of the mysteries I would love to see solved is why the United States of America has allowed itself to have the most expensive but the least efficient health care system in the industrialized world. A related mystery is why the people of the United States are as a rule so resistant to the models provided by various other countries.

In debates about the state of health care in the United States, I have heard people say firmly that they would not at all like to see the USA have a Canadian-style health care system. It is difficult to know exactly what that means, since Canada does not have a health care system. Each of Canada's provinces has a health care system, and each province has a different model. The only thing they have in common is that a person can receive higher-quality and more-affordable health care in any of them than one can get in the United States. So part of what Americans who reject Canadian models are rejecting, it seems, is quality, efficiency and affordability. Apparently, these Americans prefer overpriced mediocrity.

One of the arguments I have heard some of my fellow Americans use is that the United States simply cannot afford to provide universal coverage. Those who cannot afford health insurance policies must therefore either go into personal debt to get medical care, or they must do without medical care. This raises the question of why so many other countries can provide health insurance to every adult and child without going broke. Why is the United States alone among wealthy nations in being unable to provide reasonably priced health insurance to everyone, and to provide subsidized policies to those who cannot afford them?

Let me suggest a few speculative answers. One reason might be that the United States spends far too much revenue on maintaining a military that it really does not need, including military bases in around twenty nations around the world. According to The Arithmetic of America's military,

Our military deploys well over half a million soldiers, spies, technicians, teachers, dependents, and civilian contractors in other nations. To dominate the oceans and seas of the world, we are creating some thirteen naval task forces built around aircraft carriers….

The expense of maintaining all these unnecessary bases does not include the cost of waging wars that contravene international law and that do far more to endanger the American people than to protect them. It is estimated that the war in Iraq costs around $5000 per second. Supposing a health insurance policy costs $10,000 per year, the money being spent in Iraq could provide one year's worth of health insurance to 43,200 people for what it costs to finance one day of war in Iraq. For the cost of about three months of war, more than 4,000,000 Americans could be provided with health insurance.

Were it not for a bloated military, the United States could easily provide health insurance to all those who cannot afford it. But that still would not address the extraordinarily high costs of medical procedures and pharmaceuticals. The cost of those is held within reasonable bounds in Canada, most European countries and many Asian countries by simply putting a cap on how much profit a health-provider can make. Physicians, hospitals, and pharmaceutical companies are allowed to make reasonable livelihoods in Canada, Europe and Japan, but one will find no billionaires, and perhaps not even many millionaires, among health-care providers.

The United States has for a long time been married to an abusive ideology, an ideology that leaves Americans of all walks of life battered, bruised and impoverished. The principal dogma of that ideology is that unrestricted and unregulated competition keeps prices affordable for all consumers of every kind of product. Therefore, say those who propagate this dogma, the best way to keep costs reasonable is to make sure that providers of goods and services must compete with one another, and the best way to make sure of robust competition is to minimize government regulation and interference.

The argument may sound good, but it is demonstrably flawed. This is the system we have had since at least the time of President Reagan, and it has not worked at all. First of all, companies that are forced to compete in a free market are also forced to advertise in expensive media. Watch television for one evening and count how many advertisements you see for pills, salves, creams, ointments and powders. Who pays for those advertisements? The people who are persuaded that they need the product being sold. Who pays for those advertisements in other countries? No one. Medical providers usually do not advertise in other countries. Products there are plentiful and affordable. And the providers of those products are regulated. Their system works. The system in the United States does not work. It is perhaps time for our policy makers to stop preaching and to begin learning.

What we need to do to fix our broken health care system is no mystery. The only mystery is why we don't do it.

Saturday, May 10, 2008

12,000,000 reasons to change the law

During the past year or so, a figure that has been repeatedly used is 12,000,000. That is supposed to be the number of people who have come to the United States seeking employment without going through the formal process for becoming immigrants or permanent residents as recognized by United States Citizenship and Immigration Services . Those who enter the country without the proper documentation are often referred to as undocumented workers or illegal immigrants. Their presence in the United States causes alarm to some.

If it is true that twelve million people have entered the United States for employment, then we have twelve million good reasons to change US immigration laws. There is clearly a demand for permanent residence in the United States in people now living outside the country. If there were not, these people would not be coming here. There is also obviously a demand within the United States for the labor that these people from outside the country provide. If there were not, these people would not be finding gainful employment. What makes the most sense, then, is to make it possible for workers from outside the United States to come to this country to work, and to bring their families if they so wish. Probably the best way to do this would be to form an American Union, along the lines of the European Union, such that every citizen or legal immigrant to any country in North, Central and South America could take up residence in any other country on these continents. In this age, such documentation as passports and visas make very little sense any more; they are instruments of an earlier world whose political and economic conditions bear little resemblance to the world as it it now.

The argument most commonly used against allowing more free access to residence in the United States is that doing so would amount to a kind of “amnesty”. It would, so the argument goes, send the wrong signal to people; it would send the message that those who break the law are not punished. That claim is plainly silly. The message that amnesties in general send is not that those who break the law can avoid punishment, but that some laws are so foolish that they cannot be enforced and that those who break them really ought not to be punished.

To punish people for seeking a livelihood is clearly unjust. To put obstacles in the way of those prepared to do honest work for honest wages is monstrous. America's immigration laws are unjust—monstrously so. It is time to repeal them and bring into effect policies that reflect a more generous spirit and that manifest the celebrated American admiration of industriousness, resourcefulness and ingenuity, not to mention the kind of courage it takes to move to another country in search of a better life.

What makes no sense at all is to set up the kinds of conditions that almost guarantee a black market. When people cannot work legally, they will work on the black market, and people will hire them, and those who hire black market labor will not infrequently exploit the laborers so employed. Black market labor will almost always be paid substandard wages, receive substandard benefits (or none at all) and be subjected to the cruelties of an essentially criminal economy. As the law stands now, those who cross the borders of the United States without proper documentation are by that action alone classed as criminals. The people who employ them are also criminals. Criminals working for criminals is not a promising formula for honest, integrity and humane treatment. But the criminality in this case is a completely artificial one. It is a criminality created by a law badly in need of reform, not a criminality consisting of dangerous or harmful behavior. It is a criminality that could be removed by reforming laws, making it possible for people to do what they do now, which is to earn money so that they can feed, house and perhaps even educate their families.

One hears opponents to immigration reform talking of the need of securing our borders. One look at a map or a globe shows what a foolish concern this is. The borders between the United States and its two continental neighbors, Canada and Mexico, are mostly the work of a draftsman using a straightedge. Except for the Rio Bravo (known in the US as the Rio Grande), there is not a single natural geographical feature defining the borders between the United States and Canada or Mexico. The border to the north cuts the great prairies in half, runs in the middle of Great Lakes and bisects mountain ranges and their valleys and basins. The border to the south runs in the middle of two great deserts. They make no geographical sense whatsoever. People live in geographical realities, not on maps. When cattle graze in a basin, or when coyotes run along the ridge of a mountain, they have no idea of going from one country to the next. There is no good reason it should be otherwise for human beings. If we had any desire at all to live in a way that made sense, we would abolish all these man-made lines on the earth and allow everyone to live wherever they can make a livelihood. That may not happen within the next couple of years, but at least we Americans, who pride ourselves on pragmatic values and on observing the moral imperative to help provide the conditions of freedom throughout the world, could begin by erasing our foolish and unnecessary borders.

There, another pseudo-problem has been solved with a single stroke of sensibility and clear thinking.