CONNECT
What Kind of Society Do Americans Want?
Published: Monday 21 May 2012
The fact is that, in terms of social conscience, the U.S. is still quite a primitive place and this primitiveness is sustained by a philosophy of selfishness.
Part I - Health Care in the USA
On 7 May 2012 a new study came out on healthcare in the United States. Based on research carried out by the Urban Institute, the report is published in the journal Health Affairs. Here are some of its findings:
– There is a prevailing "trend toward private insurance policies with larger deductibles and higher co-payments..."– "Employers [are] shifting more [heath care] costs onto workers."
– "Poor and uninsured adults [there are presently 41 million such people in the U.S.] had greater difficulties not just with health care costs, but finding doctors who would see them." In addition, "too few providers are taking Medicaid" patients.
– One consequence of this trend is that "one in five American adults under 65 had an ‘unmet medical need’ because of costs in 2010, compared with one in eight in 2000."
What all this means is that health care in the U.S. has deteriorated in the first decade of the 21st century. That was also reflected in a 2005 study by the World Health Organization that ranked the United States (supposedly the richest of nations) as 141st in government spending on health. Perhaps not unrelated, the U.S. ranks number 1 in the world when it comes to anxiety disorders.
Part II - The Philosophy Behind the Decline
This situation reflects a culture-shaping philosophy that has persisted in this country, with but brief interludes, since its founding. That philosophy teaches that we all are, or should be, rugged individuals. We should take care of ourselves and not rely on others. That is our responsibility in life and if someone can not measure up its their problem, not society’s.
Where does this attitude come from? There are no doubt multiple roots, but one source is an historically deep-seated national dislike of taxation. From the first moment of revolution against Great Britain, freedom meant escaping imperial taxes. Americans of that day claimed that only elected local legislatures could rightly lay down taxes. The claim was made, in part, because within such a localized system taxes could be kept to an absolute minimum.
This attitude toward taxation is, in turn, at the heart of the original capitalist outlook as it evolved in the 18th century. According to this perspective there are only three things for which the government can rightly tax its citizens: national defense, internal security (including the court system) and the enforcement of contracts. Beyond that the government must leave people alone and that includes not "over taxing" them and not regulating any of their business affairs.
This philosophy has caused untold misery since its inception. For the first century of the industrial revolution when the government of Great Britain (the original industrializing nation) was controlled by people who wanted minimal taxation and no business regulation, working class people lived in dire poverty, environmental pollution was rampant, industrial safety was non-existent, and health care for the poor was the concern of private charity only. Why? Because for the government to address any of these concerns would cost money and that would mean raising the taxes of the folks who had money.
It took over one hundred years of labor organizing, strikes, riots, outbreaks of preventable diseases, and the incessant pestering of elected officials by that small minority of the population who thought all this was a scandal (mostly women and religious folks), to force politicians (kicking and screaming) to address social needs and enforce health and safety related regulations. The Great Depression beginning in 1929 forced the issue with a vengeance and led to larger government and the "welfare state." In other words, it led to a sense of social responsibility on the part of Western governments--most reluctantly the U.S. government. In America, that lasted through the 1970s and then the situation reversed.
One would think that memory would serve us for more than a mere forty odd years. That after suffering all the misery brought on by 19th and early 20th century capitalism we would have learned that to achieve social peace and a modicum of general prosperity, the government must perform important community functions including supplying all its citizens with decent and affordable health care.But no it hasn’t worked that way. In 1981 Ronald Reagan became president. He started the process of deregulation and shifting taxation away from the rich. Others, including Democrats like Bill Clinton, followed along. When recently Barack Obama proposed health care reform he was labeled a socialist. Now, just listen to Mitt Romney and his Republican cohorts. Just listen to the Tea Party cabal. Just listen to Fox News. All of them want to go back to the "good old days" of minimalist government and minimum taxes. By the way, in the midst of those good old days, about the year 1843, the median age of death in the industrial city of Manchester England was 17.
Part III - What Kind of Society Do Americans Want?
