Category Archives: Health

Dreams of the Future

What do I hope to accomplish within my lifetime?

Keeping the American Dream in Perspective

The American Dream is an incredibly alluring concept.  It resonates with me because my parents came from England to work and start a family back in the 60’s, and have done well for themselves.  They were not leaving a horrible situation in England, but I imagine they smelled opportunity.

This whiff of opportunity inspires new generations to come to the US, but as I’ve gotten older I’ve learned just how many obstacles to progress there still are here.  The civil rights movement was a brief generation or two ago, I have to keep reminding myself.  Cosmopolitanism and multiethnic communities are still not feasible for most, and views on immigration are muddled and confused.

The idea that you can come to the US with nothing except the clothes on your back and then build a life for yourself is still more true here than anywhere else. But the pursuit of the Dream comes now at greater cost:  the protection of the ideal of a middle class is being chipped away, while the desire for unfettered capitalism is powerful.  In other words, you have to want to get rich or die tryin’.  The safety net underneath taking risks and undertaking entrepreneurship is no longer so safe.

I love capitalism.  I love open, competitive markets.  I would love to duke it out as a business fighting competitors.  I love maximizing profit.  However, I also know that not everyone is an entrepreneur, not everyone can or wants to slug it out every day.

And it’s not enough to just get rich and then retire off to buy big boats and go to the best parties.

The idea of the American Dream is not complete until it includes the responsibility to plow philanthropic projects back into the country.  The biggest robber-barons, capitalists, and monopolists of our history, like the Kennedys, Morgans, Rockefellers, Carnegies, Gateses, Vanderbilts, Waltons, and Buffetts turned their money into philanthropic juggernauts.

No one does private philanthropy like the US has.  We look beyond ourselves, towards ideals and virtues, using wealth to create what would be impossible without that wealth.  We take on human-changing projects and change the course of history…for the better.  Who else can claim to have this in their genes?

Combine this with a theory of mine:  there’s plenty of money and food and resources in the world.  Those are not issues.  What are the central issues now are power, injustice, corruption, and tribal affiliation. These factors restrict which people have access to all that money and food, in order to get and maintain influence.

Human Capital

The underlying sense of my beliefs is becoming more strongly linked to building human capital.  Some of my fellow Georgetown MSFS grads who studied international development met up to discuss Sheryl WuDunn’s and Nick Kristof’s “Half the Sky”, a book about female empowerment and girls’ education.

In my studies I never really thought much of most development projects, which seem like dei ex machina, disregarding lifetimes of habits and traditions for the sake of Western scientific rationalism (which is not always correct and certainly isn’t embraced universally).  But bottom-up microfinance and whatnot also seemed to be like pushing a Sisyphean rock up a hill.

What I’ve come to believe is that children’s education should be viewed as a force multiplier.  Universal human rights should be viewed as a force multiplier.  Look at it this way:  if you were to spend all your money solely on 5 girls to go from birth to graduating college, making sure they received proper diets, health screenings, and education, then they may not choose to go on and use their educations.  They may even choose to just get married and have kids.  But that education is impossible to ignore:  they will raise their children better, and will probably send them on to school.  They might be so compelled by their educations that they seek to better their situations through social entrepreneurship.  At the least, it won’t just be them that’s affected.  At best, they will steer their children, demand more suitable conditions for a husband and community, and undertake more community roles.

Everyone is unique, surely, and they must be allowed to go off in the directions that they were given the talent and interest for.  Shoehorning women into jobs isn’t sustainable, but having them go to school will allow them to make more informed decisions.

With that, here’s what I intend to do with the rest of my life.

1) Found Galapag.us. This is of course the key, since it will be subsidizing everything else.  Add in tricky twists like my needing to maintain another job until Galapag.us takes off, and my not wanting to cash out on my personal baby project.  But I do think Galapag.us as a new measurement and identity/reputation system has the potential to disrupt a lot of different sectors, while bringing back human traditions.  So that should be bank…if not directly then indirectly through building a public good!

