Black Sun Gazette
Enjoy Your Health Care Shit Sandwich
My loyal readers of Black Sun Gazette are none too surprised that I am adamantly opposed to the health care bill which was recently passed by Congress. There’s a lot of confusion surrounding the bill, not the least bit due to a massive campaign of disinformation and lies coming from The White House and its toadies in the corporate media. I’m sort of amazed at how otherwise rational people are joining in the Democratic Party circle jerk that is accompany yet another massive transfer of wealth from working class people to corporate elites in this country.
The health care “reform” bill isn’t anything that deserves the name reform. The very word “reform” at least tacitly implies amelioration of social ills. For those who haven’t seen it, the fact sheet from Fire Dog Lake–a “progressive,” pro-Democratic Party blog–explains a lot about what is wrong with the bill. It doesn’t protect or aid the people it purports to and requires you to pay a large part of your income to, not a tax pool, but private companies. The bill puts pressure on insurance companies to provide fewer services of lower quality with higher co-pays which means that many people at the bottom levels of society will be paying for services that they can’t even use. The elevator pitch version? Insurance companies basically wrote this bill, Joe Lieberman pushed it and insurance company stocks are skyrocketing. If you need to know more than that, I’ve got a dollar I can loan you to buy a clue.
How the bill will actually work in reality is outlined succinctly in another article from Fire Dog Lake which uses the historically imprecise but emotionally evocative term neo-feudalism to describe this bill. To the best of my knowledge this is the first time in American history when citizens will be required by law to tithe a pre-determined portion of their income to private companies, none of which seem to have a waning rapacity for superprofits. Indeed, the health care bill can quite possibly be seen as an attempt to totally privatize and ration health care in the United States, what with its massive attacks on Medicare and Social Security–cynically called attacks on “waste” by the President and those foolish enough to believe him.
What those who have been taken for a ride by the Democratic Party (once again) on the matter of health care fail to realize is that everything good about this country, from the abolition of slavery to the Civil Rights Act, was the product of a hard fought struggle by millions of people. The rights and privileges that we enjoy in the United States were not handed down by benevolent rulers trying to “do good” by their people. Rather, things like Social Security were wrested from a terrified ruling class who would give up any scrap from their table to maintain their social power. In the words of Martin Luther King, “Freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed.” Those who subscribe to any variation of the notion that the people who run this country are going to give up anything without a fight desperately need a lesson in history and basic reality. From the very beginning, the health care bill has been an attempt at ramming a reorganization of the industry down the throats of the American people by cynically using the language of “reform.”
The health care debacle, coming on the heels of a recent Supreme Court decision allowing corporations to finance political campaigns wholesale, is a troubling sign of where the United States is headed. It also lays bare the bankruptcy of placing any faith in the Democratic Party. Rather than being a “lesser evil,” Democrats are the preferred party of the ruling capitalist elite during times of economic strife from the 1930s to today. Since winning The White House at a time when Democrats held both houses of Congress, they have failed to do anything to help working class and poor people who are struggling in America. Rather, they have spearheaded new attacks on the living standards of working class Americans through methods such as massive wealth transfers to bankers, deep cuts in social programs, attacks on teachers and the wholesale destruction of large sectors of the economy. Those who continue to rely on the Democrats are either parasitic privileged social layers, those who soon hope to be, willfully ignorant or hopelessly confused. Even the great stalwart of the “progressive wing,” erstwhile anti-choice bigot Dennis Kucinich quickly fell in line.
The politics of pressuring capitalist politicians to throw you a few crumbs leads nowhere but where we find ourselves today. Those who wish to keep begging for less severe beatings and slightly larger scraps from the master’s table are welcome to do so. These people doubtless possess a continued touching faith in the ability of capitalist politicians to be pressured to do the right thing. However, battle lines are more quickly and firmly being drawn in the sand. We all exist during what the Chinese curse calls “interesting times.” A time will come when stock will be taken and those who lined up to defend the system will be separated from those who saw a diseased and decaying system careening over a cliff and rather than try and save it, leaned in with all their weight to push it to its death. However, more important than the judgment of peers or history on this matter is the judgment of one’s own conscience. As social conditions continue to deteriorate, I sincerely wonder how those who currently act as left lawyers for the Democratic Party’s assault on American living standards (to say nothing of illegal and borderline genocidal assaults abroad) will look back on their misspent youth as liberal apologists.
Taken from:
HEALTH CARE: The Hospital as Soviet Gosplan
Recently an article of mine on healthcare, “Healthcare and Radical Monopoly,” was published in The Freeman: Ideas on Liberty. Since I wrote the article several months ago, I chose healthcare as the topic for my forthcoming C4SS research paper.
