(en)Corporate Control Versus Democracy

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Date: Thu, 26 Dec 96 17:45:27 CST From: Harel Barzilai <harelb@polygon.math.cornell.edu> To: papadop@PEAK.ORG Subject: Corporate Control Versus Democracy: Part I: Health Care

*************************************************** Corporate Control Versus Democracy *************************************************** By Harel Barzilai

Part I: Health Care

*** ** *** "That's what we're up against. Nothing short of a fundamental challenge to [corporate rule] and a ..reorganization of this society will do. What we need is economic democracy. What we need is a situation where we have worker-community ownership. Community-owned enterprises. We need a situation where we have cooperatives, community development corporations, a new paradigm of economic democracy where the people seize back control of the most vital thing in their lives: the ability to work and own a living. That's what needs to be in the hands of the people. And unless we have that we will not have a reinvigorated democracy, we'll have the same old ?? same old...

[Presidential Candidate Ron Daniels, Peace and Freedom Party, formerly Jesse Jackson's campaign manager, who ran under Peace and Freedom when Jackson stayed in bed with the Democratic Party even as it continued to show its contempt for minorities, working people, women, non-heterosexuals and others. Candidates Forum, 21 May 1992, Oakes College, UC Santa Cruz.]

*** ** ***

Do we allow Wal-Mart to expand into Ithaca [N.Y.]? What for National Health Care? And what about the international version of NAFTA, the GATT [The General Agreement on Tariffs and Trade, essentially an international NAFTA]?

What do the debates over these issues have in common? The debates are not merely over whether a given Bill or Agreement is implemented, and the issues run deeper than what system we should choose today. At stake is the fundamental question of how major decisions, which will have far-reaching effects on all our lives, will be made not only today, but tomorrow.

By whom will the fundamental decisions be made? By an elite group, or by the general population? How will the decisions be made? Democratically: one person, one vote; or undemocratically, such as: one dollar, one vote? Will the allocation of resources be decided by all the people, with the mechanisms driving policy based on the democratic exercise of engagement towards meeting human needs? Or will allocation of resources be decided by the few, and will the mechanisms which guide decisions be fueled by a drive towards increasing profit margins?

In this first article, I examine how the above general themes fit into the debates over address the issues of Health Care. Part (II) will examine media double-speak about "Big Government" and "Special Interests".

Part (III), which will appear in the next issue of the Perspective, will address "Free Trade" and we return to the Wal-Mart debate in Part (IV)and how these issues apply to that debate.

The Health Care Debate

Take Health Care. There are several obvious reasons to support a "single-payer", or what is often called "Canadian-style" system -- so called because Americans are not allowed much information about the national health plans that every other industrialized country in the world has, save for South Africa.

Under this system, instead of paying insurance premiums -- plus co-payments, deductibles, other "out of pocket expenses" etc -- as we do today, we pay instead -- and end up paying far less -- through the tax system; a single, publically controlled administration pays all the bills to providers, hence "single payer." No forms to fill out. No worries about whether an insurance corporation bureaucrat, intruding into your relationship with your doctor, will approve or deny a procedure your physician prescribed.

The standard procedure in attacking institutions which are democratically (publically) controlled, rather than in the control of private hands for private profit at public expense, is to call publically controlled institutions "state-run", or "government-run" and hope we hide in fear of our own shadow. A great deal effort and ideological indoctrination is put as well into convincing people that publically controlled enterprises are "wasteful and inefficient."

In fact, under a single payer system, and only under a single payer system 75% of Americans pay less for health care than they do today according to Johns Hopkins University; in fact, only single payer will reduce national health care expenditures by up to $175 billion annually and streamline health administrative bureaucracy by up to $100 billion each year, according to the Congressional Budget Office.

In addition to these recent findings, three years ago the General Accounting Office found that "If the universal coverage and single-payer features of the Canadian system were applied in the United States, the savings in administrative costs alone would be more than enough to finance insurance coverage for the millions of Americans who are currently uninsured. There would be enough left over to permit a reduction, or possibly even the elimination, of co-payments and deductibles" [In These Times, June 26-July 9, 1991, emphasis added; The more recent findings are cited in American Health Security News office of U.S. Rep. Jim McDermott, Vol II, No. 30]

The mainstream media are immune to such mere facts which contradict the Establishment, Corporate Party Line; including "establishment liberal" sources like NPR who, despite being all too well aware of the substantial savings possible under a single-payer health plan, as activists have repeatedly communicated to them about; thus an NPR commentator, speaking about elections in different states and noting that voters had insisted on lower costs in one such election, and on more health care in another, the commentator snickers in mock bewilderment about how these silly voters "just aren't putting two and two together."

Savings due to the elimination of the vast private bureaucracy with hundreds and hundreds of forms, companies, and players each spending time, effort, and cost in trying to transfer costs on to other players -- to say nothing of the vast private profits health insurance corporations make at the expense of the suffering of millions, huge CEO salaries and "perks", and other wonders of profits-based administration -- are quite substantial.

Moreover under single-payer, you are free to choose any doctor you want, rather than being dictated by an insurance company, and your doctor's decisions are not second-guessed by insurance corporation bureaucrats whose job is to keep costs down for the insurer, and thus to keep their profit-margins -- rather than people -- healthy.