This leads us to the question, just what sort of society do Americans want? Indeed, do they want a meaningful society at all?. Why not just stick to family units or small tribes drifting about in a state of nature? Well, in a sense that is what we chose to do. The tribes have become larger and today we call them nation states. But in the American version, localism makes for myriad sub-tribes. In the state of Pennsylvania, where I live, the people in the relatively rural center of the state as well as those in the urban suburbs, not only care little for those living in cities such as Philadelphia and Pittsburgh, they actively dislike them. They don’t feel like they live in the same society. And they certainly don’t want to be taxed to help an urban population with a lot of poor folks. In others words, whatever sense of social solidarity rural and suburban Pennsylvanians feel, it does go much beyond their own local community (or "tribe"). And Pennsylvanians are by no means unique in this country
The fact is that, in terms of social conscience, the U.S. is still quite a primitive place. And this primitiveness is sustained by a philosophy of selfishness. Among other things, that prevailing philosophy is making an ever greater number of us unhealthy. Is this acceptable to most Americans? Is thos the kind of society they want? The political practice since 1981 seems to answer, yes.
ABOUT Lawrence Davidson
Lawrence Davidson is professor of history at West Chester University in West Chester PA. His academic work is focused on the history of American foreign relations with the Middle East. He also teaches courses in the history of science and modern European intellectual history.
ldavidson@wcupa.edu
To The Point Analysis
Twitter Feed
ldavidson@wcupa.edu
To The Point Analysis
Twitter Feed
Follow Lawrence Davidson via RSSMake your voice heard.
Write for NationofChange
Write for NationofChange
9 comments on "What Kind of Society Do Americans Want?"
June 15, 2012 2:09pm
Now, a general comment about the 'tax and spend' mentality that seems to have such a hold on 'progressives'. First of all, taxes make their way to the coffers of the politicos in DC. There they become disposable income for a group of irresponsible, power hungry individuals of the left and right. Who says that they have the right to take my money and give it to someone else? That is nothing short of downright theft, to sit there funding pet projects, or deciding that 'we' the people should gift money to sooth our collective 'social conscience'. That is akin to attending church on Sunday and being frisked at the door, and having your 'tithe' removed from your wallet by those who know more than you. This is not the US of Europe, where governmental interference is welcomed. There is an independent spirit here that rankles at the leftist drivel presented by some.
May 27, 2012 7:24pm
This reminds me of John Steinbeck in "America and Americans": "I guess the trouble was that we didn't have any self-admitted proletarians. Everyone was a temporarily embarrassed capitalist". This problem is also applicable to education and public perception of academia.
May 27, 2012 12:45pm
Do We Really Have A Choice In Health Care?
This year, the “Affordable Health Care Act” will increasingly affect us and we should be prepared for the debate.
Politicians will seek our votes by presenting all sides of the health care issue. Actual facts will often be distorted or left out of the discussion.
Health care is extremely important to all of us. We do need to pay attention and try to sort through the facts.
The following information came from the latest Organization of Economic Development and Cooperation Report on Healthcare for 34 leading industrialized nations. (Source: www.stats.oecd.org)
Annually, the US spends $2.7 Trillion or 18% of our gross domestic product (GDP) on health care. This is $7980 per person. In 2000 it was $4793 per person or 12.4% of GDP. This is a 66% increase in just over a decade.
The other 33 industrialized countries spend about half of what we do. Canada spends $4478, UK $3487 and Denmark $4348
The money we spend on health care is the reason we believe we have the “best medical care in the world”. Sadly it is untrue.
Child mortality and life expectancy validate the untruth.
The child mortality rate in the US is 6.5 deaths per 1000 live births compared with Australia 4.3, Italy 3.7, and Finland 2.6.
Life expectancy at birth for the US is 78.2 years versus 82.3 years in Switzerland, 81.8 years in Spain and 80.3 years in Greece.
So why do we spend so much and perform so poorly?
There are several reasons. Spending on drugs is one.
In the US we spend $956 per person per year on drugs compared to $275 in New Zealand, $521 in Switzerland and $734 in Canada.
Senator Kohl (D-WI) and Grassley (R-Iowa) may have moderated drug expense in the US by requiring the drug companies to report money and other items like trips and dinners given to doctors. A New York Times analysis published on 1/16/12 stated that 25% of doctors take cash directly from the drug companies.
