We’re All In This Together
Government exists to protect a self-defined group – a tribe – from outside existential threats. Long ago the threat was other tribes. Today it includes fire, crime, disease, drunken drivers, natural disasters and more. But government’s first reason is to protect us from them – to ensure that which our tribe holds dear is successfully defended. Be that property, principles or our basic human right to exist.
Today, roughly 15 percent of U.S. government spending is on military defense, about 5 percent of GDP. (That’s more than the next seven nations combined.) Few quibble that the U.S. needs a robust military defense. We may grumble about it, hate its excesses, or decry its misuse, but in the end every U.S. citizen is well-defended, to everyone’s benefit. About 30 percent of government spending is on major medical programs, about 10 percent of GDP. (Social Security comes in around 24 percent of government spending, or 8 percent of GDP.) Yet even as government spends twice as much on health care as on the military, it can’t fully defend our citizenry from ill health.
Among the industrialized nations, we alone eschew universal health care. As citizens we spend almost three times as much annually per person – around $11,000 – as the average of citizens of the other developed nations. Using national health plans, those nations average $4,000 per person per year. It’s also worth noting that our outcomes are not better and are frequently worse. It’s wasteful, ineffective, and unfair.
Where are the flies in our ointment? Private insurance companies pay large salaries to fleets of executives. They provide returns to investors. They spend huge sums lobbying our elected representatives. They have huge staffs doing all the same paperwork: There are over 900 private health care companies in the U.S. Then there is the fact that every form of medical delivery systems, not just insurers, is highly redundant.
There are 7,200 hospitals in the U.S., out of 16,500 hospitals in the world. Redundancy is huge as hospitals spend heavily on the latest medical equipment to compete with other hospitals. Doctors are expensive to hire and support. Insurance chooses networks based to some degree on the broadest range of services offered, so the medical facilities scramble to offer them. And of course, drug costs are huge (and drug companies are cash cows) mainly because the bargaining power of 900 different insurers is heavily diluted.
Yet it’s claimed that the U.S. can’t afford universal healthcare: It will break our middle class backs. In response, Elizabeth Warren says her universal plan will be funded by higher taxes on the rich and on corporations, and the middle class won’t have to pay more. Some analysts think she is too optimistic.
Bernie Sanders says his plan will indeed cost the middle class more. Some analysts agree.
First, let’s say Warren is too optimistic and that Sanders is right. I say we should all be lining up to pay more. Not just to defend ourselves and our immediate families from ill health and disease, but because it is part of our social pact to help look after our fellow citizens – our tribe, if you will. Employ the government to use its weight and power to reduce drug and other costs.
If health care still costs us more, we can put off buying a new smart phone every two years. We can drive our car for seven years instead of five. We can eat out less. And so on. None of these are onerous choices. If poor people need assistance to pay the increased costs, give them assistance. Bring everyone into the deal and stand together.
We are willing and able to pay to defend ourselves from existential external threats to our nation’s greater well-being. We should be willing to do so with existential internal threats to every citizen’s personal well-being.
Larry Bennett, recently retired
Brewery Ommegang creative director
who is active in local causes, lives in East Merideth.