A market-based system also increases costs for us all in the long run by under-emphasizing preventative care, where inevitably, costs are immediate while the [greater] financial payoffs accrue only in the long term, as noted by Physicians for a National Health Program ["A Better Quality Alternative: Single Payer Health System Reform" by Dr. Gordon Schiff and the PNHP Working Group on Quality. Copies of the paper are available from PNHP at (312) 554-0382. Fact Sheet by PNHP]

PNHP emphasized that a single-payer system would allow patients to choose their physicians and to continue to see them if they changed jobs or financial status: "This continuity of doctors and nurses , who can get to know and care about patients, is critical to quality, but is rapidly disappearing from the medical landscape, as HMOs/insurers hire and fire physicians, and employers shift plans to take advantage of the lowest price each year. These disruptions in care are built into other reform proposals." and "According to the Congressional Budget Office, single-payer would save $225 billion by 2004, more than any other proposal."

According to a study co-authored by George Scheiber in Health Affairs, the U.S. spent $3,094 per capita on health care costs in 1992 compared to single payer countries like Canada and Germany which spent $1,949 and $1,775 respectively. The study also notes that after spending the most, the U.S. still lags behind other industrialized nations when it comes to life expectancy and infant health. Knight-Ridder reporter Susan Fitzgerald quotes Scheiber as saying, "We the U.S. spend more than any other country... yet we have 15% of our population uninsured and on measurable health outcomes, we don't do well."

As noted in a previous Perspective article, Blue Cross of Massachusetts employs 6680 people, more than are employed in all of Canada's health programs, which insure 10 times as many people, and the share of the health dollar for administrative costs is over twice as high in the US as in Canada. [See my Health Care: The Excluded Option in the last Spring 94 issue. Nancy Watzman, Multinational Monitor, May 1992.]

But the most fundamental reasons for supporting Single Payer have to do not with providing much needed medical care to millions who are now without, while saving money -- but with democracy.

Should health care be a right or a privilege which is a "market commodity" to which the maxim "you get what you [can] pay for" applies?

More fundamentally, since, as we learn in economics 101, each economy must prioritize or "ration" every "good," we must ask, ourselves: do we ration, or prioritize, the delivery of health care based on (a) Need or prioritized based on the size of one's Bank Account, so resources go first to paying for cosmetic plastic surgery (or expensive and unnecessary or even harmful procedures which are lucrative for providers) for millionaires first, and later (if at all) towards critical necessary care for the less affluent among us? Most crucially: Should health care issues be decided democratically by the public or be controlled by private interests, by profit-maximizing corporations accountable to CEOs and stockholders?

A single-payer system, like proposition 186 which will be voted on this November in California, creates a democratically -- publically -- accountable system, including a Health Care Commissioner. Advocates of 186 note that the Health Commissioner is elected "by a direct vote of the people for a 4 year term. His job is to collect the money, keep within the budget, and pay claims in a timely manner. He must answer to us! Who does the CEO of your insurance company answer to? -- the Stockholders! If the Commissioner does not do a good job we will be able to vote him out of office. Can you fire the CEO of your insurance company?"

Under prop 186, Independent Consumers Council will operate independently of the Health Security System and will have the power to, among other things, take the Health Commissioner to court on behalf of consumers. The Consumers Council, designed by Ralph Nader, is separate from the Regional Consumer Advocates, which are appointed by the Health Commissioner as part of the Health Security System.

These fundamental issues of democratic public control are regularly obfuscated; we are denied the right to exercise such direct democratic control, and are then told about the great "freedom" we have in choosing between different Goliaths, which one we want to undemocratically control our health, our relations with our doctors, and so on. That's "freedom" under the "private enterprise" ideology.

Of course, the term refers to an economic system where systematically it is the costs -- not profits -- which are socialized. One example is cited by Dr. Fazlur Rahman in the mainstream business pages: "Basic biomedical research has long been heavily subsidized by United States taxpayers" to the tune of billions of dollars; "high-tech pharmaceuticals owe their origin largely to these investments" but are often "out of reach of our patients" as corporations rake in private profits [New York Times, Sunday, April 26, 1992, page F13]. In other words, the public pays for basic research, and if anything comes out of the research that is marketable, it's turned over to the likes of Merc Pharmaceuticals; that's public subsidy, private profits, or what's called "free enterprise." The ideological servants of power and monied interests somehow fail to demand a percentage of the profits go back to the "investor" when it is the general public rather than the wealthy.

--Harel Barzilai

** Similarly, the amount the federal government collects annually in rent or royalties for minerals taken from public lands -- the market value for free hard-rock minerals (gold, copper, etc) taken annually from public lands is $4 billion -- is $0 [Working Assets newsletter, Money Matters, winter 93/94].

** When Rush Limbaugh asserted that "banks take risks in issuing student loans and they are entitled to the profits." Fairness and Accuracy in Reporting [FAIR] pointed out that in reality these loans are federally insured -- again, public money is put up, but the profits, somehow are not collected by the public. In Limbaugh's official "rebuttal", he offers a quote from a bankers' association spokesperson, who asserts that the "risk" bankers face is that they might fail to comply with federal procedures, and therefore might not receive the reimbursement... The other rebuttals are equally amusing. [See recent issues of FAIR's Extra, available in the Alternatives Library in Anabel Taylor Hall]

[Article originally appeared in the November 1994 issue of the Cornell Perspective ]

------------------------------------------------------------------ Health Care Graphics from The National Health Care Program Book by Himmelstein and Woolhandler. ------------------------------------------------------------------

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E-mail address for Jim Ramsell: ramselj@peak.org Owner single-payer list: single-payer@peak.org My webpage is: http://www.peak.org/~ramselj

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