Update

Started a new job last week. Haven't really started doing what I was hired to do (mostly been reading/watching/studying some of what I'll be using) but, hey, at least I'm employed now! And I should be doing some interesting stuff.

That means I have a lot less free time now, but that's okay. In celebration (and for my birthday) I bought a couple of books, and my brother gave me one as a birthday gift - The Enlightened Capitalists, which covers a topic I was very interested in. It discusses why and how some attempts to combine making money with doing good failed. It's something I'd like to believe is possible, but it's always worth finding out why/how previous attempts didn't work out.

Also picked up a book called The Regency Years, which is interesting. Has more parallels to today then I really expected, tbh. I picked it up for a couple of reasons... first, because we generally look at history in isolation (i.e. the Constitution, the Civil War, etc) and don't get a sense for all the massive number of events going on concurrently. Like the old canard about how samurai and cowboys existed around the same time. The second reason? Well... regency romance is a genre, probably because Jane Austen and Georgette Heyer wrote for that time period, and I wanted to know more about it.

Not sure how much reading I'll be doing right now, but I've enjoyed what I've gotten through so far.

The Enlightened Capitalists has been thought provoking, especially as it touches on the desire for control. It talked about how Carnegie originally was an Enlightened Capitalist, before reading something-or-other that made him think his ability to manage resources showed he shouldn't be (i.e. better to have the profits in his hands than to pay his people more, and then he got involved with union busting and using the Pinkerton agency and whatnot, only to later turn around and get into philanthropy.)

It's like... I'm *mostly* a capitalist. I don't believe in central planning, at least. Nobody can predict what goods and services will be needed ahead of time, and the market does a better job of it. (I also can see the point in rewarding people for highly desired and rare skills, like managing large organizations. It's just that I think there are limits, and when we're talking about record profits and falling wages, the specific situation requires something different. Or, well... I'd really rather people were wise enough to choose to do something different, but if they're all going to be stupid enough to ignore that then they'll get the unrest that anyone could predict, and on their own heads be it.)

I talked before about how people don't just roll over and die for lack of access to needed resources, but there are tons of stories already about people who need insulin - or other medical care - already doing that. Dying, that is. Like the rather depressing Twitter conversation where someone asked what event radicalized you against the US healthcare system.

I can see the need to invest money in research and development, to get new and better treatment. Sure. But if that's what's going on then I really don't expect to hear reports about massive profits. (Though, to be fair, since I always try to look for arguments disproving my biases, the profits may not be as massive as we think. Still, people are dying because their health care - if they have it - doesn't cover enough of the costs.)

I wonder sometimes, well. Retirement plans that give workers stock in the company they work for ought to give workers some sense of ownership/profit for making their company a success. Assuming they get that option in the first place. But when you reap the results decades down the road, and the stock price is affected by all sorts of other parts of the business, and maybe some idiot CEO comes along and destroys the value of the stock you own, the end result is that most workers don't really feel like they benefit from any such profit their company makes.

I dunno. It seems to me that there's more than one way to organize a system. Like, why make ourselves think inside the existing box? It's not just capitalism or socialism. Heck, much of Europe used to be feudal, and people back then would have a hard time imagining the world we live in today.

But before going further into that I probably ought to discuss something else... and that probably ought to be a separate post.

Healthcare

Nice to see an article exploring what happens when the uninsured can't afford needed treatment.

Not quite what I predicted, as it doesn't show in higher premiums so much as in tax deductions.  Still, we are all footing the bill.

Healthcare

A quick search on Google revealed common reasons for high healthcare costs.  What's funny is that none of these mention the costs of providing care for the uninsured.  I don't know if it's rolled up into administrative costs or what.  I decided to try to do a little comparison, but I know that (to a certain extent) I'm comparing apples to oranges.  For example, this article, written in 2010, says that medical malpractice lawsuits cost about $55.6 billion a year, or 2.4% of the nation's total healthcare expenditure.

Interestingly enough, this article says that in 2013 unpaid healthcare costs for the uninsured totaled $84.9 billion.  This one, on the other hand, has no obvious date for the article (the article beneath it says Jun 2017, but given that this one says 'President Obama' I think it's obviously older) and says that unpaid uninsured costs totaled $42.7 billion.

Regardless of the exact number, I think it's safe to say unpaid costs of the uninsured is comparable to the effect of malpractice lawsuits in driving up the costs of health care.

Now, since 1986 we have laws saying that public and private hospitals alike are prohibited by law from denying a patient care in an emergency.  For good reason, I think.  I know I don't like the idea of living in a world where people die because a hospital refused to treat them.

But that means that hospitals must treat the uninsured, and they aren't getting compensated for it.  Which means they wind up transferring the costs to those who can pay (since hospitals have to pay their staff, and buy medical supplies, etc.)

All of which is a roundabout way of saying that we already pay for the uninsured.  It's just obscured by our complicated system.  Nobody says "this portion of your copay is for the uninsured."  And, heck, with insurance most of those costs get paid by the insurance company anyway.  We see it in higher premiums (since insurance companies stay solvent by making sure that more people pay for insurance than they pay out in claims.  Higher costs means they need higher premiums to compensate for the more expensive payouts)...but most of that gets taken out of your paycheck directly.  If you're so lucky to have an employer that provides healthcare, that is.  Good luck for the self-employed (and with the gig economy, there's more of them out there) and for people in minimum wage jobs where they cut your hours rather than pay healthcare.

