Thursday, July 9, 2009

Our biggest mistake

Whenever I try to reason out why something that seems crazy to me is as it is, I always end up concluding that something very fundamental about my perspective is different. Thus the challenge I face in trying to explain a suggestion is actually to coax the reader to share that perspective, if only for a moment.

An example of this is noticing that any genuine health care industry's most fundamental goal would be to put itself out of business--render the administration of health care honestly obsolete. Even if that end is never reached, it suggests that the best measure of a health care industry is how few people need any health care. To me, that suggests I should compare it to the way we deal with fire. (I posted a reform strategy earlier.)

The only real difference between the two industries is that you are unlikely to ever have a health condition that seriously threatens your entire community. Whereas the opposite is true for fires. You're very unlikely to have one that does not threaten everyone else as well. Too bad for all of us I suppose because if we viewed health care as we do fire, we'd have no doubt discovered enormous numbers of preventative measures we could deploy to mitigate the need for emergency response.

Because of the difference we can easily see why we have basically a socialistic approach to fire (where the state pays for fighting them and forces compliance in safety measures from us.) Private companies compete to sell us compliance, insure any loses, but also have a conflict of interest in that an opportunity is created for them to lobby government to adopt standards that may be more about generating business for them than making our lives safer from fire.

Because of the similarities, we already incorporate part of health care, emergency response, into fire departments. The logistics involved in having more than one coordinated entity to cover an area make response any other way simply impractical. A fringe benefit is that you can get a pretty accurate idea of what it costs to provide that part of health care per person per year. There are about 201,200 paramedics earning a median wage of $28,400 to cover roughly 300 million Americans. It comes to $19 each, but just pays the salaries. So the per person per year cost of the 911 based emergency health care response is about fifty bucks.

How is this paid for now? Haphazardly probably best describes it. And very unfairly considering that everyone in a community enjoys exactly the same coverage whether they pay anything for it or not. Its just another tiny cut in the flesh of our credibility as a society, no big deal on its own. But these cuts are everywhere, and they're remarkably easy to fix, completely needless artifacts of a legacy predating computers that should now yield to a better mechanism that leaves us more connected to reality.

We can fix only what we can see is broken. By burying the costs of things in layers or mixing them together we undermine our own ability to address them. We disconnect our ability to see our own role in creating them. We make it harder to discover relationships between things. A better idea of the true cost of health care would leave us more motivated and better able to discover and evaluate preventative measures.

But worst of all we undermine our own ability to have respect for our society! We have allowed the infrastructure of our lives to become opaque and arcane and no longer respect or even trust it. This seems to do everything from allowing people to rationalize criminal behavior to avoid paying all their taxes. It's just incredibly dumb to accept this situation for lack of fixing such amazing simple problems--like letting people actually see an itemized bill for the things our society does for us we might not even notice.

If our government honestly wanted to become better at governing us well, wouldn't their highest priority be to ensure the electorate had enough education, knowledge, and information to choose the best representation and most competent peers and successors? To me that means giving us a map of our economy, looking for ways to educate us on the reasons things cost what they do, on how our choices affect those costs, and what opportunities there are to avoid them. We need the information necessary to better connect the choices we make to the actual price we, as individuals, pay for them. Not doing that is our biggest mistake because it costs us the very selective pressure that would enable us to make the sort of choices that leave us most empowered, free, and striving towards the goals that enchant rather than simply sustain us.

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