Big Government, Big Business, and the Little Guy

Do you ever get the feeling as you observe the current health care reform debate that no one is really looking out for the “little guy”? The principle of subsidiarity has been tossed out the window. On the one hand, you have Democrats arguing for greater state control of our health care system; on the other, Republicans are arguing for continued control by private industry. One is arguing for big government and the other for big business, but neither is arguing that maybe — just maybe — control of health care should be put back into the hands of everyday people instead of either government or business bureaucrats.

Often, there’s a good litmus test for whether or not an idea is a good idea. If both the left and the right absolutely hate it, then it just might be a good idea because it doesn’t conform well to either of their ideologies. Enter the idea of health care cooperatives. The right dismisses cooperatives as government care under a different guise. The left rejects them because, they say, cooperatives will be fraught with mismanagement and corruption (because of course one finds none of this in government). Yep, anyone who talks about cooperatives have become persona non grata to Beltway ideologues. But what exactly are health care cooperatives?

The basic idea behind a health care cooperative is that citizens rather than bureaucrats come together to essentially create their own health care coverage and then to continue managing it. It is, in reality, the only true public option in that it would be an option organized directly by the public. The so-called “public option” being peddled right now is really the state option, which would leave bureaucrats appointed by the state (read: the president) in control of health care. Although the terminology of “death panels” has been exaggerated for maximum effect, it is quite likely that such a system so distanced from the concerns of the everyday person will lead to dangerous rationing of care. A cooperative would stay grounded in the concerns of the public.

One thing I like to point out to my more liberal friends is that, while they might like the idea of state health care now that their president is in office, they need to think further ahead. Do they expect Democrats to hang onto the White House forever? Obviously, Republicans don’t like the idea of their health care being managed by Barack Obama or, worse yet, his appointees (frankly, neither do I). But when I ask my liberal friends if they want their health care managed by someone like George W. Bush, they shudder (and frankly, so do I). What I’m getting at here is that those on the left and the right should be able to agree that health care is too important to be subjected to the ongoing war of partisan politics. That is exactly what will happen under state health care, and exactly what can be prevented by cooperatives.

Then you have the Republican solution, which is to allow even greater control of our health care system to be given to private industry. While some Republicans might claim that this approach is rooted in subsidiarity, ask yourself: If your health care is being managed by administrators who earn substantially more than you do and who may in fact have better health care coverage, is it really being managed at the lowest level possible? How far is your health care coverage from your everyday concerns? Under a private for-profit system, how much control do you actually exercise over your own health care?

The system that Republicans propose is in fact no better than the system proposed by Democrats. Instead of state bureaucrats, under the Republican plan corporate bureaucrats make decisions about your health care. They do so for the maximization of their profits rather than the maximization of your health. As liberals have argued at length, the private for-profit system has its own version of “death panels.” This privatized rationing includes but certainly isn’t limited to denial of coverage for pre-existing conditions or for so-called “experimental” treatments. When the ultimate goal is profit, there can be no question that health — my health, your health, our families’ health — will suffer. A non-profit health care cooperative is bound to be more compassionate.

This should be an idea that both the left and the right could get behind. For the left, it has the advantage of taking control of the health care system out of the hands of private industry and putting it into the hands of ordinary people. For the right, it has the advantage of preventing a state takeover of health care and enhancing health care choice. There’s something here for everyone, yet both left and right have shouted an emphatic “no” at this option. Why? Because the left can’t get past the enhancement of the state and the right can’t get past the enhancement of the market. Like I said before: Big government and big business, but where’s the “little guy” in all this?

In the end, and this is going to sound cynical, there’s virtually no chance that such a boldly centrist proposal that utterly defies ideological classification will pass muster in the uberideological Beltway. If anything passes, my money is on one of the following:

1) The Baucus Compromise: Includes expansion of Medicare and SCHIP, elimination of pre-existing condition rules, tax credits, and a national health care exchange with a public option. Personally, I’m not seeing the compromise here. The proposed expansion of Medicare and SCHIP is only likely to increase Republican opposition, especially given the former’s impending solvency crisis.

2) The Snowe Compromise: Features a “trigger” proposal that will specify a time period in which the private for-profit system must improve quality and decrease costs or face the automatic creation of a public competitor. There are two problems that I immediately see. The first is that there would be no mechanism that would force the private system to permanently improve quality and lower costs; after the designated time period private health care could, in theory, go back to business as usual. The second is that there is no “trigger” to abolish the public system if it proves to be as bad as private health care or worse.

If I had to bet on which of these two compromises will actually become law, I would go with the Snowe Compromise. It would give the illusion of giving the private for-profit system an opportunity to shape up, without giving private health care the tools it would in theory need to lower costs (like opening an interstate market and legislating tort reform). The Snowe Compromise would also give the Obama administration the illusion of bipartisan compromise that it so badly needs. After all, if the compromise bears the name of a Republican senator then it must be bipartisan, right?

Meanwhile, as we end up with a health care system that will likely increase the power of big government and big business over our health care, you have to wonder if we’ll ever see reform that will increase the power of the “little guy” over his own health care.

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Explore posts in the same categories: Culture of Life, Economy & Solidarity, Government & Subsidiarity

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