This column ran in today’s edition of the Saint City News. In this on-line version, I have added a few footnotes to support my arguments.
Do you think politicians are all liars? Did it ever occur to you that lying politicians might be the least of your troubles?
Sometimes politicians tell the truth and we can hardly believe our ears! So when they say what they think, we should pay attention. (1)
Albertans had one of those moments last week – or should have – when Health Minister Ron Liepert explained what’s being called his “private health vision.” (2)
Mr. Liepert was actually explaining why he’s packed the province’s new “health care super-board” with business types, while the body that will replace Alberta’s nine regional health authorities conspicuously lacks physicians, nurses, health union members and ordinary citizens. That is, people who know what they’re talking about and have more of a stake in the system than just squeezing money from it.
“What we need is a board with people who have … private sector business experience,” Mr. Liepert told the media. “I don’t view myself as an MLA as being a member of the board of directors. I view myself as a shareholder in this operation. And as an investor … I want the best return on my investment.” (3)
Say what? (Question: What do investors look for? Answer: profit.) Albertans didn’t elect this government to be passive shareholders. We elected them to run things. That is, to act like a board of directors.
The fact is, where business does run health care, it’s a colossal failure. Nowhere is this more obvious than among our neighbours to the south, where, weirdly, our provincial government looks most often for health care inspiration.
The U.S. health system defines dysfunctionality. It costs American taxpayers more per capita than any health system in the world, including Canada’s and Alberta’s. (4) Yet the results it delivers are pathetic – lower average life expectancy than most other rich countries, higher infant mortality than Cuba, for heaven’s sake! (5)
Its most spectacular failure is that it leaves approximately 50 million people out of a population of 300 million completely without health insurance! (6) Another 100 million have too little to cover a major illness. (7) So it shouldn’t reassure us that Mr. Liepert has placed atop the super-board a representative of the private insurance industry – which can’t even deliver cheaper auto insurance than government, let alone health insurance. (8)
Albertans suffer cognitive dissonance when we contemplate the real problems of health care. We know the private sector can’t do the job, and we know why: built-in profits, bloated corporate bureaucracy, higher administrative costs, resources wasted screening out high-risk patients, and so on. (Adopting Canada’s single-payer system, notes economist Paul Krugman in the New York Times, would save the U.S. system $200 billion a year.) (9) But still we look to corporations for answers. If nothing else, this demonstrates the power of ideology over common sense.
Imagine, for a moment, if the “successful” U.S. health system was projected onto our community. There are approximately 60,000 of us here in St. Albert, so – using the U.S. as a yardstick – roughly 10,000 of us would have no health insurance at all. If we got sick, we could die.
Another 20,000 St. Albertans would have some insurance, but not enough to save us from financial ruin if we suffered from, say, cancer or a heart attack.
The remaining 30,000? Well, I guess they could gather at Servus Place and say, “I’m all right, Jack!”
Who would be among the 10,000 with no health coverage? Anyone with a predisposition to a medical condition, of course – diabetes, Down syndrome, asthma… Many of the elderly, young people starting families. (10) (Do you think St. Albert’s taxes are too high? Try paying U.S. style private health premiums!) (11)
Are you are having trouble imagining this? It doesn’t sound like Mr. Liepert is. Indeed, it sounds as if he’s counting on us to confuse two concepts that sound similar, but don’t mean the same thing: “businesslike” and “like a business.”
Does Mr. Liepert actually believe that the private sector can do a better job of running health care than public enterprise? This is the scary part: despite all the evidence, it’s a safe bet he does.
In other words, he may just be telling the truth, and that makes him really dangerous!
(1) Arguably if we had paid attention when certain middle European politicians had made their governance plans known in the late 1920s, the world would have been a better place.
(2) Edmonton Journal Headline, Page 1, Saturday, May 17, 2008.
(3) Edmonton Journal, Page 1 and 2, Saturday, May 17, 2008. The full quote from the Journal reads as follows: “I don’t think government does a good job of running a $13-billion operation. What we need is a board with people who have governance, private-sector business experience, running it like a $13-billion operation. And I don’t view myself as an MLA as being a member of the board of directors. I view myself as a shareholder in this operation. And as an investor, as a shareholder in this operation, I want the best return on my investment.”
(4) Wikipedia, quoting the U.S. Census Bureau, Aug. 2007. “The U.S. spends more on health care, both as a proportion of gross domestic product (GDP) and on a per-capita basis, than any other nation in the world.”
(5) Wikipedia, quoting the United Nations Population Division and the CIA World Factbook, List of Countries by Infant Mortality Rate. From the CIA list, which is more favourable to the United States: U.S., 6.3 per 100 live births; Cuba, 5.93; Canada, 5.08; Singapore, 2.30.
(6) This number is well established. The figure most widely quoted on the Internet is 47 million in 2006, with estimates of other reasonably reliable sources ranging as high as 61 million. A paper put on line at Case Western Reserve University suggested this number would reach 55 million in 2008. Most sources report the number of completely uninsured Americans is on an upward trend.
(7) Determining the number of under-insured Americans is much harder, with estimates all over the map. Estimates from reliable sources range from 14 million to well over 100 million. The problem, of course, hinges on a definition of “under-insured,” which is ultimately a matter of opinion. However, if we include U.S. Medicare enrollees (40 million) and Medicaid enrollees (50 million), the numbers would easily be well over 100 million.
(8) The Consumers Association of Canada reported in 2003: “Alberta consumers pay on average about twice as much for auto insurance than consumers in the other three western provinces with public auto insurance systems.”
(9) One Nation, Uninsured, by Paul Krugman, New York Times, June 13, 2005. Krugman’s columns on this topic are all worth reading, and can be accessed from the New York Times’ Website.
(10) High blood pressure, diabetes, HIV, pregnancy… you name it! Pre-existing conditions can get your health insurance denied in the United States. Administering this saves individual insurers money, but costs the system as a whole much more. Of course, the United States being the great market that it is, you can buy extra insurance to cover pre-existing conditions – if you have the money, of course.
(11) In 2004, according to the Kaiser Family Foundation, health insurance premiums in the United States reached an average of $9,950 annually for family coverage ($829 per month).