corporate accountability

Medicare at 50: Our Moral Imperative

R. Horton1 Comment

Last year, on the 49th anniversary of Medicare, I wrote a post advocating the expansion of Medicare to ensure that everyone in the United States can have access to basic healthcare. In the past year, I have read and heard many arguments against the expansion of Medicare and, in fact, single-payer systems in general. As I read the arguments, I realize that in a sense “Medicare for All” and “single-payer” have become a shorthand way of saying we need to guarantee “universal access to healthcare,” but I still think Medicare for All is the way to go in the United States.

I happily admit, though, that my commitment is to universal access to healthcare, not Medicare. The first step, in my opinion, is to declare that we will provide access to medicare for allhealthcare to all United States citizens. Take this simple idea, and make it law: We will provide healthcare to every citizen of the United States. Once that law is passed, we can have extended debates about whether Medicare can fulfill the purpose of guaranteeing that all citizens will have access to healthcare (my repetition is intentional).

Here are some of the objections I’ve heard and read to expanding Medicare along with my replies:

I don’t want to pay for healthcare for people who are too lazy to work.

Many people I talk to are extremely optimistic about their ability to pay for their healthcare in the case of extreme illness or injury. The fact that you’ve made it so far only means you’ve been lucky, not self-sufficient. Mary Brown, who sued the government over the Affordable Care Act because she didn’t want to purchase insurance, went bankrupt and was unable to pay her bills. In response to her own bankruptcy, Brown reportedly said, “”I believe that anyone has unforeseen things that happen to them that are beyond their control.”  Yes, and the Affordable Care Act was designed to reduce the impact of unforeseen illness and injury. Unlike Mary Brown, many people who become medically bankrupt had insurance but weren’t able to cover their medical bills, anyway. A study in 2007 found that three-fourths of people who were medially bankrupt had insurance.  A study by NerdWallet Health found in 2013 that “Despite having year-round insurance coverage, 10 million insured Americans ages 19-64 will face bills they are unable to pay.”

For people who do have insurance, most get it through their employers. Too many people seem to forget that when they face unforeseen illness or injury, they will also be unable to work and are likely to lose their employer-provided insurance. If not immediately, it will happen sometime further down the road. Whether the road is long or short, it leads to bankruptcy. While some are rich enough to be impervious to mounting medical debt, most of us are not. A few hundred thousand dollars may sound like a safe cushion against medical disaster, but many life-saving treatments exceed that amount quickly. Selling your house and other assets to pay your medical bills may not be a solution. In fact it probably is not a solution.

The fact is that supporting a national program to guarantee access to healthcare free from the risk of burdensome medical debt is not something you should do only for other people. It is something you should do for yourself. And it is something we should do for our country.

As a nation, we share many burdens: national defense, national safety, public health, personal security. Like infrastructure and security, we are not talking about items we can choose to forgo in leaner times. These are basic human needs. Any society that does not meet the basic needs of its citizens will falter. If we can share the cost of providing a strong military, food inspectors, fire fighters, and police, we can share the cost of providing health services. The financial life you save may be your own.

Most countries don’t have a true single-payer system.

The argument here is that many countries that do guarantee universal access to healthcare do not use a “true” single-payer system. I am willing to concede that even Medicare for All might technically require the use of more than one payer. What is important, really, is that the payers are not invested in fleecing their clients, which often seems to be the case with for-profit insurance companies. In fact, if we had a single for-profit insurance monopoly, we might find our processes somewhat more efficient but not beneficial for consumers, so it matters who the single payer is as well. Just to repeat: we must have a system that guarantees access to healthcare without the risk of bankruptcy.

Medicare is fraught with fraud and abuse.

No one can deny that fraud and abuse exist within the current Medicare system. We need greater transparency, oversight, and regulation of the system and of the providers. Also, Medicare must have the ability to negotiate prices, unlike the disastrous Medicare Part D that currently exists for prescription drugs.

Corporations will game the system.

It is true that for-profit providers, whether they are pharmaceutical companies, for-profit hospitals, biotechnology companies, medical equipment suppliers or food vendors, will strive to earn as much profit as is humanly possible. This is why we need a system that empowers taxpayers to hold bad actors accountable and demand transparency regarding pricing and profit. Corporations will serve the common good only when common people demand that they do. Fatalism is an excuse to avoid the hard work of diligence.

We need price controls.