And as for death panels - we may not have people meeting to decide who lives and who dies, but the same effect happens anyway.  It's just obscured by the lack of deliberation.  Who has insurance, and who can afford treatment...those things dictate who lives and who dies just as much as any death panel.  It's just, again, our system obfuscates the decision so that nobody can really blame anybody.  Oh, you didn't have insurance for a kidney transplant, and your GoFundMe didn't raise enough money?  Oh well, it sucks, but that's just the way it is.  (Yes, that's sarcasm).  It's not a death panel, nobody's deciding you don't deserve to live.  Except, in a way, they are.

So everyone agrees that our current system sucks.  And, as repeated deliberations in Congress show, nobody quite has an idea on how to do things better.

Or rather, there are ideas...and they are shot down immediately because of our current political climate.

Of course, one solution is to take advantage of our republican system (i.e. push options down to lower levels.  Empower the states, or cities, or county governments to come up with their own health insurance plans.  It lacks consistency, it means there'll be gaps between the states or cities or counties that create great plans and the ones that say 'tough luck'...or the ones who just can't afford better.  But it does take the decision away from the federal level and pushes it down to a level more closely tied to a community, so people can feel it's their decision.)

I do want to talk about single-payer healthcare for a bit, but I wanted to address the political climate first.  Or perhaps both at the same time.

When I was in the Army, we had Tricare.  And yes, there were issues with it.  When I was taking the Captain's Career Course, our instructor had had a personal tragedy a year or two prior.  He'd been deployed to another country, and while he was away his daughter died.  I think it was something that looked like the flu initially, but wasn't.  Horrible tragedy.  Anyways, one day one of the students had an issue with the healthcare system and our battalion commander took steps to address it.  Our instructor, obviously thinking about his daughter, stopped class for a bit to discuss the system.  He said that the pressure might make things better for a bit, but that our hospital just didn't have enough people...the staffing wasn't there...and any improvement could only be temporary.  He then dismissed us for lunch early and said to go spend it with our loved ones.

I wanted to point out his comment - the hospital just didn't have the staffing and resources to take care of everyone properly.  See, in our current political climate there's a strong tendency to, as Grover Norquist says, "cut government in half..., to get it down to the size where we can drown it in the bathtub."  And some of the complaints about incompetent government are actually blaming the government for programs that just don't have the resources to do what they're supposed to do.  You starve them of funds, make it impossible to do what they're supposed to, then blame them when they predictably fail to do so.

Which is not to say "government good: spend, spend, spend!"  I'm not advocating that.  I'm just pointing out that defunding the government and then complaining it's incompetent and using that to defund it even more is kind of stupid.  (Or brilliant, if you're trying to drown the government in a bathtub.  Stupid of people not to see through it, though.)

As for government incompetence - I grew up believing that privatization was better.  That competition in  business would force efficiency, and that government programs were inherently less efficient.

I've kind of grown a more nuanced view since, for a variety of reasons.  First, I want to point out that the military (which so many conservatives praise) is, yes, a government organization.  It's got it's issues, it's definitely not the most efficient.  Good luck trying to understand the military budget.  Yet there's very real dangers to privatizing it...and most people don't find the military incompetent at it's basic purpose.  Or rather, the soldiers are trained, fight, and resourced well enough (once they got past Rumsfeld's 'go to war with the army you have' crap) and incompetence at fighting wars has more to do with poor strategies and higher level decisions than any real question about the tactics, techniques and procedures of the troops themselves.

My first real challenge to my views on privatization came from studying for my Master's in Public Affairs.  (Yes, higher education, which study after study shows is tied to more liberal views.)  Basically I learned that in certain situations privatization didn't actually improve the product.  If the only market for a service is the government, there's not really any business competition...so all the inefficiency and waste just gets passed on to those privatized companies.  Except now the government also has to deal with contract management.  You don't just hire a private business to perform a service and forget about it!  You have to monitor that contract, make sure things are being done to standard.  Now, instead of an inefficient public agency you have a public agency trying to manage the contracts of inefficient private businesses.

The second challenge came from working in the private sector.  From what I've seen, businesses are not necessarily any more efficient than the public sector.  Particularly a large corporation...it has some of the same challenges as a large public organization.  As for competition...businesses can get by for a while without improving their efficiency, and public organizations can improve their efficiency tremendously when they're trying to do as much as they can with a limited budget.

At the end of the day, I came to the conclusion that it didn't matter to any great degree whether you're talking about public or private organizations...what mattered was having good management.  Good management, in either sector, will result in better and more efficient service.  (The public sector does struggle to compete for good management, of course, though what it can't pay in wages can be made up for in a feeling of service...so I'm not going to say that the private sector always gets the best managers.)  Regardless of public or private sector, you have to provide the resources to get the results you want.

Now, there's some good reasons to question whether it's the government's place to provide certain goods and services.  Yet once we, as a group, have decided to have those services we need to provide the resources to do it right.

Anyways.  To bring this back to single-payer healthcare, the criticisms I've heard of it come from a couple of reasons:

1. An unwillingness to fund it (i.e. don't raise my taxes to pay for your healthcare!!!)  Since we're essentially paying for that healthcare anyway, I think it's short-sighted to say the least.  Especially since our confusing system has a lot of waste in it, in terms of hospitals hiring people to work with multiple different insurance companies to process claims as well as uninsured people postponing care until an emergency forces them to it...resulting in much more expensive treatment passed on ultimately in our healthcare premiums.  Whether it's higher taxes or higher premiums, you're paying for the uninsured as is.

2. A disbelief that the government can do anything competently (i.e. "government isn't the solution, government is the problem!)  I somewhat addressed that above.

and

3. A sense that single payer healthcare smacks of socialism.  What a blast from the Cold War past!  As the article I linked to shows, or another one here, a single payer plan is not socialist.

And yet, round and round, our conservative Congress is determined to rollback the ACA and will probably never seriously discuss single payer healthcare...which means whatever they come up with will probably suck for many Americans.