My first semester in college, I talked my way into a political economics class restricted to upperclassman. Never one to shy away from a challenge, I wanted to take the course because I was passionate about understanding the intersection between government and the free market and how it shapes our society. Not surprisingly, it was the best class I’ve taken and its lessons continue to influence my views on the balance between government and the private sector—and lessons that leaders in Washington would be benefit from learning.
While the fiery debate on the Affordable Care Act continues with discussion of malfunctioning websites, cancelled policies and rising premiums our attention is on the symptoms rather than the cause of the problem. In the elegantly simply lessons of that sun soaked classroom we focused on two kinds of economic goods: public and private. Public goods are those things that must be experienced by the whole both in terms of costs and benefits. For example, a small group of people can’t have national defense while excluding others from it—either we have it or we don’t. Same goes for roads, clean water, public safety, etc., these are all goods that contribute to a strong society, and cannot be paid for and used by only a select group of people, those items are private goods. If you want a house and have the resources to secure it, you can own a house and not everyone needs to own a house to have a healthy community. Perhaps oversimplified for the sake of this this article and its simplicity is what enamored me; if a good has a public benefit then it is most economical for it to be provided for by our society without profit. Essentially, if we want everyone to have it then, we share in its cost through taxes and it is distributed to best serve the community.
The truth we seem unwilling to accept in this country is that health care is a public good—to have a healthy vibrant society, we need healthy people and the health of one person does impact all of us directly and indirectly. Just imagine the one sick person on an airplane, bus or crowded elevator—he is having an impact. Or the economic impact of a sick woman on her family, employer, school, etc., also has costs. Even more to the point, is that we have decided as a society that we will treat any person, regardless of their ability to pay—to me the perfect definition of a public good.
Yet, that is not how we view healthcare in the United States, we treat it as a private good—and it isn’t working for anyone. The only beneficiaries of the current system are the behemoth insurance companies that profit mightily from the enormous sums of money being spent on “healthcare” not patient care (or the nurses and doctors who provide the service). We are stuck trying to pay for public goods through private sources and no matter if a website functions or not—it isn’t going to work. The real problem with Obamacare is that it didn’t address the fundamental issue—to effectively deliver health care we need to treat it is a public good and put the investment of our nation’s resources—public and private on keeping people healthy and treating the sick from a place of ease of access and belief that individual contribution provide for the health of all, especially those who fall ill.
Follow the money, is a well-worn refrain and yet no one in Washington seems to be doing it. The dirty little secret is that people employed by large employers have the best coverage at little or no cost—negotiated big business to big business. For those who work for themselves or small companies, an increasingly larger share of individuals do each year, or are non-working adults such as students or caregivers, they are left to fend for themselves in the morass of individual plans. While Obamacare is noble in its desire to pool individuals to be a part of a larger group, the current problems are endemic of a system that doesn’t want economies of scale—it wants profit.
Ultimately the key question is should insurance companies be profiting from a healthy citizenry? Although we already know the answer, insurance companies don’t profit from healthy people, they profit from sick people, so we have a health care system that is the world’s most expensive and one of the least effective in keeping people healthy. If our political leaders want to address this issue they will get beyond rearranging the chairs on the deck of the Titanic and be honest about the need for a single payer system. Of course that would be mean standing up to one of the largest political contributors—health insurance companies.
For the public, it is time to look to electing leaders who can see beyond the next campaign contribution to provide what we all want—quality health care that is assessable to all for the betterment of our society and the health of those with whom we share our communities.