Friday, September 25, 2009

Personal perspective on problems with our privatized health care system

Many of the debates surrounding health care seem to dwell in the realm of ideology and polemics, and fail to address the way in which this issue meaningfully intersects with people's lives. I have had numerous exchanges with a good friend of mine on this issue, and we find ourselves in disagreement over it. However, this is an issue that did directly affect me over the past year, and I think it's important to discuss that in order to change the tone of debate.

About 15 months ago, I was dismissed from my position as a teacher in a public high school. I'm not going to go into details regarding that dismissal, other than to say that it was likely due to personality conflicts more than my performance as an aggregate over the entire year, from start to finish. I had invested a good portion of myself in that job, regularly putting in an additional 25-30 hours per week outside what I spent in the classroom, so when the district administration essentially let me know that my efforts were not valued nor appreciated, it affected me quite significantly. I had to eventually seek counseling in order to maintain my state of mind while working in a less-than-hospitable environment.

When the fall came and I was still unemployed, and my family was facing great financial difficulty as a result, I slipped into the depths of a depression that I just could not get out of. By depression I am not talking about just feeling a "little down," I am talking of being consumed with thoughts for significant lengths of time on how to hang myself down in my basement, or to simply speed up my car and swerve into a bridge abutment, and so forth. I'm not kidding in the least -- it got that bad. I probably was not that far from actually acting on these impulses, a thought that sends chills down my spine today when I think about how it would have affected my wife and young daughter.

When my wife finally confronted me on this and basically told me that I had to get some kind of help, I figured that the best place to turn would be the counselor I saw at the end of the previous school year since we already had an established relationship. I needed help immediately, so I scheduled an appointment and resumed counseling.

Since I had lost my job, we also lost the health insurance policy we had used the previous year and had to switch to my wife's plan. Not to worry my counselor told me, he was a participant in my new plan, so all I had to do was to make the co-pays. Except after a few sessions, I started receiving statements from my wife's insurance demonstrating that my counselor was NOT a participating provider, so the services were not covered, and instead of paying a $30 co-pay for the appointments I would have to cover $120 per visit!

As it turned out, the provider we had (and still have) has a myriad of different plans. While my counselor was a participating provider on most or all of the other plans, he was not a participating provider on the specific plan that we had. Fortunately for me, he was willing to drop the fee from $120 to $60 per visit, and I was able to keep seeing him. Eventually, after going on medication for a period of time, I was able to gain the perspective on my illness and overcome it. However, this experience certainly gave me a personal perspective on our health care system as it currently is, and how it needs fixed.

First of all, one of the common refrains heard in opposition to any kind of government-run system is that "decisions should be left between a doctor and patient, not put in the hands of some government bureaucrat." Funny thing is, under our for-profit system, decisions were NOT in the hands of my provider and myself. They were subject to corporate decisions.

Secondly, losing one's job and the inability to get another one is one of the most traumatic experiences that a person can go through -- especially a man in our society. When I was not able to work, I felt that I could not make any contributions to my family -- primarily because the way our society measures a person's worth to their family is the financial income they contribute. I was lucky in that my wife has a successful career that provides us health insurance. Given the current state of our economy, what about the millions of others who may be in similar situations but are not fortunate enough to have a "Plan B" like we had? Where do they turn in our for-profit system that ties health insurance to employment status? Answer: there is NOWHERE for them to turn.

Thirdly, when I lost my job an additional $30 (or $60) per week in counseling expenses was one that we really could not afford on our already-strained budget. When you don't have income, a medical co-pay can be something that strains your home finances past the breaking point. However, given my state of mind at the time, forgoing professional help was not really an option. Lucky for us, my parents stepped in and paid for the services. But regardless of our good fortune in this regard, what are those who are not lucky enough to have outside support like us supposed to do? Where are they to turn under our current for-profit system? Answer: there is NOWHERE for them to turn. It is undoubtedly situations like mine (and more dire than mine) that are the reason that medical costs are the #1 reason for bankruptcy filings in our nation over the past several years.

