How to operate Medicare

If you want a good society, then figure out a way so that the good doctors and good teachers get to run their professions. In other words, the politicians don't get to do it.

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Image Credit: Michael T. Hertz

A longtime conservative friend of mine and I have been arguing back and forth about Bernie’s plan of Medicare for All.  I’m very much in favor of it, and my friend is against it. During this argument, I happened upon articles concerning the system in Finland for operating its very successful school system. The basic core of the system is that the society, through its government, provides all of the financial support for all schooling.  Home schooling is permitted, but the school system is so effective that few people take advantage of that option. Private schools are permitted, but their finances are all provided by the government, and the schools are not permitted to charge extra fees. In effect, the private schools operate on the same budget as the public schools. The result is that the wealthy, the middle class, and the poor all attend the same schools, which means that the wealthy support the public system and the parents of all children are engaged in making certain that the schools operate well. And they do.

Here’s the difference between the socialism of Finland and the socialism of Russia. Russia wants the government to run everything. The Finns (and I) want it to be possible for private groups to run things. You can have private schools in Finland.  You just can’t charge money to do it. Well, who cares? If you like to run a school, you can apply to have one.  The government will pay the costs, and you get to run it. The real question is how much control will the government exercise. But you can imagine a country in which the government puts up the money but the teachers get a lot of freedom to run their classes – can’t you?

Now apply the same basic structure to healthcare. Can you imagine a country in which the doctors have a lot of freedom to run their practices but they are paid out of general taxes? Sure, they can’t become billionaires, but they can do what they wanted to do – be doctors.  Save lives. Make people healthy. What’s important: making money, or saving lives?

If you’re a good doctor in a country like that, you may not be earning millions, but you are going to earn the right to make the healthcare system a better place. In other words, what you get for being a good doctor is power within the system. And one other thing: you get recognition and respect from the community and the society.

If you want a good society, then figure out a way so that the good doctors and good teachers get to run their professions. In other words, the politicians don’t get to do it. The people educated to operate the system set the rules along with the clients of system. The people operating the system are motivated to make it operate effectively.

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The problem with the U.S. is that it believes that MONEY is the chief incentive for people to help their society. This isn’t true. If you an adequate income, your focus shifts to gaining recognition and respect and having power to make changes within your profession. From a social standpoint, you should want more equality in spreading money around. And people will accept that result so long as they see that the good doctors/teachers/lawyers/etc. get recognition and respect and earn power to control their own professions.

One important thing I learned in attending law school was to watch out about laws and rules that have bad side effects. Unfortunately, almost every law creates bad side effects, and you have to draft laws and rules that avoid that result as best possible. If you have a society in which MONEY is distributed unequally, you soon discover that the people with money corrupt the political and social system. If, on the other hand, everyone has a fair amount of the social wealth, this would be far less likely to happen.

The basic argument for capitalism is that the right to earn money without limit inspires people to create economic ventures, and those ventures improve the society. That certainly can be true, but we’ve found that letting MONEY go into the hands of a small group (even one that includes people who create economic ventures) means that the society can become corrupt, and far too many people are deprived of enough MONEY to live decent lives.

My belief is that people can be (and are) motivated by recognition and respect and the right to have power within their profession. In other words, if everyone has enough money, people are still inspired to create.

If you look at the economics of our society, I think you’d quickly realize that we could spread the wealth around and give everyone plenty of money. I did a quick Google and learned that the total household value in the U.S. is $100 trillion and that there are 126 million households. Do the math. If you divided the wealth equally, every household would have $793,000. In other words, everyone would have enough, and no one would have too much. (They say that Bernie Sanders has about that much money).

I’m not saying that EVERYONE needs exactly that same amount. But is no household had less than $500,000 or more than $2 million, corruption would be less rampant. And if the government funded all the enterprises the way they do in Finland with schools, the people with good ideas would be able to make them reality.

The real issue in a society like that would be: who gets to decide how the government spends its money? My hope would be that the smart people would get to make those decisions – and that they would be paid in recognition and the power to make those decisions. And, of course, they would have plenty of money, as would all members of society.

The people who want capitalism would argue that an egalitarian society would make people lazy (because they had a guaranteed income). I don’t believe that. Kids work hard in school, and they don’t earn money doing it. They earn recognition and respect. In other words, there exists motivation for reasons beyond money. The billionaires have plenty of money and yet they continue to strive. They want recognition, respect, and power. Those are the real motivators of society.

But who would be doing the crummy jobs if everyone had money? Over time, the crummy jobs would need to be eliminated, or the way we treat those who do crummy jobs would need to change. We would need to find incentives so that those who did crummy jobs would feel motivated to do them. But in the meantime (hopefully) doctors and teachers would be motivated to do their own jobs, using government resources and finding new and better ways to make healthcare and education function better.

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