Who’s in Control of Health Care?

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The system will not improve unless there is democratic control of health care, which means something akin to Canada’s single-payer system.

The central issue in health care can be summed up in one word: Control. And not just controlling costs, which is how the issue has been cast by the politicians and lobbyists in Washington. Indeed, if controlling cost is the primary goal, HMOs are miserable failures. We need democratic control of health care, control of waste, fraud and excesses — like more million-dollar MRI machines than are necessary — but the bottom line is that good health care for Americans is going to be costly… but worth it.

A key measure of our success as a society is whether our fabulously wealthy nation is going to devise a system of providing good care for all. It’s a worthy expenditure; just ask Canadians and people in the European nations that pay a lot in taxes for their systems but get excellent coverage in return. Their systems enjoy phenomenal approval by the populace.

We pay even more than they do when you add our health-care tax dollars to the billions in annual premiums and out-of-pocket costs we pay — yet we get poor coverage, and the system is about as popular as COVID-19.

The control that I’m talking about is of the system itself. Why the hell would we think that giving control to a handful of for-profit corporations would give us what we want rather than what they want? Their entire incentive is not to deliver the best to the most, but the least they can get away with in order to pocket more profits and jack up their stock prices. This has nothing to do with good or bad intentions by HMO executives, but with a corporate imperative: The CEO’s job is to fatten stockholders’ wallets (and CEOs are themselves stockholders). Period. It’s one thing to let this singular and selfish incentive control widget-making, but the delivery of health care?

“The entire medical enterprise exists for the benefit of patients. This principle, honed over several millennia, is now being undermined by a system where the central aim is to maximize profits,” said Dr. Bernard Lown, winner of the 1985 Nobel peace prize and former chair of the Committee to Defend and Improve Health Care.

The first step is to reject the insidious notion that health care is an industry. It’s not. It’s a basic human need.

The system will not improve unless there is democratic control of this basic need, which means something akin to Canada’s single-payer system, in which patients come first. Neither a corporate nor a government bureaucracy runs the system there; patients go to their own doctors and get the treatment they need. The role of the government is to collect the taxes and pay the bills (making it the “single payer” in the system), which reduces administrative costs.

Paul Ellwood, who coined the term “HMO” and founded the pro-business Jackson Hole Group, startled a Harvard audience by saying that “government intervention” is needed to improve the quality of health care. Motivation to improve the quality of care “is not going to come from within” the system, he said. “Market forces will never work to improve quality, nor will voluntary efforts by doctors and health plans.”

Washington is not going to push meaningful reform, because both parties are mired in the corrupting muck of corporate campaign money. Democratizing health care requires the kind of grassroots rebellion that is already moving in various cities and states where citizens are pushing their own initiatives to put people in charge of the system. The good news is that the people are ready for the rebellion.

Jim Hightower
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