Digging deeper into the data it is clear some of the disparities can only be explained by widespread disease conditions. The first and maybe the largest is obesity. Being obese means you are 20% or more over your ideal body weight.
In the US, 27.7% of us are obese compared to 13.4% in Denmark, 11.2% in Sweden and 10.2% in Italy.
Hospital beds, in the US are 3.1 beds per thousand people versus 13.7 in Japan, 8.2 in Germany and 5.1 in Switzerland.
The number of nurses per 1000 people is also an indicator of how well people are being cared for. We have 10.8 nurses for every 1000 people compared to 15.3 in Iceland, 15.2 in Switzerland, 14.8 in Belgium and 11.0 in Germany.
In addition to an apparent nurse shortage, medical doctor graduations, per 100,000 people, are also coming up short. The US graduates 6.5 doctors each year for every 100,000 people. This is two thirds lower than other countries with Ireland graduating 16.2, Denmark 16.4 and Germany 12.5.
Tragically, over 50 million Americans do not have access to regular health care. This is in direct opposition to the rest of the industrialized world that, without exception, provides coverage for all their citizens.
If we normalized our total spending on health care to include the 50 million people that currently do not have access (Source: Kaiser Report on the Uninsured), our cost would soar to over $3.25 Trillion per year or 22% of our total GDP.
That is the cost if we continue to operate health care as we do now.
Insurance companies extract as much as 40% of the premiums we and our employers pay. The insurance companies use these funds for non-medical corporate expenses including marketing, administration, bonuses, dividends and profits.
The “Affordable Health Care Act” will limit the amount of funds that insurance companies can extract to 15% of premiums paid, but this is still being lobbied. Medicare manages the same functions for an economical 2-3% according to the Congressional Budget Office.
We should remember health care insurance companies never deliver actual health care. It is heart-breaking that as much as 40% of what we pay is carved out by these companies.
Private insurance explains much of the cost disparity between the US and other industrialized countries. We need to remember that all comparative industrialized countries have universal national health care systems similar to our Medicare for Americans over 65 years.
When it comes to health care in the US it is evident we are paying for a Cadillac, but we are driving a Kia.
According to a January article in the Atlantic magazine, the concentration of health care spending is excessive, with the top 5% of people consuming 50% of total expenditures. The major cause is that they are often elderly, gravely ill, and approaching death.
We also have a system of “paying” for procedures versus outcomes. If we pay doctors for success in outcomes, they would do it as cost effectively as possible, without calling for excessive procedures to achieve maximum allowable billing while avoiding potential lawsuits through un-needed “defensive medicine”.
All of this means we really have disease management versus true healthcare. We need to strategically change this as soon as possible to achieve better outcomes and greater economy.
The health care issue in America could be resolved for less than the $3.25 Trillion needed to cover everyone.
Simply modify the existing Medicare eligibility language to, “All Americans qualify for Medicare at minus nine months of age.“
Doing this will “transform” health care in America.
We could begin to pay for medical outcomes versus services provided. We would have everyone in the plan with effective preventative care. We would reduce infant mortality. We would improve our overall health and extend our lives. We would train more doctors and nurses. We would become healthier and more competitive as a nation as we would be more productive at work. We would have everyone contributing to the program. We would have more resources for actual health services.
Importantly we would forever be free of insurance and drug companies tampering with our personal freedom and democracy. Their corrupting influence on our health care, via lobbying in Congress, would end.
What we have today is an unbalanced, inadequate, unsustainable and outrageously expensive system which, some would suggest, looks a lot like a “racket”.
As we move into this election year, it is important that we convey our point of view to our political representatives at the local, state and national levels of government.
As we think this issue through, we might ask ourselves these questions:
“Can the current health care I have with my family, continue into the future?”
“Will my employer continue to pay for it? And for how long?”
“What will the price of health care be five, ten and twenty years from now?”
“If the current trends continue, will my family be able to afford health care?”
“What will I do if my family and I lose our healthcare tomorrow?”
So, do we really have a choice in Health Care? I believe we do.
It is called, “Medicare for all”.
