United States

What Would Woody Say?

By Gregg Shotwell

Whenever I am faced with a conundrum, a really stubbornly complicated communication problem, I ask myself, “What would Woody say?”

I think Woody Guthrie would say that two people can use the same word and mean two different things. For example, the C-words—compassion, conservative, cooperation—have different meanings in different mouths. Which leads to the fourth C-word: conflict.

Rather than argue semantics I think Woody would say, “Which side are you on?”

On one side of the health care debate, we have those who advocate a socialized system like Medicare. On the other side we have those who advocate that individuals take care of themselves.

Doctor Donald P. Condit believes everybody should take care of themselves. “If patients participated at the point of service in paying for their care, health care expenses would diminish.”.(“Time to Rethink Employer Provided Insurance”: Grand Rapids Press: February 25, 2007.)

Thankfully, Dr. Condit provided a clue to his magic thinking. He is going back to school; not to advance his skills as a surgeon nor enhance his talents in the healing arts, but to acquire his Masters in Business Administration (MBA). Medicine in the U.S. is big business and Dr. Condit felt the need to sharpen his pencil before some wily patient paying out of pocket for surgery got the best of him.

The doctor with a bottom line philosophy of medicine asserts that patients who have insurance provided by their employers are irresponsible consumers and create a “moral hazard.”

Proponents of this “moral hazard” theory believe that free and equal access to health care is like a gateway drug that leads to abuse instead of health. Why? Because patients who don’t have high copays and deductibles treat medical care like a free, all you can eat buffet. There might be some merit to the argument if a colonoscopy, a pelvic, and a visit to the dentist were appetizing.

The pundits of “moral hazard” assert that if patients paid their own way, they would consume less services, less medicine, and less professional advice. They would cut corners and clip coupons. They would shop around for cheaper doctors, discount clinics, pre-owned prosthetics, Internet diagnostics, and pharmaceuticals imported from China. The competitive fervor would plow fertile ground for a WalMart revolution in health care. Imagine the efficiencies: a breast examination and an oil change in one stop.

Dr. MBA believes that patients who pay out of pocket are tough customers. After all, just because you have cancer doesn’t mean you can’t drive a hard bargain.

Dr. Condit’s business pursuits have made him an expert in behavioral modification. He states unequivocally, “Patients with stronger incentives to stay healthy decrease the burden placed upon society by smoking, obesity, diet-controlled diabetes, heart disease, strokes and alcoholism, to name a few.”

It takes an MBA to believe that people who fear losing their homes if they get sick will stay healthy. Trouble is, the working poor don’t have time to go to the health club after work because they have to get to their second job. They can’t get away for the weekend because they need the overtime. They can’t afford a personal trainer or a vacation but they can squeeze in a smoke, a greasy bag of fast food, or a Mickey’s Big Mouth between the barge and the bale. Small gratifications are all the working poor have a chance for. And the first thing we learn on the shopfloor is never slow down.

At the new state of the art GM assembly plant in Lansing MI. workers don’t have time to walk to the cafeteria, sit down, and eat. Meals are delivered to the line just like the Charlie Chaplin movie Modern Times.

Do truck drivers have an alternative to fast food and a sedentary occupation? Do nurses, social workers, clerks, sales reps, ever feel stressed beyond endurance? Maybe they would all take a deep, self-empowering breath, and lower their collective blood pressure if they realized the alternative to staying healthy—bankruptcy—was worse than death.

Dr. MBA contends if “employees were paid more, with the intention of providing for health coverage” they would negotiate with health care providers more cost effectively than businesses.

Apparently night school has limited his experience in the manufacturing, retail, and service industries where employers routinely cut wages and shift the cost of health insurance onto workers. His fundamental assumption, employer cooperation, doesn’t have a crutch to stand on. Not only is Dr. MBA out of touch with the economic reality of working life in these United States, he has conveniently neglected to calculate the discount of scale that gives an employer an advantage in bargaining with insurance companies. How can I, as an individual, get a better deal than Amway?