2) Get Married, Have Kids. I mean, otherwise, what’s the point?  I believe in the security and strength of having an equal companion to rely on, and raising kids has to be the greatest educational lesson one could ever receive.

3) Build a New School. I was watching Andre Agassi’s interview on 60 Minutes.  He reveals that his father thought his education was a waste of time, and he preferred that Andre would go practice tennis instead.  Andre was a meal ticket, and he loathed tennis for it.  Later he would bottom out, CHOOSE to play tennis, and become a great player because he found the love.  What really made the story, though, was hearing that Andre had created a school in Las Vegas to give selected students the education he never had, as long as they and their parents swore to go to college afterwards.  Andre just had his first graduating class, and ALL the kids were going on to college.

How can you measure the social good of that?

4) Subsidize Co-Working Locations and Up-and-Comers. For me, raising capital isn’t the main barrier to starting a project.  It’s finding enough incentive to not just get a normal job that provides stability.  So provide consummate hard-workers and creative types with a competitive salary ($70k-ish) so they can work on their projects without the stigma of not actually having any income.  As for the social environment that work provides, a co-working area with other alpha-dog social entrepreneurs with common, open offices that allow for collaboration, sharing, and resources to build businesses or work on “20%” ideas.  Certain people will always work hard and try to create things; they just need security and stability in order to feel safe enough to reach higher.  Web folks championed this idea; see Citizen Space in San Francisco.

5) Philanthropic Contribution to American Education, Health. I’ve long had a dream of giving away money to developmental projects.  Studied the damn subject in grad school.  And nothing seems to be more of a force multiplier than education, particularly girls’ education.  And nothing seems more measurable in developmental work than disease vaccinations, hygiene, and nutrition.  Final point:  I don’t know any country as well as I know my own, and there is a LOT of poverty, illiteracy, and other scarcities of human capital to address.  So my developmental work would focus on the United States. Similar to what Bill Gates is doing up in Seattle for their schools.

6) Open a Digitized Restaurant. I would like to build a ChurchKey-like dark-woodish comfort food bar that is built from the ground up around digital technology.  Touchscreens at every table and at the bar for ordering, having seamless order processing and check-out ease for large groups.  A strong, embracing neighborhood presence with approachable comfort food items.  Suggested:  a damn good burger, gourmet PB&J, smoothies.

7) Own an NBA Basketball Team with My Buddy Chris. Surely the most selfish thing on the list.  It’s an idea we’ve been throwing around for a while.  I guess my angle is that basketball is full of some pretty insipid business people who seem to run franchises into the ground, so why not give it a shot?  Hell, there’s so many things I’ve always wanted at a game that you’ll NEVER see because owners are all pretty conservative…  Read Bill Simmons’s “Welcome to the No Benjamins Association”.

8) Contribute Legal Fees for Key Cases. It seems true that the scales of justice are easily tipped by enough money and lawyers.  For a mega millionaire, throwing a million dollars’ worth in legal fees towards a significant intellectual property or civil rights case seems justified, and keeps your dogs in the fight, instead of letting justice fail just because a sole voice of dissent can’t afford the financial bullying cost (i.e. SourceWatch, “Goliath and David:  Monsanto’s Legal Battles Against Farmers”).

See this propaganda, by the way:  Monsanto, MPAA.

So yeah, there you have it.  That’s what I’ll be up to.  Of course, it won’t turn out this way — you can’t predict anything — but these are my dreams.

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Filed under Anthropology, Education, Health

On the Health Care Debate

[read my previous post on this subject for more context]

Tea Party Rally (Again)

On Wednesday, I went on a 5 mile run to the Capitol and back to my apartment before my afternoon shift of work began.  On the west lawn of the Capitol was a fairly sizeable Tea Party rally that took up most of the greens.  I’d heard a whiff of this rally while reading some of the political blogs, knowing that Michele Bachmann would be leading it, but knew little else.  There were more people than I thought there’d be, I suppose, and filling that lawn was pretty decent.