Now, the self-interested way of looking at this scenario might be for me to simply say that I was able to get through it and make it work, therefore other people should do the same. However, I cannot do that when I think of others who could be going through similar (or worse) circumstances and do not have the outside support to get the help they need. This is why I support, at a minimum, a public option in our health care system. I would rather see a single-payer system, because I believe it would completely circumvent many of the problems that I encountered. However, a public option would ensure that those who find themselves unemployed, underemployed, or in other difficult circumstances would not be simply left out in the cold.

At the heart of the matter, our health care is a MORAL ISSUE. It speaks to who we are as a society. It is way past due to listen to the better angels of our nature, and show ourselves to be a society that promotes the common welfare rather than self-interest. It is past time to institute a viable public option that will allow the government to use its volume to negotiate for lower prescription drug and service costs. It is past time to ensure that people have access to services WHEN THEY NEED THEM, and not tie that access to present employment status in an economic downturn.

I support a government takeover of our healthcare system because, based on my own experience and the mountains of evidence available, our current for-profit system has failed too many of those who needed health care. It is well past time for them to step aside. The kind of thinking and approach that got us into our current predicament is not going to get us out of it.

Tuesday, February 17, 2009

A Question of Taxation

The following post is based upon an email exchange I recently had with a friend of mine (and since he's one of the few people who check out my posts, I'm sure he'll recognize it). He asked me whether or not I thought I was taxed too much. The more I thought about the question from a historical perspective, I was intrigued by it. Anyway, here's the response....

I wanted to get back to you on the question you posed earlier, whether or not I think I pay too much in taxes. In short, my answer is no -- I do not pay too much in taxes, considering what taxes are necessary to maintain a somewhat stable society that exhibits highly advanced job specialization and interdependence.

Let me explain. From the time that people abandoned small-scale and egalitarian hunter-gatherer ways of life for larger, more centralized and stratified agricultural societies, there has always been an increasing need for government intervention to maintain political order.

One of the biggest problems faced by any society is social stratification. Those toward the lower end of the scale want more of what those in charge have. Those in charge will want to retain their advantages however they can. The problem is in how do you reconcile these unequal classes in an orderly fashion?

The most common means through which this was accomplished in ancient history was the rise of a centralized monarch who held the very real power of meting out physical violence at their command. However, force alone was never enough. The monarchy, in order to become a dynasty rather than rise and fall with one generation, had to ally itself with some sort of religious or quasi-religious justification for their dominance. In China, this was the "Mandate of Heaven" claimed by emperors. In the Middle East, it was exemplified by the Islamic Caliphate that unified disparate peoples under one rule for centuries. The medieval Christian Church legitimized rulers who followed its religious demands. The attitude of medieval rulers toward excommunication demonstrates the seriousness with which people took the dictates of the Church.

There is another important commonality between these three examples. They helped unify their diverse subjects under a common script, often infused with a divine inspiration. China's uniform ideographic script, initially imposed by Qin Shi Huangdi around 221 B.C., was a political tool that allowed diverse spoken tongues to continue around a single script (a situation that continues to this day). For Islam, the script was Arabic -- the language in which the archangel Gabriel delivered the Quran to Mohammed in the early 600s. For Christendom, the language was Latin -- the only written language learned through much of the European Middle Ages, because it was the language of the Church's sacred scriptures. Medieval Europeans viewed Latin literally as a means of talking to God, infusing the bilingual Church intelligentsia with significant social power.

What does all of this have to do with taxation? Well, for all of these entities, the larger and more centralized they became, the larger and more bureaucratic their governing apparatus became, primarily out of necessity. This trend hits a spike at about the same time to which we can trace the origins of capitalism. This is due to several factors.

The first is the spread of news as a commodity among the merchant class. The first literal "news letters" were letters circulated among Renaissance Italian merchants that detailed political and economic developments in distant ports. After all, a good merchant could not make good business decisions without knowledge of those events.

