Health care reform debate is in the air. I thought I'd write a more theoretical post on what I take to be the critical underpinnings of this debate, so please don't expect things like statistics and numbers, I don't really do those.
I'll start with a discussion on business teleology. What does teleology mean? Coined by Aristotle, the wikipedia entry defines teleology or telos as: the philosophical study of design and purpose. So when I suggest that we'll be looking at the telos of business I'm merely indicating that we'll look at a broad understanding what the aims of business is, set in the context of health care.
Real quick, there's another term I'm going to be throwing around: ontology. Another Aristotelian word defined by wikipedia as: the philosophical study of the nature of being, existence or reality in general, as well as of the basic categories of being and their relations, i.e. in order for a quality of a thing to be considered an ontological quality it must in some way define the thing. That is, without this ontological quality a thing is not recognizably what we define it to be. So, an ontological quality of a hydrogen atom is that it only contains one electron. If an atom has more or less than one electron then it is not a hydrogen atom.
So, what are the teleological and and ontological qualities of a business? For starters a business aims to make a profit. This would be an ontological quality, if an organization aims at something other than making profit, then it is not a business. The teleology of a capitalistic business is to make as much profit as possible. These two things are quite obvious and it seems silly to lay them out like this, but it's important to do so. In summation, a business, in the broadest sense has two very basic aspects: to make a profit and to make as much of a profit as possible.
Another thing to go over real quick is the difference between means and aims. Think of your favorite company, I am partial to Apple Computers, I like their products. Apple is in the business of making quality computers and computer equipment. I shop at Whole Foods which is in the business of providing high quality and premium groceries. I buy video games at Gamestop which is in the business of stocking a wide selection of new and used video games. Each one of these companies employ different means all of which designed to satisfy the same aim: to make as much profit as possible.
The point I'm driving at is this: all businesses, regardless of means, aim for one, and only one thing: profit. Apple Computers, Whole Foods, and Gamestop are moneymakers FIRST! Their products are secondary considerations designed only to achieve their primary aim. This is a dangerous situation. As anyone who's seen Food, Inc. recently can attest to, companies have an incentive to lower the quality of their products and services if it serves their aim the best. So, McDonald's and Whole Foods share a common aim, NEITHER business is in the business of feeding people, they're only in the business of turning profit, that's it, end of story.
What does this have to do with health care? Well, our country's health care system has been in the hands of private interest for some time now. Our country's health care system is a business. Saving lives and keeping people healthy is the means. So have we experienced a "McDonaldizidation" of our health care, wherein the quality of the product is sacrificed for an increase in profit? That's for you to decide I suppose. There's piles of evidence for and against this question. Rather than wade through all that crap, just look at the theoretical aspect of the question.
Is health care, currently, a business?
Yes.
Do businesses have an ontological and teleological incentive to reduce the quality of their means if it increases their profits?
Yes.
Further, is a business that maximizes its profits a better business than one that does not?
Yes.
Are businesses willing to sacrifice the quality of human life or human life itself, in order to maximize profits?
Yes (it has happened in the past.)
So, the question boils down to this: is it right for health care to be the means of a business? There are certain commodities that we have that are defensibly commodities: luxury cars, computers, beer, movies, etc. These are things that are not essential to human life, so skimming a buck off of them shouldn't really raise any alarms. However, does it really seem right, in that gut feeling, intuitive way, to make PROFIT off of providing life saving health care to individuals? Does it really seem right to make money off of the sick? Is it right to tell a person they're going to die simply because there's no immediate profit to be made off of their living? If I saw a man bleeding on the road and told him I'd only call for help if he paid me $10 you would be appalled, I'm sure. I don't see how the current health care system is significantly different from that.
If a rich man and a poor man get the same disease, is really part of America's fundamental ideals that the rich man, who can afford the life saving surgery, live while the poor man dies?
I hear the remark, "I don't want politicians interfering in my life," or some variation. I take it to be the case that these people are perfectly satisfied with having CEO's, lawyers, and accountants interfering in their lives. Because that what this all really boils down to.
Who do you trust less: politicians or CEO's, lawyers, and accountants? Because ONE of those two groups is going to be running our health care whether we like it or not and I hope to have demonstrated (at least, theoretically) why one of those groups not merely untrustworthy, but downright inhuman, scum sucking, hell spawns (hint: I'm talking about the CEO's, lawyers, and politicians.)
One last word, for those of you who lay awake at night fretting over the encroaching socialism that seems to be knocking at your door, I'm afraid you've been hornswoggled, duped, tricked, lied to. You're being used, like a cow who's been taught to herd her kin into the slaughterhouse. Take a moment, sit quietly with your fear and think, think really, really hard about the situation.