I stopped at the half-point of my run to walk through the rally and to get a sense of what it was like.  I’d seen the previous Tea Party that was held on the Washington Mall; it was much larger and more boisterous.  The stories and photos online of some of the horribly racist, offensive, and ignorant things at the rally were true:  that first rally really was a national disgrace and a panoply of the worst elements you could imagine.

However, this rally on Wednesday was not much like the previous one.  Gone were the disgusting signs, replaced with signs that were far more focused on just health care and big government (and not the panoply of other conservative pet issues).  It looked much more like a good ol’ fashioned American political protest.

The signs still compared Obama to socialism and communism, implying that he endorses Mao, that sort of stuff.  But this at least makes sense from the perspective of people who believe that Obama is ushering in a predatory government.  I have no problem with that line of reasoning from the Tea Party.

The audience seemed to be more fit this time, fewer obese and grossly overweight families. I would attribute this to the rally taking place on a weekday and with much less fanfare:  people from the midwest and south couldn’t make the trip out for this one, because they had to work.  This is just a hypothesis, though.  The people at Wednesday’s rally seemed like the smarter, more politically savvy/motivated types.

The rally was, again, composed almost entirely of white people, most approaching their 50s or older.  Again, most of the blacks, Latinos, etc. were DC and Capitol security.

Abortion

This rally seemed only tainted by the large number of anti-abortion demonstrations, whereas the earlier rally in September only had anti-abortionists as a fringe element.  But these people seemed to take center stage.  I stopped by one demonstration, in which a man dressed up as the Grim Reaper with black covering his face, used a megaphone to mock Reid and Pelosi.  Those two were played by characters wearing suits but covered in fake blood, locked in chains attached to fake baby fetuses.  “Reid” and “Pelosi” wailed while the Grim Reaper taunted them about supporting abortion.  I thought this was pretty grotesque, some sort of macabre scene you’d picture right before a stake-burning in Victorian England of some village witch.

I didn’t stay long, so I missed witnessing what some pretty decent independent reporting published about later that day:

“A seemingly endless parade of speakers seemed to encompass virtually the whole of the House GOP caucus.

“What really set this event apart from all others is that the long list of Republican lawmakers assembled before the crowd did so as part of a day’s work in Congress on the steps of U.S. Capitol, cheerfully facing a barrage of signs that decried Pelosi and President Barack Obama as socialists, and the president as a usurper and transgressor of the Constitution.

“Sure, you’ve heard that that story before, even bits and pieces of it out of the mouths of individual members of Congress. And, yes, U.S. senators and representatives have been present before on podiums where the Obama-as-fascist-socialist-Marxist-Muslim-foreigner story revealed itself in the chants and signage of protesters. But here was the leader of the House Republicans, addressing just such a crowd as part of his day job, leading perhaps 20 members of Congress to join that fray.”

Big Weekend

This latest rally was a last-ditch attempt to lobby Congress to block “Obamacare”, which was debated extensively yesterday (Saturday) for a vote later that evening.  I went for another run to the Capitol yesterday and there was a much smaller rally on the southeast Capitol lawn, participating I suppose in a vigil during the health care wrangling inside the building.

The President’s convoy was seen leaving the Capitol to the White House, and later I saw the Marine 1 helo convoy leaving the White House to God knows where.  It was a busy day on the Hill while the rest of us DCists enjoyed our beautifully sunny and unseasonable warm weekends.

It’s pretty satisfying to be drinking beer with friends at a bar and see your House Representatives still slaving away at work.

Last night the House passed the bill and no one really knows what it all means and none of it probably matters till the Senate is ready to vote, anyway.

Here Comes the Opinion

So here’s my take on all this.   Please read my previous post on the Tea Party for more context, first.

