In the case of the US medical system, we've been taught by our leading opinion-shaping institutions – public relations, marketing and advertising – that health care is a privilege to be auctioned off to the highest bidder and not a universal right to be shared by and for the general welfare of society.
Single-payer butts heads with the American archetype
We're so steeped in the rugged individualist, go-it-alone archetype that the idea of making common cause with "those other people" – working toward a shared objective of improving quality of life for all members of society, not just those who can afford it – is anathema and, increasingly, un-American. I fully expect some gasbag GOP presidential candidate, before primary season mercifully ends, to come up with something like, "If we go to a non-profit health care model, the terrorists win." Any bets?
In fact, our apathy or antipathy toward those who don't share our looks, background, ideals, language, income, education or culture is driving the US toward an endgame that bears an uncanny resemblance to the Friedman/GOP-style unregulated free market model, with peace for none and antagonism toward all.
They've divided and conquered very well. No surprise; given the massive resources of the entire insurance industry, along with an approving pat-on-the-back from our "representatives" in Washington, it would be odd if they hadn't done a good job of keeping us at each others' throats and away from theirs.
The insurer as friend and savior
Distraction also helps produce the suspension of critical thinking required to believe in the most illogical premise of all: that America has the best medical care system in the world and has achieved that lofty position because the most voracious, profit-hungry, inhuman corporate institutions routinely ignore their sole reason for existence, as well as a file cabinet full of SEC regulations and case law precedents that demand a publicly held corporation pursue profitability with single-minded, sociopathic disregard for basic human values. This is nothing less than a case study in the impossible, but it's the core tenet of the great American health care fairy tale nonetheless.
So are these corporations portrayed in media and pop culture as the enemy, as one would expect? Of course not; they're the solution. The US, unique in the world in its child-like belief in corporate good citizenship, expects these rapacious profit machines to completely abandon their chartered mandates requiring them to churn out ever more money for their stake-holders and, instead, act in the best interests of their customers.
Never mind that those two objectives are locked in inexorable conflict. Never mind that medical insurance is a zero-sum game and, when the insurer pays a claim, that's money grudgingly subtracted from the bottom line. Never mind that the insurance industry employs an army of obstructionists – known ridiculously as claims adjusters – whose main job it is to find some quasi-legal way to "adjust" your claim all the way to $0.00. Never mind the inevitable outcome of those conflicts: that the US isn't even in the top 30 according to the landmark 2000 World Health Organization study. Nope, never mind all that. The industry is our friend and savior, and where would we be without them? Other than healthier and happier, with more disposable income, that is.
As one California psychologist who serves on several managed care rate negotiating teams in the Santa Cruz area told me a while ago, “They have become adept at providing the illusion of health care, while avoiding the messy and expensive reality of having to actually deliver it – to the extent legally possible. And you’d be amazed at what’s legally possible. Most of the time you can’t even sue them so, at some point, the consumer literally has no recourse but to beg for his or her life. Increasingly, those pleas fall on deaf ears as the race to maximize profits obliterates what’s left of basic human kindness.”
So much for the good news. We now need to examine the nature of single-payer, universal-access health care: what it is, what it isn't, how it compares and contrasts with the US for-profit model.
So what exactly is single-payer and why is it better than what we have now?
Well, surprise surprise, it's not socialized medicine. The federal government won't set up shop in every doctors office and medical facility. Unlike the current system, in which privatized pests occupy a permanent position overlooking every doc's shoulder, governmental bureaucrats won't be making harassing calls to doctors offices every five minutes to second-guess whether a patient actually needs that procedure, or that test, or that prescription.
Let's say your doc has his own small family practice, which he runs as an LLC. He probably accepts payment from a couple of dozen different insurance carriers. Does that mean he works for, say, Blue Cross or Cigna or Aetna? Of course not.
Under single-payer, he would no more work for the government than he now works for an insurance company. He gets paid by the feds, but runs his own business exactly as he has for many years.
In fact, if a patient just looks at the outward signs, things are very much as they've always been. You see the same doctors and support staff. You have blood drawn at the same labs. If you're seriously injured or suddenly become ill, you end up at the same ER. You see the same specialists. If surgery is required, the same group of medical professionals handles the entire process – from pre-op to rehab. You find that service is about as fast, or as slow, as ever. And if you want a tummy tuck or nose job, you're still going to have to pay for it out of your own pocket.
The payer changes – from any of hundreds of private insurance companies to a single entity – but the process of providing and receiving medical care remains the same. Actually, it improves because single-payer eliminates the armies of bureaucrats the insurance industry employs in an effort to squeeze the last mil out of every penny by denying coverage or illegally reducing benefits.
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