The philosophy of humanism developing from the re-discovery of Greek philosophy was also more readily accepted by a merchant class whose orientation was toward rationalism and away from tradition founded upon religious belief. Merchants became successful by paying attention to worldly events, not by attending extra prayer and confession. This meant that the gathering of news itself and selling "news letters" gradually became a market in itself -- news developed as, and continues to be, largely a commodity.

However, there was one advance from the period surrounding the beginnings of capitalism that was more incendiary than the others -- movable type printing. The explosion of ideas enabled by Gutenberg's printing press expanded literacy enabled the Protestant Reformation to succeed, brought down the dominance of the Catholic Church, precipitated the Scientific Revolution, furthered the Enlightenment, and encouraged the development of societies ruled by dominant bourgeois (Western Europe, North America, Japan) or intellectual classes (Soviet Union, Communist China) that overthrew (United States, France, Russia) or controlled (Britain, Germany) the old tradition of dynastic rule.

It was movable type priinting that allowed the creation of an imagined community of bourgeois individuals. Print enabled a writer and reader to have a conversation of sorts, thus creating an imagined social bond between two people who may never meet face to face, and who may even be living during different time periods. I can appreciate this point of view in light of how the death of Kurt Vonnegut, a writer whom I never met but all of whose books I read, made me feel as if I had lost a personal friend. It was this "imagined community" among bourgeois merchants that allowed the formation of the joint stock venture, perhaps the most important economic development in the history of capitalism.

The Virginia Company of England was a joint-stock company formed specifically for the colonization of the Americas. It was the only way that they could raise the capital required for such a venture, and it also insulated shareholders against risk. However, investors would not be willing to invest without certain guarantees -- namely, government guarantees for political and military support. These guarantees require a standing army and navy. Standing armies and navies required a constant flow of funds, which meant higher (and more regular) taxes. Regular taxation required an expansion of the government bureaucracy, especially around the treasury.

Business interests get increasing governmental guarantees for open markets through diplomacy and military force, which allows them to expand their business, which means that the government collects more revenue in taxes. It's a situation that benefits both those in government and business. It is also a system organized around the idea of constant growth. It is this expectation of growth that permits banking to take on increased levels of debt -- something done only when future growth can be expected to pay it back. However, it can also lead to greater social unrest due to widening inequality between those with access through contacts and/or capital, and those left on the outside looking in.

In my estimation, this was the means for the Progressive and New Deal periods in American history -- a need to reduce the level of social unrest due to widening inequality. The solution wasn't to eliminate Western capitalism as was done in Russia (for reasons specific to Russian demographics and history, that I won't go into here), it was to spread its benefits around a bit. Since business had proven unwilling to do so (resulting in violent confrontations and increasing radicalism on the part of workers), the government had to intervene. Thus, we see that government and business both grew in concert with each other AND in competition with each other.

Higher levels of taxation have arisen because not only has government expanded in order to guarantee markets for business, it has also has expanded to provide a counter to unbridled capitalism and the inequality and social unrest it has engendered. In summary, our modern levels of taxation continue to be for three purposes: to provide business interests with access to more markets thus enabling constant growth, to expand the scope of government and empower those individuals within its highest ranks, and to maintain some level of welfare state to keep a lid on social disorder as a result of capitalism's inequalities and extreme levels of specialization and interdependence. We can debate the merits of such a system in and of itself, but that doesn't change the fact that this is the system we have right now. In my own estimation, if we were to remove any of the three purposes I outlined above, we would risk social chaos -- but the end of our expectation of growth may make all of those impossible within a certain frame of time anyway.

Considering that I think that significant social unrest may be a result of reducing my tax burden because of sharpened inequality, I do not think that my tax burden is too high. Sometimes I wonder if it is enough, especially in regards to reorienting ourselves away from what John Kenneth Galbraith described as afflicting 1950s Amerca: "private opulence and public squalor."