First of all, I think the Tea Party is intellectually bankrupt.  The Gadsden flag, a yellow flag with a snake on it, accompanied by the phrase “Don’t Tread on Me”, is the prominent symbol displayed.  This rattlesnake symbology is not really relevant anymore.  Said Benjamin Franklin of the rattlesnake:

“I recollected that her eye excelled in brightness, that of any other animal, and that she has no eye-lids—She may therefore be esteemed an emblem of vigilance.—She never begins an attack, nor, when once engaged, ever surrenders: She is therefore an emblem of magnanimity and true courage.—As if anxious to prevent all pretensions of quarreling with her, the weapons with which nature has furnished her, she conceals in the roof of her mouth, so that, to those who are unacquainted with her, she appears to be a most defenseless animal; and even when those weapons are shewn and extended for her defense, they appear weak and contemptible; but their wounds however small, are decisive and fatal:—Conscious of this, she never wounds till she has generously given notice, even to her enemy, and cautioned him against the danger of treading on her.—Was I wrong, Sir, in thinking this a strong picture of the temper and conduct of America?”

This played well when America was an upstart group of colonies finding its cajones against an imperial British oppressor.  Glenn Beck’s 9/12 Project also plays off the rattlesnake, cut into 13 pieces for the original colonies.  What the Hell is this supposed to symbolize back to the past?  We should return to the colonial days before the Revolutionary War?  Doesn’t it seem kind of silly to treat the world superpower as a rattlesnake that will bite if it’s not left alone?

History_of_US_flags_med

Surely the thought behind this is that common working folk in America just want to be left alone and not be harassed with a corrupt, growing government welfare nanny state that usurps them through taxation.

Fine.  But tie this into health care.  Health care costs have skyrocketed and the system is not sustainable.  The middle states will be even more burdened by this inflation of costs as the jobs that currently exist there disappear, combined with atrophying job skills.

Seriously, you want to be left alone?  The American way of life will cease to be if you just want to be left alone.  Encroaching corporate interests, already brethren with government regulatory precedents, are Big Brother’s brothers and sisters.  You have as much to fear from big business as you do from Big Brother.

A Revised Mission Statement

The spirit of the Tea Party should be thus:  elites, whether they be government or business, are encroaching on our personal rights and freedoms.  Elites, whether they be government or business, seek fees, taxes, scams, oligopolies, and changes in the law in order to take away our hard-earning money.  We, Americans, coming from a capitalist tradition, value first amendment rights, competition, and fairness above all.

Playing business off government is the only way to ensure proper competition:  left alone, they will corrupt each other to take advantage of the people.  Health care is uncompetitive, with 90% market concentration in some states.  Telecom, retail (see grocery store shelf-space positioning), sports teams, et al are just some of the sectors in which we do not benefit from competitive markets but instead only have an illusion of competition.  Yes, you have 20,000 products to choose from, but they’re owned by 5 companies.  Yes, you have several telecom providers to choose from, but they all fix prices to be very similar, block new entrants, and are notoriously opaque about their operating practices.  Yes, there are plenty of sports teams, but any attempts to compete against their leagues results in failure and artificially priced closed markets.

This is what the Tea Party should rally against.  When I can see Drudge Report going off on Obama’s spending, and then go to Huffington Post to see them complaining against GM and Goldman Sachs funneling taxpayer money out to executives, there SHOULD be common interest there.

Democrats and Republicans enjoy the two-party system because they have no viable competition from new entrants.  They can play off each other as it suits them and take bribes and lobbying knowing that any corruption is just written off as DC politics and not as a referendum to kill that party entirely.

The Tea Party has glimpses of being this way:  it sounds like Palin and Beck are playing the populist drumbeat, fighting against the big party Republicans like Gingrich in, for example, east coast politics.  But the bottom line is that the Tea Party is organized and motivated by staunchly conservative lobbyists.  It is not grassroots by any means.

The Tea Party should attack it as big interests dividing and conquering the American citizen.

That the House GOP caucus made an appearance at the latest Tea Party rally might end up being a key moment.  These career politicians and lobbyists, in an effort to thwart Obama and health care reform, are throwing their lot in with the anti-federal government right-wing that could just as easily turn on their masters and throw the top Republicans to the wolves when the wind changes.

So this is why I can’t take the Tea Party seriously.  Clearly we need to break open all the monopolies and oligopolies that exist throughout our systems, but it won’t happen.  Clearly the Tea Party could forge itself as the strong Public point of the triangle between Government, Business, and Public, but seeing as how the Tea Party is conservative, that makes it anti-union and anti-anyone who isn’t of the party (i.e. immigrants, minorities, the coasters).

