Response to AMA on Healthcare Reform: The Problem is NOT the Solution


I am beside myself with confusion on how the American Medical Association thinks promoting "a robust private insurance market" is the solution for "Improving the U.S. health care system" when it is absolutely obvious that the problem is "a robust private insurance market."

Logicians, eat your heart out.  The biggest association of medical professionals is seriously trying to tell us that the problem is the solution?
 
There are two things that should be scrutinized more closely:
 
  1. Private enterprise. How can one claim that for-profits and their genuflectors, men and women in dry-cleaned suits, sitting around corporate conference tables trying to decide what corners to cut or what product to charge more for in order to get those precious numbers on that two-cent piece of paper in better shape for the stockholders is efficient when the very purpose of the enterprise is to sell only what is profitable and to make as high of a profit as possible?  That is, to use bargaining power to charge more for something than it is actually worth is intrinsically inefficient. Even still what something is "worth" is still warped, distorted and twisted beyond recognition because we do not have a humane system in place that considers the true social and environmental costs of production, allocation and consumption. This brings us to…
  2. Markets. How can one claim that the allocation of health care services through a system that only considers the interests of buyers and sellers – and even then is biased towards who can manipulate and exploit bargaining power to their advantage – will be efficient and accessible to all?
In private enterprises and market systems you vote with your dollars and those who have the most dollars have the most votes.  This is precisely why nearly 50 million Americans do not have insurance, and why millions more are underinsured. This is also why over half of those who file bankruptcy do so over medical bills – and over half of those have private insurance. This is why cancer and AIDS patients pay hundreds and sometimes thousands of times the cost of producing those life-saving, pain reducing medications.
 
Health care is a right, not a privilege.  It is not a fucking commodity. How can you be so cruel as to not understand this?
 
Just like education is a right.
 
Or, to have police protection.
 
And a public fire department.
 
A couple of centuries ago the latter, the fire department, was itself a private insurance that one had to buy in order to get its service. Just the thought of the police or education being a private insurance allocated through markets terrifies me more than Orwell’s classic dystopia, 1984. And you’re suggestion is to treat our health like that?
 
Seventy percent of Americans have private insurance, as you noted, and we are being beaten down under the weight of handing over profits to a minority of wealthy folks who decide our own health – that is if we can afford to finance their trip to the Bahamas. This is not just about putting profits over people. This is far more sinister. This is organized crime – extortion. This is holding our health hostage while Aetna says, "Empty your pockets or your sick child gets it!"
 
It is no wonder that The Commonwealth Fund wrote this as their Overview in the study "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care" just over two years ago
 
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries’ health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
 
There is a movement growing for a post-Capitalist society.  Some of us call it a Participatory Society. The working class and the poor are getting fed up with their lives being turned into commodities bought and sold on a cold, stale, heartless market. We are tired of toiling away our lives for the privileges of others and with not much to show for it other than heartache.
 
We are tired of having to sell our labor, to forgo our own desires, or to watch our communities waste away just to live paycheck to paycheck. We want a planetary commonwealth, a grassroots democracy, a fair, just and humane society built and managed from the bottom.  In fact, we don’t want a bottom because that would imply there is a top. What we see is a horizon and a new rising sun.
 
We are not dumb.  We are not stupid.  We know the difference between right and wrong.  We know we don’t want to compete with each other like hungry rats in a barrel full of rotten trash.  We know you smarmy pieces of shit only oppose social insurance because you want to preserve your own racket.
 
And it’s not just about health care.  It’s about the whole kitten caboodle – it’s about inequitable social relations – it’s about The Have’s and The Have-not’s.
 
I will tell you not what we want but what we will have: we will abolish your private enterprise.  We will abolish your markets.  We will abolish your hierarchical divisions of labor and modes of decision making.  We will abolish your tyranny.  We won’t destroy or smash it.  We will watch it crumble, wither and die of disuse and we will take its petrified, fossilized remains and put it in a museum and tell our children, "Can you believe how barbaric they were?"  Your own children will be shocked and awed.
 
And in its place we will have social and economic justice.  
 
Where there is private enterprise we will have social enterprise.  Nothing happens in our economies that doesn’t affect others. Whether you like it or not we are invested and we will have a seat at the table. 
 
Where there are markets we will have democratic and participatory planning. We don’t want some technocratic elite "who can’t tell a pigeon from a poet." (Chomsky) We will plan together, we will build strong social bonds that consider the interests of others, we will produce and consume together without resorting to anti-social fits of fleecing one another.
 
We don’t need your archaic ways and we are offended by your insult that the problem is the solution.

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