The government would or could have an even greater advantage in volume discount than Amway, which is why those who profit from health care prefer privatized insurance sold on an individual basis. Privatization tips the balance of power to the seller’s advantage much like a company bargaining with an individual worker rather than a union.

Dr. MBA contends “greater harm would result from a centrally planned and controlled system of health care” because “rationing occurs” which causes a “compromise in quality.” Apparently he hasn’t noticed that rationing predominates by default in a system that deprives 46 million citizens of health insurance. The working poor who make too much to get medicaid and too little to afford health insurance, are rationed right out of the waiting room. By every measure of quality, from infant mortality to life expectancy, the U.S. ranks below nations with universal health care.

But Dr. MBA contends if we socialize medical care, patients will die on waiting lists. His solution? Shorten the list through natural selection as in, no room for you in the waiting room if you ain’t got the Do Re Mi. Survival of the richest is the golden rule in business school where doctors learn they can make more by rationing health care for the poor. Which leads us to some underwriting questions.

Is it impossible to meet demand if everyone is insured? How do other nations like Canada, England, France, Germany, Italy, and Japan meet the needs of their citizens? Is supply more limited in the U.S. than other modern industrialized nations?

If the supply is limited, is it just and moral that some go without so the privileged few may have all they want? Do the working poor who go without health insurance actually subsidize the rich by giving up their place in line?

When the expense of health care is spread equally across the entire population—the young and the old, the healthy and the ailing, the wealthy and the poor—the cost diminishes per individual. When a single payer representing the entire population negotiates with a drug company or other health provider, the discount of scale outweighs the cost of covering everyone. The savings in red tape and rigamarole currently siphoned off by insurance companies could be used to educate and employ medical staff rather than burdensome, counterproductive bureaucrats.

As an added benefit, universal health care reduces the risk of workers going bankrupt, and all of society is healthier, wealthier, and wised up to the fact that the real “moral hazard” is a health care system which compels doctors to seek MBAs and come out of school quoting theologians who shill, “A corporation is not a church, a state, a welfare agency or a family. It is an economic association that serves the common good by being a business.” [Time to Rethink Employer Provided Insurance: Grand Rapids Press: 2/25/07 Theologian Michael Novak]

Theologians might know something about theocracy, but they don’t know jack about corporations or how it feels to hump the line for 30 years as all your body parts wear down and your soul is sucked metaphorically out of your grasp. Except of course, the corporate theologian, Michael Novak.

“One of Novak’s niches within the neoconservative faction has been to provide the moral, ethical, and theological underpinnings of American corporatism. He views the corporation as a sacred relic that needs constant polishing.” []

The quote by Novak that Dr. MBA cites to relieve corporations of social responsibility is from “an article published as part of a Pfizer-sponsored “advertising series” on public policy questions.”

Can a man of God possibly have a conflict of interest?

Novak served on Pfizer’s Board of Directors. His brand of theology is divinely lucrative. He not only polishes the corporate halo, he is an unfaltering advocate of war in Iraq. He actually claims the “surge” is working. And it is working for Halliburton, Lockheed Martin, Boeing, Blackwater, Chevron, ExxonMobil, and the etcetera of multinational corporations that know how to make a killing in a morally hazardous marketplace.

It doesn’t take a degree in divinity to recognize that corporations are responsible for promoting war for profit, polluting our environment for profit, and obstructing the will of the majority of Americans who desire single payer universal health care. Members of the Medical Industrial Complex serve their masters, not “the common good.” Corporate immorality, not Medicare, is hazardous to our health.

I think Woody would look at Dr. MBA and his sidekick theologian and decide he’s on the other side. The side of working Americans who believe the most compassionate, economically conservative, and cooperative approach is a system that gives everyone equal access to health care.

Stay well, stay solid, and give them hell.