When I was at Georgetown, the Nobel Prize-winning economist Eric Maskin came to speak about voting systems in the US.  One of the ideas floated about in this discussion was having a multi-party election where conceivably you could come in second in every state and still win, because the people who came in first in every state were all different.  That is, if there were 3 states voting:

Alabama:  #1 A, #2 B, #3 C, #4 D

California:  #1 C, #2 B, #3 A, #4 D

Texas:  #1 D, #2 B, #3 A, #4 C

Then B would win, because it’d have gotten the highest number of higher positions.  What this conveys is that party politics would become more about consensus, and not winner-takes-all.  It incentivizes being less radical.  It captures the silent majority’s opinions, which both the Democrats and Republicans both routinely claim backs them.

A viable third party would need something like this in order to ever be successful.

Some Final Points

Health Care Chickenhawks

A chickenhawk is someone who pushes for military aggression (usually conservative) without having ever served in the armed forces.  But from time to time, Republicans have dared attack the only socialized medicine in the US outside of Medicare:  military health care.  Take Tom Tancredo, racist former presidential candidate.  He argued that veterans want vouchers (lol, the only people who know what vouchers are are creative libertarians) instead of their government-provided health care.

Problem was, I guess he didn’t know his opponent, Markos Koulitsas, was a US Army veteran!  I guess he just assumed that a liberal must be a pussy who would never fight.

So Markos laughs at Tom and calls Tancredo out for getting a deferment from Vietnam because he had depression.  Tancredo got pissy and stormed off the set.

Chickenhawks are pretty vile because there’s a slew of them who continually send our nation’s children to war without having been to war themselves.  This is a cardinal sin for anyone who’s been in the military:  you don’t ask your soldiers to do something that you aren’t willing to do yourself.   The list of Republicans, I might add, who never served, is pretty substantial.

The list is not exactly partial, nor does it include Harry Reid or Nancy Pelosi, who clearly never served, themselves.  But let’s be honest.  No left-wingers like Reid or Pelosi either, so it’s funny to see the right attack those two and expect a defense from progressives.  They’ll get very little response.

My opinion is that I would rather have an integrated, digital health care 2.0.  I enjoyed the days of walking into the Army clinic to get my yearly physical or shots or whatever and never having to worry about paperwork.  It was done without my having to push it through the whole way.

Certainly, if I need some heart transplant, I’d want to pay for the best doctor I could find.  But for most stuff?  To include preventative treatment (which went out the door because of rising health care costs)?  I’d rather walk into a government clinic, have it done, and never worry about it again.

Slack-Jawed Ideologues

The chickenhawks are examples of a larger trend:  Republican ideologues are increasingly career politicians.  No military experience, no public policy experience.  They didn’t earn their way up through any institutions.  They’ve been tucked away in think-tanks and lobbyist groups.  They have no actual experience running anything, and if they did, it probably failed (see Bush the Younger, or Rove/Rumsfeld during Nixon).

Go ahead!  Wiki it.  Pick a Republican leader and see what his/her background is.  John Boehner?  He got a “bad back” and dropped out of the military, to go become a prolific House tearjerker.  Phil Gramm?  Got into military academy because of his dad, but then didn’t join the military.  Studied economics instead, and went totally neo-liberal/Friedman (a fiery mess of economics we’re still recovering from, in reality and intellectually).  Rush Limbaugh?  Family of lawyers, was classified as injured and so was an emergency Vietnam draftee never called up.  Glenn Beck?  He was a morning zoo jockey!