The real problem is with the racket the combined healthcare and insurance companies have going. There is no justification for the costs being billed on medical services.
ReplyDeleteHowever, socialized medicine is not the answer.Some limited form of government regulation, but not control. We're not Norway. There are a hell of a lot more people, with a generally lower standard of living, than northern European countries where government controlled healthcare has been effective.
Here's the answer hippies, the same answer that your hippie parents failed to grasp: raise your children to be good men and women. If our society had a moral conscience we wouldn't be talking on this subject. If all of us did this we really can change the world, but for our grandchildren and their grandchildren.
Trying to fix our society's ills overnight with nothing but iealistic rhetoric is just tilting at windmills.
Thanks for the comment Michael. I agree with your statement that the status of health care is a racket at the moment. Though, what I advocate, at least philosophically, is for a complete de-commodification of the health care system, basically to ban the ability to turn profit on health care related goods and services.
ReplyDeleteIn order to facilitate that, a large scale non-profit organization with enormous funding would need to take control of that. The government is not the ideal candidate for this job, but perhaps the only organization that can pull it off.
You're also correct, if our society had a good moral conscience then this would never have been a problem in the first place. Unfortunately, after seeing Idiocracy, I have little hope of a "ground up" revolution in social conscience.
Well, I'm a numbers person but I'll entertain the philosophical aspect of this debate and reduce it even further because, in the economist world two maxims hold sway in normative questioning: "Only individuals matter" and "all individuals matter equally."
ReplyDeleteSo let's reduce the idea of firms seeking profit down to individuals and the main aspect of the economic Principle of Voluntary Exchange: every individual engages in trade with the idea that they will walk away from the exchange better off. Now, remember, that's *both* parties in the exchange, not just one.
This motivation is why a baker bakes bread for not just himself, but for other people in exchange for goods (or the currency to buy those goods) that he wants more than bread. And people buy the bread because they want the bread more than they want the money they have to spend.
The reason we, as humans, are not dying at the age of 35 anymore is because the motivation of voluntary exchange became more efficient after the Industrial Revolution and thrived in those places where private property rights were strongest. The motivation for profit has led to human existence in the last 200 years improving thousands of times over all the other previous centuries of human history combined.
Now we come to the normative question: should healthcare be a commodity that exists in a profitable sector and my answer is absolutely. Products and services get better when there is a profitable motivation to apply innovation toward doing so. The desire for maximizing profit means you will pursue your research and development in the most efficient and cost-effective manner possible; government bureaucrats have no motivation to do that and in fact have a disincentive against doing that because money you say the taxpayer in your department simply means you'll get less money the following year. In this sense government is not distributing capital efficiently to the sectors that need it, which is the inherent problem of command-and-control economies in general. The market is far more efficient than central planners.
So, let's get to the real crux of the argument then: if private firms seeking profit is good for healthcare (like it's good for every other industry) why is the system so screwed up? I'll answer it with one word: regulations.
ReplyDeleteSee it's not the private aspect of the healthcare system that is the problem, it's the public one. I'll give just one example out of the myriad examples that contribute to the distortions of the healthcare system: Licensing organizations and medical boards have essentially become cartels not at all unlike mercantilistic trade guilds; they have used government power in order to secure monopoly rights over the healthcare system.
All the countless and seemingly endless committees, commissions, boards and bureaus have their fists tightly in control of everything from medical education, medical school enrollment, accreditation of those medical schools, accreditation of specialty residency training programs, foreign medical graduates, and medical licensing in every state, this creates a huge monopoly that crowds out competition and forms barriers of entry for other practices to come up. So in attempting to resolve the market failure of asymmetric information we create a new one in asymmetric competition.
What good is supposedly high-quality healthcare to people who can't afford it? If you are desperate enough for the care, you'll analyze the risks and benefits on your own and make your own decision regarding the pursuit of care. No bureaucrat should be able to make that analysis for you, especially when such analysis prices you out of getting ANY care in the first place.
So in the philosophical argument, the idea of profit being a motivating factor in something as essential as healthcare is no different than profit driving housing or agriculture (and both of those industries also suffer market distortions from clumsy bureaucratic handling) or toothpaste and t-shirts. The problem with the argument that healthcare is essential is that it tries to aggregate individual desires under one umbrella. Rational human beings make decisions based on what makes the most sense for their own cost/benefit analysis. This drives the market and what most allocates resources to their most efficient ends.