One thing I barely touched on in the article for The Freeman, that I’ve been digging into heavily since, is the absolutely astonishing levels of overhead in hospitals, and the pathological organizational culture that contributes to it.
Of course Obama’s healthcare “reform” is focused almost entirely on the insurance industry, rather than on the costs of healthcare itself. But while insurance company price-gouging and profit margins contribute to skyrocketing premiums, it’s very much a secondary effect–mostly icing on the cake. The main factor behind rising insurance premiums is the rising prices hospitals charge for delivery of actual services.
And the organizational culture of hospitals is the main culprit. Standard management accounting practices are at the heart of that culture. Under GAAP accounting rules, which Donaldson Brown played a major role in developing at Du Pont and GM ninety years ago, only labor counts as a direct/variable cost. Capital expenditures and administrative costs go to general overhead, and are treated as fixed.
So while the MBAs obsessively try to shave off every possible minute nursing staff are scheduled, they pour money down ratholes on the kinds of wasteful white elephant capital boondoggles you might have seen in the old USSR–not to mention having a level of administrative overhead rivaling the Ministry of Central Services in the movie “Brazil.”
At the hospital where I work, I’ve seen entire floors remodeled at enormous expense, just to make them less functional than before. I’ve seen a perfectly functional telephone system on my ward replaced at a cost of thousands of dollars, and a totally acceptable photocopier replaced at a cost of thousands more, just because they had the money in their capital budget and couldn’t think of anything else to spend it on. I’ve seen the hospital add a DaVinci “surgical robot” and invest in extremely expensive specialty treatments for high-end niche markets, while patients shit the bed waiting for bedpans and go five days without a bath or linen change. Most recently, the hospital announced an $8 million expansion of ER; the money spend on that alone would probably be enough to increase the staffing ratio to one orderly for each six patients, what it used to be fifteen years of downsizing ago, and fund it at that level for ten years. But spending that money on labor for patient care would lower “productivity,” according to their pointy-haired MBA metrics–despite the fact that the money they’re ostensibly saving from staffing cuts now is more than offset by the resulting increases in med errors, falls, and hospital-acquired infections.
The objects of capital spending remind me of Friedrich Hayek’s predictions for a centrally planned economy:
“There is no reason to expect that production would stop, or that the authorities would find difficulty in using all the available resources somehow, or even that output would be permanently lower than it had been before planning started . . . . [We should expect] the excessive development of some lines of production at the expense of others and the use of methods which are inappropriate under the circumstances. We should expect to find overdevelopment of some industries at a cost which was not justified by the importance of their increased output and see unchecked the ambition of the engineer to apply the latest development elsewhere, without considering whether they were economically suited in the situation. In many cases the use of the latest methods of production, which could not have been applied without central planning, would then be a symptom of a misuse of resources rather than a proof of success.”
In particular, Hayek cited “the excellence, from a technological point of view,” of some Soviet industrial machinery. It was excellent. It’s just that nobody had any idea, given the grossly distorted incentives and price signals in the Soviet economy, whether it was worth the resources put into it.
But under GAAP rules, overhead doesn’t matter because, thanks to the miracle of “overhead absorption,” it just gets passed on to the customer as a markup. Hence the $3 bag of saline solution that’s billed for $300–not to mention the infamous $10 aspirin. It’s what Paul Goodman called “the great realm of cost-plus”–the very same culture that gave us the $600 toilet seat at Pentagon contractors.
The only solution is to let conventional bureaucratic hospitals rot, bypass them, and start over from scratch. It means eliminating the organizational culture of prestige salaries, mission statements, Weberian “best practices,” work rules, and job descriptions. It means, instead of interdepartmental “quality improvement committees,” empowering those actually providing the care to act on what’s right in front of them without interference from pointy-haired bosses.
It means, especially, decentralized delivery of service and cooperative finance: small, neighborhood cooperative hospitals that bypass the insurance system altogether and operate on the same flat-fee membership basis as John Muney’s clinics in New York, or Qliance in Seattle. This would have two primary benefits: first, because of the flat-rate fee, there’s no incentive to mutual logrolling between specialists, padding the bill with a $6000 CT scan, etc.; second, as Muney pointed out, it eliminates the 25% or so of costs that come from insurance paperwork.
The future of healthcare is not Obamacare, or any other statist legislative agenda created at a table where the seats are all occupied by the people who created the problem. If there is any hope for affordable healthcare, it lies in small, bottom-up, patient-driven institutions that route around all the inefficiencies and irrationalities of state capitalist healthcare.
Good post.
ReplyDeleteYou've inspired me to read Hayek.