I mean those were the first (and most notable) names I came up with!  Total hacks.  There’s absolutely no experience running anything except a media juggernaut or a courtroom there. [Note:  Reid and Pelosi were little better…]

What’s worse:  half these folks go absolutely gay for Ayn Rand.  You know Ayn Rand.  Fountainhead.  Atlas Shrugged.   Yes, she was a fiction author.  FICTION.  See this biographer talk about Rand on the Daily Show (I apologize for the lefty link).  Yet she’s the heroine of some movement for entrepreneurship.  Really?  How many of today’s tech/social entrepreneurs love Ayn Rand?  The selfishness and lack of empathy is so perfectly captured in Stephen Colbert’s book title, “I Am America (and So Can You!)”.  It’s a wonderful mix of rugged narcissism and consumerism and desire for success all wrapped up in one.  Even “Don’t Tread on Me” is essentially a selfish slogan.  Quite a bit deal different than my old Special Forces unit’s motto, “De Oppresso Liber”, or “To Free the Oppressed” (or alternate translations).

Business

Excuse me, but if you love small business or any kind of business, why would you advocate that businesses should have to provide health care coverage?  This saddles businesses with paperwork, operating costs, and a lot of headaches that reduce their competitiveness worldwide.

Competition

It is no lie that America is home to commerce.  But it’s also true that the US has some of the least competitive markets in the world.  And these markets are backed by government subsidy and loose regulation.

The same for health care.  For Americans who value competition so much, it just seems ignorant that they wouldn’t seek to have more competition for health care insurance providers.

I can seen an argument that the government should not get into health insurance, because governments tend to grow in influence and power and crowd out business.  Okay, I can buy that.  That’s why you have to have a legal spirit of regulation allowing for a government option to compete vigorously against private interests.  The government option’s interest is in protecting the health of its citizens, while the private interest is to make profit.

These two must be put together in a system which encourages them to compete.  This is the only way to make it sustainable.

Balance of Powers

To me, there should be a vigorously-fought balance between Government, Business, Citizenry, and the Media.

Government is currently made up of lawyers.  It should be made up of public policy people whose only interest is to protect and encourage the Citizenry to be more active.  That is, make sure the Citizenry is healthy, happy, and has protections and rights.

Business seeks profit.  It is doing its job just fine in America, but it corrupts the country through lax regulation.  While I see business as working fairly successfully, I see the Government as having been infiltrated by private interests and lobbyists so that the Government has not been doing its job of protecting the Citizenry’s interest.

Citizenry needs to hold Government and Business to account.  Contesting large amounts of tax payer money for programs is key.  But so is attacking companies that pollute the Citizenry’s land and environment.  So is attacking the media for not providing them proper information.

The media could also use more competition.  MSNBC and FOXNews are as partisan as you can get, and offer no value to the Citizenry at all.  CNN is just plain worthless.  There are plenty of journalists who are trained and professional enough to seek multiple views for their stories, but a corporate-dominated media structure means that ratings win, and the best way to get ratings is through opinion.  Despite government-run organizations like NPR, PBS, and BBC providing good reporting, the Internet has now turned into the best source of news.

The Internet I did not include because it’s a medium, not a “branch” of government.  But the Internet is the only place that still has options for the Citizenry to disrupt the other branches.  This may change.  If the Citizenry wants to maintain any sort of fingerhold on Business and Government, it needs to ensure that the Internet is a public space for the Citizenry to organize, learn, innovate, and experiment.

Boy, have I digressed…  Sorry for this sprawling post.

[P.S. A couple Tea Party links.  1:  divisions amongst the ranks.  2:  some in Tea Party promote Russian analyst’s US-breakup prediction.]

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Filed under Business, Economics, Government, Health, Internet, Policy, Politics

Health Care Ennui

Just a quick note on this; been busy settling in to my new place so I have a lot to say but not much time.

The health care proposal is grinding and painful to watch.  What’s worst about all of it is I think everyone knows that the system will still suck no matter what happens.  Such ennui is what I would blame for Obama’s polls dropping.  Of course the Republicans finally found a topic to nail away on him for.  That’s a pretty risky strategy on their part, but it has consolidated them a bit.

What I really want to say is that it seems ridiculous that we can’t even CONSIDER that health care in other countries might work better than our system.  Frontline did a great story on looking at health care systems around the world to see what they did, including Taiwan, which started from scratch, taking the best from different systems.

What’s also ridiculous is that the Republicans fight tooth and nail against universal health care, even though the military operates under that system for not only servicemembers but also for their families.  Yes, that most red-blooded system in America, the US military, uses SOCIALIZED HEALTH CARE paid by tax-payers!