Again, simply removing all but one payer will not, on its own, lower prices. If Medicare simply sent checks to providers for whatever charges they submitted, the United States would continue to have the costliest healthcare system in the world. Medicare must have the ability to negotiate prices and set limits on unchecked profits.

We must limit unnecessary tests and treatments.

In a pay-for-service system, hospitals, labs, equipment manufacturers, and others make money every time someone is tested or treated for anything at all. More and more studies are finding that many tests lead to unnecessary treatment, waste money, and (even worse) cause more injury and death than they prevent. Unfortunately, limiting the number of tests and treatments available to patients is likely to be perceived as (shriek) rationing.

With our current system, we trust insurance companies to refuse payments for useless or harmful tests and treatments, but we know this does not always happen. When it does, clients fear they are being denied necessary tests and treatments. They fear this largely because it is sometimes true. Whether Medicare is expanded or not, we need better ways to evaluate what tests and treatments are beneficial, and we need better ways of educating patients on what is and is not beneficial.

Movements toward paying providers for results, not services, may reduce unnecessary and harmful services greatly. It may also force patients to become more responsible for their own health.

Finally

The only real imperative here is that we, as a nation, must decide whether we will provide access to healthcare for all our citizens. Once we agree that we will, we can begin to work out the most efficient and cost-effective means for achieving our goals. Almost no one in the United States is immune from the possibility of medical disaster and bankruptcy. This is a matter of caring for our fellow citizens, but it is also a matter of caring for ourselves.

On the 50th anniversary of Medicare, take a stand for healthcare justice.

The High Cost of Occupation: The High Cost of Injustice

R. Horton

According to various reports, the Occupy Wall Street movement has cost cities upward of $10 million. As the protesters are angry at the diversion of public funds away from public services (I know people say no one knows what they want, but they are really quite clear about what they want), it might seem that this wasteful spending is only making things worse. The more cities spend on police, the less they can spend on libraries, public parks, infrastructure, and all the other things that make society work. We might ask whether military ordnance such as Tampa Police Department’s tank (no, armored rescue vehicle) is a good use of money, but policing protests takes a few pennies either way.

Somehow, it seems cities always have enough money to deploy an army to suppress a non-violent protest but not enough money for basic services. The cash tin for security is bottomless. But surely, even those in power would rather not have to spend all this money on security if it can be avoided. No one wants to have to live with barricades everywhere. And no one wants to live with the inconvenience of constant protests.

And that is the point. Protests are intended to create a situation that everyone would rather avoid. As Martin Luther King put it, “Nonviolent direct action seeks to create such a crisis and foster such a tension that a community which has constantly refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored.” This is what this movement, and any other political movement, seeks to accomplish. It is obvious that $10 million is not enough to create a crisis for the current established order.

When the current order is threatened, it will of course blame the dissenters for a new sense of crisis and chaos. This blame is misplaced. It is a breakdown of order that provokes civil disobedience in the first place. Mass movements are made up of people who want a just and civil society. As John Rawls, another great American philosopher, said, “If legitimate civil disobedience seems to threaten civil peace, the responsibility falls not so much on those who protest as upon those whose abuse of authority and power justifies such opposition.”

Which brings us to the final point. The purpose of protests is to make the cost, financial and otherwise, of injustice greater than the price of justice.

Tea Party Fights Corporate Abuse

R. Horton

The East India Company, chartered in 1600, was the first corporation in the modern sense. Members would invest capital, management would conduct the operations, and investors would receive repayment in proportion to their investments. For the first time, investors and mangers were separate persons. At this time, it was unclear who would be responsible for wrongs committed by the corporation.

As this and similar ventures developed, investors were increasingly separated from the actions of the corporations, and limited liability (investors could only lose the amount they invested in the corporation) became the norm by the end of the nineteenth century. This also made corporate immortality possible as corporations could outlive their owners.

The British East India Company (BEIC) rapidly gained economic power and exerted global influence. It formed the largest standing army in the world at the time, gained control of India and the surrounding islands, controlled the opium trade in China, and managed slave trading out of Madagascar. One-third of British parliament members held stock in BEIC, 10 percent of British tax revenues came from tax on BEIC tea, and the King depended on loans from the company. In exchange for these benefits to the British government, BEIC was granted many favors, including monopoly rights.

The company conscripted thousands of British for forced labor in Jamestown, a colony set up in America by BEIC. Eighty percent of these laborers died before completing their seven-year tenure. Because of its rapid expansion and competition from small colonial business, though, BEIC was almost bankrupt. It was able to overcome this setback with more favors from the British government, which expanded its monopoly and led to the 1773 Tea Act, lifting tariffs on tea and enabling BEIC to flood the market with cheap tea and destroy its competition.

