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Once the Pandemic Passes

March 23, 2020 (1,240 words)

Early in what proved to be an anti-climactic debate between Joe Biden and Bernie Sanders on Sunday, March 8, Mr. Sanders claimed the COVID-19 outbreak exposes flaws in our healthcare system.

Maybe he was referring to the fact our current system is run like a business, seeking efficiency by controlling costs, in order to be profitable.

You have to admit, maintaining empty hospital space with unused ICU beds is not efficient. Neither is having spare doctors and nurses on staff to treat non-existent patients. The same goes for the PPE equipment those medical professional would need to administer the inventory of test kits that don’t exist. Or the critical mass of mechanical ventilators nobody keeps lying around, waiting for a wave of people who might one day contract a deadly virus.

But Mr. Sanders’ accusation is misleading, too, since this very same charge can be leveled against the state-run healthcare systems already in place throughout the industrialized world.

Even though these publically-administered systems aren’t trying to turn a profit, they struggle with a familiar problem: inadequate funding. No country can afford excess capacity of anything. Authorities everywhere keep staffing to a minimum and rely on just-in-time delivery of necessary medical equipment and supplies.

Meaning it is unrealistic to expect either type of healthcare system, privately-run or publically-administered, to possess the appropriate level of readiness needed to combat a contagion the world has not seen since the Spanish Influenza of 1918.

Still, one could be excused for thinking a publically-administered system might be in a better position to react to such a pandemic, first and foremost by being a single-source disseminator of important information: providing early detection, issuing full or partial quarantine orders, and deploying testing and treatment resources as needed.

(One is led to this conclusion by the simple fact our own highly-touted, best-in-the-world privately-run healthcare system has been completely AWOL in this, the early stages of the COVID-19 crisis.)

So Mr. Sanders would have been better served had he directed voters’ attention to what everyone has been grousing about for weeks: the lack of early detection and unified response on the part of the federal government, including a decided lack of coordination between Washington, D.C. and the states.

Then he should have decisively used this widespread complaint to make the now-obvious point that in times like these, it seems everyone prefers a publically-administered health system, after all.

remembering the first mission of healthcare…

In the coming weeks and months we will be concentrating on beating back this virus. In doing so I hope we don’t exhaust our collective interest in how our everyday system functions. Once things return to normal we should continue the discussion of how best to execute the basic mission of healthcare: providing necessary medical treatment to all who need it, at a cost they can afford to pay.

To his credit, this has always been a big plank in the Bernie Sanders platform. His advocacy can be gruff, and rub some people the wrong way. But all that exasperation has an explanation. This raging argument over healthcare reform is more than a century old. It’s left some proponents a little hoarse.

Our last attempt at major reform was enacted into law exactly ten years ago today, March 23, 2010, when President Obama announced his signature plan had received the required number of votes to pass, with lawmakers splitting on strict party lines.

Who can forget the unfortunate snafus with the government web site experienced by millions of citizens, when they tried to sign up for this new coverage. It crashed ever-so-dramatically on more than one occasion, fueling the contempt of Republicans, and every American with a built-in aversion to government-run anything.

Eventually Obamacare did add some 20 million previously uninsured people to the rolls, which is no small feat. But unfortunately The Affordable Care Act, as it was formally known, failed to do anything to make healthcare more affordable. It did not address the underlying problem of cost.

how to maintain incentive while calibrating profit?…

Our current system produces so much innovation – so many new treatments, procedures, and medications – precisely because we practice free-market capitalism. It provides incentive for entrepreneurs to invest in research and development, with the hope of being rewarded for their investment and hard work.

The same applies to medical professionals who spend years and vast sums of money to be trained in their field. They come into the workforce drowning in debt, and faced with exorbitant premiums for liability insurance. You can’t blame them for wanting to get paid handsomely.

The intractable problem we have been unable to solve, the impossibly tangled Gordian Knot we have been unable to untie, is how to “calibrate” the amount of profit the various players in the system are going for: the innovative entrepreneurs, the pharmaceutical and insurance companies, the corporations that manage our hospitals, and the medical specialists themselves.

Mr. Sanders is known for issuing broad salvos against certain economic actors he describes as profiteers. In response he is accused by conservatives of believing “all profit equates to greed.” But this is an extreme characterization perpetrated by his critics. What Bernie Sanders and Elizabeth Warren object to is the “grab everything you can get” mentality that seems so pervasive in the world of the highly-successful.

The problem is what some have called “casino capitalism”: If you take risks you should be able to claim all the reward when your ship comes in, regardless of how out-sized the prize may be. And no matter how your reward may render destitute the average Jane or Joe.

We haven’t figured out how to reconcile the basic tenets of free-market capitalism with concern for the common good, or the demands of the Christian ethos. All we have to work with is a tired notion of “enlightened self-interest,” which doesn’t begin to address modern economic realities.

the simple facts are beyond dispute…

The facts are just as Sanders and Warren present them. We spend double for healthcare on a per capita basis than does any other industrialized nation, including paying far more for prescription medications. Tens of thousands of our people go bankrupt every year after they are diagnosed with a serious illness, and attempt to fight that illness with treatment.

Opponents of reform are quick to point to the problems other countries are experiencing in executing their version of socialized medicine. But how does that lessen the pervasiveness of the problems we have with our for-profit system?

Aren’t the problems in other countries a matter of inadequate funding? Isn’t that also the reason our own VA Administration doesn’t function more efficiently and effectively than it does?

Doesn’t the problem of inadequate funding fall at the feet of our wealthiest corporations and individuals, who are practiced in the art of tax avoidance?

(The common refrain we hear is that government is out to “soak the rich,” when the opposite is true. The ultra-rich have been siphoning off an inordinate amount of the wealth being created by our productive society. They are sucking society dry.)

A final thought: That thousands of Canadians cross the border each year to pay for treatment out of pocket is frequently cited as proof our system is better than Canada’s.

All it really proves is what we already know and is undisputed: Good healthcare is readily available in this country, as long as you can afford to pay for it on your own.

Robert J. Cavanaugh, Jr.
March 23, 2020

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