Monday, September 28, 2009


I was walking around my neighborhood at six AM today, and sort of mulling life, as my iPod died on my walk. I had a thought, rather a series of thoughts, and wanted to share them with you on this, Yom Kippur.

I guess this train of thought was triggered by watching LinkTV's presentation of an address by author and journalist T R Reid regarding his world tour surveying healthcare abroad.

(SIDE NOTE: If you can give, this is a good time to donate to LinkTV, a network dedicated to bringing you perspective and analysis of the news that you won't get from mainstream media)

Reid consistently pointed out that, logically, it is impossible to frame the current healthcare crisis as anything other than a moral question: Is the healthcare system fair? What is the ultimate responsibility of a government to its people if not to ensure they have long and productive lives?

He has a point: for all the flaws inherent in other country's healthcare systems, most notably the long waits for elective procedures in Canada's Medicare system, they are at their lowest common denominator, fair. The length of time a rich person waits under Canada's Medicare system (which was LBJ's model for his eldercare system) is the same as for a poor person.

It is, at heart, an ultimately fair system. Yes, if a rich person can afford to, he or she can opt to fly to the States and pay for knee surgery or to see an orthopedist, rather than wait a couple of weeks in Canada. But Canada also doesn't extend this triage function to life-threatening conditions: if your heart is on the fritz, you get seen immediately, rich or poor.

Fairness. It never has to be justified. But unfairness does.

And somewhere in the dark of the night of my sleep, this thought nagged at me, and I began to have an insight into human beings.

When we behave badly, we have to rationalize ourselves. We have to justify that behavior. We have to make excuses.

Fairness is inherent. Fairness is obvious. Fairness needs no excusing.

Just like getting up off the couch and taking a four mile walk needs no rationalization. It needs nothing other than "I wanted to stretch my legs."

Sitting on that couch for another hour, that requires rationalizing. That requires excusing: "It's raining. I'm tired. It's cold."

Or to put it another way, when was the last time you had to explain to a cop why you were going under the speed limit?

Good behavior is what it is: Bonnum commune communitatis. Bad behavior needs to be explained, excused and forgiven.

Back to healthcare then: what rationalizations would the corporatists give for the current state of healthcare in America? That it makes a profit for the shareholders of insurance companies?

Is that fair? Is it fair that the CEO of Oxford or CIGNA or Blue Cross earns a fat little bonus at the end of the year while people without insurance, some 700,000 each year, are forced into bankruptcy and 200,000 people die of treatable and preventable illnesses, all because insurance companies have to protect that precious little dividend and that precious little stock price at the expense of a healthier citizenry?

This is not about socializing medicine, either. For example, America generally operates under the German healthcare system, developed by Otto Von Bismarck over a century ago. Private doctors, private insurance, private hospitals, except costs are controlled. For example, Japan, which has 3,000 health insurance providers, cap administrative costs at 1.5% of premiums, meaning insurance companies have to spend 98.5% on insuring patients. Canada caps costs at 6%, and that's with a government health insurance.

American insurance companies bank 20% of premiums as "administrative costs". That's an awful lot of forms to fill out! And the Japanese spend about $3,500 per annum on healthcare and insurance. Americans spend $7,500.

And no one in Japan files bankruptcy because of medical bills.

Fairness. It never has to be explained, it never has to be justified.

It only has to be experienced.