This was the catalyst for the Boston Tea Party. During the Boston Tea Party, protestors dumped more than 90,000 pounds of tea into the harbor, which was then closed for more than a year and a half. This led to the battles of Lexington and Concord; as a result, America’s founders vowed to protect the United States from corporate power and corruption.

The Boston Tea Party is an enduring symbol of America’s popular resistance to the collusion of corporations and government against the interests of the people.

Information for this blog came from:

1. Christopher D. Stone, Where the Law Ends: The Social Control of Corporate Behavior (New York: Harper & Row, 1976).

2. Shelley K. White, “Corporations, Public Health, and the Historical Landscape that Defines Our Challenge,” in The Bottom Line or Public Health: Tactics Corporations Use to Influence Health and Health Policy, and What We Can Do to Counter Them, ed. William H. Wiist (New York, NY: Oxford University Press, 2010).

When should corporations be treated as people?

R. Horton

I recently attended a conference on business ethics, and one of the presenters asked what human rights corporations had. When some scoffed at the notions that a corporation could have any human rights at all, the presenter asked whether corporations did not have the right to buy property. Indeed, the earliest laws regarding corporations dealt with just such problems.

Lawyer Christopher Stone described some of the history of corporations in his 1976 book, Where the Law Ends: The Social Control of Corporate Behavior. The earliest corporations arose from the need of some organization, such as the church, to own property. It did not make sense to say that the abbot owned the property, could buy or sell it, and pass it on to his heirs. Rather, the property belonged to the church, and the congregants were responsible for it. When the abbot died, the church would still control the property.

And property was the primary function of the early proto-corporations. As you may know, some people, especially libertarians, assert that all human rights are property rights (see Murray Rothbard). If all human rights are, indeed, reducible to property rights, then the corporations, having the right to hold property, also are entitled to all the rights any human might reasonably demand. This is what free-market thinkers mean when they say corporations are people without the slightest pause.

The earliest commercial corporations were entities such as trade guilds. Although these guilds operated as one organization, when harm was done, individuals, not the guild, were held responsible. If you got bad meat from a butcher, you would blame the butcher, not the butcher’s guild. Stone points out that this system had its own drawbacks. It may be that a guild created a culture or corruption or failed to create a culture of safety. In this case, you may want to hold the corporation responsible rather than seeking out individuals.

You may demand that the corporation lose its charter, which was once the threat the public had against corporations. To withdraw a business charter would be the death penalty for a business. If such things still happened, perhaps we could better handle the equation of corporate rights with human rights, although it still does not sound right. But just imagine how life would be different if corporations could effectively be sentenced to death for wrongdoing. Well, they can, but it will take a great deal of political will to reinstate the death penalty for corporations.

Occupy Wall Street

R. Horton

For more than 30 years, I have mourned my country’s decline. When it comes to generating capital, the United States remains a leader, creating wealth at unprecedented rates. This meteoric rise in wealth, however, is accompanied by equally steep increases in indifference, poverty, and environmental degradation. Anyone who expresses concern or even sadness is mocked and rebuked. In an Orwellian turn, “compassion” is now “hating America.” Concern for declines in education and employment is now “liberal fascism.” As a nation, we have forgotten our humanity.

Like many in this country, I had given over to despair and resignation. Corporations are allowed to fund our elections as well as write and enforce our legislation. How can one resist a power that comprises the global economy and the governments of the developed world? Perhaps, it is still not possible, but the Occupy Wall Street protesters have sent one clear message: “By virtue of being a human being, you deserve a modicum of respect.” This belief, that people do matter, is common to every religion known to me. It is also common to every philosophical approach to ethics and morality that I can name. Even Ayn Rand’s exhortation to “selfishness” recognizes the demand that no one has a right to trample the needs of others. To pursue your own happiness entails concern for promoting good relations with others.

America has become a nation of talking points and PowerPoint lectures. When people ask what the protesters want, specifically, they are really demanding a “study sheet” for a humanistic movement. What do the protesters demand first? That humanity be recognized as something of concern. People must be treated as persons, first and foremost. From this assumption, policy decisions will flow. No simple solution exists, so no one can articulate it. Life is complex. Economies are complex. Legislation is complex.

If we can once again affirm the value of our humanity, however, we will live in a better, if imperfect, world.