Michael D. Muoio
Appleton, Wisconsin
November 10, 2012 2:54pm
HEALTH CARE IS AN EXTENTION OF CAPITALISM,IF AND STRESS THE WORD IF WHEN WE ALL PAY FOR A PART OR ALL OF OUR HEALTH CARE I BELIVE WE ALL WILL BE ON AN EVEN PLATFORM.BUT WHEN YOU HAVE A GROUP OF PEOPLE BY NO FAULT OF THEIR OWN THAT CAN NOT AFFORD TO PURHASE HEALTH CARE THAT PUT THE STRAIN ON EVERY ONE IN THE COUNTRY.AND BELIVE ME ITS NOT THAT THIS IS THE CAUSE FOR SOARING COSTS BUT IT ADDS TO THE PROBLEM.AND THEN YOU HAVE PEOPLE THAT WILL NOT PAY AT ANY COST FOR INSURANCE AND WHEN THEY GET SICK WE AS A NATION GET STUCK WITH COST WITH SOARING COST FOR CARE AND THE COST TO INSURE ARE FAMILY.I AGREE WE NEED A ONE PAYER SYSTEM AND A REAL EFFORT TO CUT THREW THE CHASE TO HEAL A PATIENT IN THE HOSPITAL AND TAKE EVERY EFFORT TO HAVE PROGRAMS TO STAY AHEAD OF THE GAME WITH EARY DECTION AND SO FORTH
July 02, 2012 3:20pm
This is one of the most concise, factual responses I have read on America's health care system and how it must change. Thank you Michaelo Muoio! Having been to international medical meetings abroad, as well as traveled to many countries on my own, I can attest to the fine medical care in other countries. Those in medicine there love it, the people love it and neither would do without it. As one man, changing my tire, stated, " I don't like taxes anymore than anyone else. But I don't mind it going to my medical care. It is good, the doctors are great, and no one in my country has to go bankrupt because of illness or accidents. I can't believe that Americans put up with the system they have.; insurance companies telling what surgeries , drugs or treatments patients can have, not insuring someone because of a previous condition or getting such a profit off of the sick. At least my government doesn't tell my doctor what to do, no drug or insurance company is paying them to do something, and we have great care." Even Canada, that pays doctors directly, doesn't tell them what to do, so Canada isn't 'socialized' medicine like the country I had my tire changed in- but Canadians consider their health care system their greatest acheivement...and rightly so. I also discovered that the 'wait' time in those countries is only for non-emergency care. That's what we already have here. Doctors wait for scheduling, hospital booking, and insurance approval which puts non-emergencies on a wait of 4 to 6 weeks on average. And since we have fewer doctors here, their own schedule can often add several weeks into the picture.
The fact is, we have been lied to over and over about socialized medicine. Who has done the lying? Follow the money for the answer- who has more to lose?
June 14, 2012 12:10pm
Excellent, well thought out post, sir. I agree 100% with it. Personally, I feel the place to begin is with a wholesale reform of Congress, namely, to end the corruption that lobbying is causing. So long as the health insurance industry and Big Pharma continues to make multimillion dollar campaign contributions we can never hope to have Congress on the side of the American People. Instead they will continue to kowtow to big business.
May 27, 2012 8:25am
Bumper Sticker seen while driving through Oklahoma:
VOTE CHRISTIAN! NOT MORMON!
Those Okies aren't as dumb as they look.
May 25, 2012 9:43pm
The Medigap insurance we use, AARP by United Health Care, to which we as a couple have been enrolled more than 5 years, has increased our premiums from $173.00 each to $235.00 each. That is a huge, huge chunk of our Social Security income. Our Florida Home Owner Insurance with State Farm (which we had for 35 years) went up 38%. .. to $395 monthly. And we have had very few claims for home damage during that period. We don't live on the water or in flood zone. Our disposable income has plummeted to poverty levels, and most of the blame goes to private insurance companies and other private corporations.....where profits are soaring and CEO pay is outrageous.
June 15, 2012 1:57pm
I've heard similar stories from others in my area in Florida. State Farm has actively been trying to move people off of it's policy rolls to decrease it's exposure. The answer? Get quotes from other insurance agents! Don't just pay it with no effort to find another company. Same thing with UHC, look for alternatives. Homeowner's insurance through an independent agent should cost you more than $150 month, unless you are close to the coast or a low lying area.