Somewhere in the1970’s, the chief operators of the health insurance industry announced that the providing of medical care needed to be run “as a business.” While that ostensibly suggested that it should include principles of efficiency and proper management, in actual fact those in charge really meant that the driving principle of medical care should be, not the quality of care, but that the guiding principle behind the providing of medical care should be profit.
That decision created a paradigm shift in medical care. Insurers made generous use of exclusions such as refusing coverage for pre-existing conditions, and an entire new industry arose, the subrogation industry, to help insurers recover payouts from other insurers. Meanwhile, the providers of medical care adopted the same commitment to profit, and the cost of medical care itself soared. While Obamacare has corrected some of the inequities arising from the primacy of profit in medical care, medical care in the United States remains a disaster, with millions of people still uninsured and the cost of care and insurance seriously hobbling both American industry and the budgets of the average American household.
The core lesson of this horrendous experiment is that there are some aspects of the community that do not fit the paradigm of business. As the chaos of the present political debates is beginning to show, the American people are deeply disturbed by the politicians who have served the god of profit instead of the interests, the needs, of the community they were elected to serve.
Business, of course, has its place, and it remains true that the free market does in fact both encourage creativity and create competitive prices. The problem is that the principles of free market capitalism can be perverted. If, for instance, both supply and demand are controlled by the same people, the results unfairly favor those who hold those strings. This is precisely what happened with treating medical care as a business. The medical industry creates need and then controls the supply and, accordingly, the price of that supply. It is the doctor who tells you that you need an MRI or that you need this or that medication, and it is the medical industry that tells you, utterly without competition in price, what that examination or medication will cost. No one asks how much an MRI or a CT scan will cost. No one asks how much it will cost to be hospitalized or how much a program of antibiotics or statins will cost. So we accept treatment that costs thousands of dollars with absolutely no voice in the level of cost.
What all of this suggests is that communities have to operate on a more complex principle than the single paradigm of business. Where a need is universal, that need should be paid for by the community in whatever way that community decides is fair. We all need roads. We all need schools. We all need health care. We all need police and fire protection. We all need military defense. For these things, the paradigm of business just does not fit. It is, instead, the community that needs to pay for these things in whatever fashion the community thinks is fair. Whether that is income tax or property tax or value tax or use tax, the fact is that universal need is best satisfied by a system of universal payment, with profit not being an element.
When you sift through the smoke, the haze and, far too often, the stench, of the present political debate, this is what is at the heart of the political struggle. Flint, Michigan, happened because the primary consideration was profit rather than the needs of the community. The disastrous treatment of aged and disabled veterans in Michigan happened for the same reason. Our massive infrastructure failure, our massive problem of health care, our massive problems in education, all find their base in the inappropriate application of the paradigm of business to the universal needs of the community.
The point here is that we need to do far more than stop arguing about tans and wet pants in sorting out our political needs. We need to stop hiding from the real problems. We need to address straight up how to best serve the universal needs of the community. Herein lies the real test of the merits of the candidates. Those who refuse to address the real business of the people do not deserve anyone’s vote.