Make sure you read/watch Bill Kristol telling Jon Stewart that military servicemembers deserve better care than American citizens.  Kristol, of course, has never served.

I miss the military medical care cushion.  So when my senior sergeants’ wives got pregnant, the Army paid for ALL of the costs associated with the pregnancy and delivery.  When my friends got sick or hurt, the Army took care of them.  Sure, some of the diagnoses and surgery were horrible, but the preventative care and defraying the costs that are associated with the medical system were superb.

It was wonderful to transfer to a new assignment on a new base, or deploy to Iraq, and NEVER HAVE TO WORRY ABOUT HEALTH CARE.  It was a centralized system (although not yet on an online database that you have control over, like what Google Health is trying to do) and you’d always be taken care of.

The best part?  Far less stress on everyone’s part, and the system wasn’t trying to make money off you.  Not wholly, but partially, the system also had proper economic incentives to make you healthier faster instead of trying to rape your pocketbook.

I’ve read that China used to have proper incentives:  if your health failed to improve, your doctor wouldn’t get paid.  How did this end up working out, I wonder?

I would like to see health care examined as a guarantee under citizenship.  I would hope that participating part of one’s identity and time to serve the government or military would confer upon that person the ability to receive a standard of health care so that he may be productive back to American society.  But right now, under a poorly regulated private insurer system, insurance dominates by reducing people to normalized baselines where abnormalities are punished (read NYTimes’ article on defining “health”):

“And then there is a larger question. How does “absence of abnormality” affect our perception of health? This construct is both too narrow and too broad. It’s too narrow because there is more to being healthy than striving to avoid death and disease. Health is more than a physical state of being; it’s also a state of mind.

“And it’s too broad because all of us harbor abnormalities. The construct drives the system to look for things to be wrong — a search that will be successful in most of us. We then feel more vulnerable. This induced vulnerability undermines the very sense of well-being and resilience that in many ways defines health itself. Viewing health as the absence of abnormality thus conflicts with the desire for a healthier society.

“Furthermore, the strategy has created a host of other problems: doctors who are overwhelmed by the number of ailments their patients allegedly have (and who are often distracted from the most important ones); doctors in training who are increasingly confused about who is really sick and who is not; lawyers who increasingly have a field day with the charge of “failure to diagnose”; patients who get too much treatment or lose health insurance because they been given a new diagnosis; and a frazzled, fearful public adrift in a culture of disease. Oh, and did I mention that it has been a disaster for health-care costs?”

Paul Krugman explains it right:

“The key thing you need to know about health care is that it depends crucially on insurance. You don’t know when or whether you’ll need treatment — but if you do, treatment can be extremely expensive, well beyond what most people can pay out of pocket. Triple coronary bypasses, not routine doctor’s visits, are where the real money is, so insurance is essential.

“Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.”

Until free market ideologues understand that productivity is a long-term affair and not just grinding more hours/day out of each employee for fewer wages, the resolution of the health care system in America will never take place.  Wellness, preventative care, and incentivizing health care providers and insurers to make sure people actually are HEALTHY…those are the goals we’ll end up building our system for.

One last note:  what if there were a private market of new incentive metrics?  Or maybe this could even be a joint program with the doctors’ associations and NIH.  What if we could come up with new happiness indices and measures of lifestyle health (how many times one exercises, how much one walks per day) that doesn’t penalize you in the context of what risk you pose to an insurer?  We have virtually no lifestyle metrics that aren’t being kept from us and which aren’t being used to hurt our viability for insurance or recruitment.  We need our own tools to measure our lives and form our own metrics of what we consider important to ourselves.

Some ways:  Nike+, FitBit, Galapag.us.

Thoughts?  I’ve about given up on the US seriously reforming health care.  It’s just not going to happen politically (we can’t even allow gays to openly serve in the military yet) unless a strong executive strong-arms it through — and that may not necessarily be a good thing.

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Filed under Economics, Government, Health, Military, Policy