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Band-Aid Plan To Fix Health Care Won’t Work

(Published in the Main Line Times and the Delco Times)

As the attempt to reform our health-care system crescendos, it is difficult to pinpoint exactly where the debate lost its way. Perhaps it never truly began in the right direction.

Between the fear-mongering and the screaming, it seems some of the most pressing issues – medical inflation and warped incentives – have been sidelined. And why? Perhaps because they are more complex. These issues require quite a bit of explanation and historical context, which doesn’t always fly too well in a sound-bite culture.

One of the main problems regarding our health-care industry is its lack of any organization. There was no grand design in its creation; it is a Frankenstein monster, cobbled and patched carelessly together since its birth in the wage controls of the World War II era, with little regard for consequences.

Yet, any grand design is practically doomed from the beginning, as the only two viable options – a single-payer system or a complete overhaul of incentives and the creation of a truly free market – are both met with opposition. Consequently, we receive a bill that is the worst of both worlds.

True, the House bill does work at creating a marketplace in the health insurance exchanges (an important, but underplayed, provision), but it also includes a public option. Supposedly, the public option is meant to control prices by adding a more virtuous competition into the marketplace, but when you look at the details – its limited eligibility, and the fact that prices will be set by negotiations with health care providers – it doesn’t seem as if it will control prices at all. After all, medical inflation has not left Medicare and Medicaid, two government plans, unscathed.

So, who is to blame? The Democrats or the Republicans? Both. To their credit, the Democrats have actually gotten the ball rolling on health-care reform and have put forth a bill, though their proposal remains flawed.

The Republicans, on the other hand, are too busy trying to give President Barack Obama his “Waterloo” (this can be seen in the misnomer “Obamacare,” which would be more accurately titled “Congresscare”) and preaching about fictional provisions such as nonexistent “death panels” to actually provide legitimate criticism and a legitimate alternative.

Both accept money from the big health insurance and pharmaceutical giants and allow them to actively craft the bill as well.

We, the citizens, are also to blame. We are too easily led by the talking heads to one particular conclusion. A single-payer system is not the devil, and it does not ration care any more than our current system does. Any system we adopt will require a give-and-take.

A single-payer system will cover everyone, unburden businesses that pay for employees’ health care (and thus help small businesses). It will purge the system of waste, but everyone will be required to pay through taxes and waiting lines — secondary, optional care will be a bit longer (though primary care may very well be shorter, as it is in Britain).

Remember, the government is already inextricably involved in our health-care system. A complete rebuilding of the health-care free market, hand in hand with other reforms (like tort reform), can control prices through innovative market forces and reshaped incentives. Both plans are bold and both have their strong and weak points. What we can’t afford is another plan that simply slaps a Band Aid on the issue and kicks it along to the next generation.


Who Built America, Mr. Buchanan?

Yesterday, Pat Buchanan talked about how America was “built, basically, by white folks.” He goes on to talk about how all the founding fathers were white and how white people fought in the wars, etc… Let’s do some fact-checking.

First of all, any talk that considers ‘white folks’ is problematic for the simple question of: how do you define ‘white’? For years, many ethnicities now commonly considered ‘white’ were ‘othered’. Take this excerpt from “Performing Whiteness: Naturalization Litigation and the Construction of Racial Identity in America“, written by John Tehranian and published in the Yale Law Journal:

In reality, however, many individuals of European descent were not readily integrated into mainstream American society. If anything, they found themselves caught on the dark side of the white/black binary. The Irish, for example, endured heavy prejudice in the United States,  and, for years, they were considered the blacks of Europe.  Similarly, Italians,  Greeks,  and Slavs  suffered from low social  [*826]  status,  and their racial status was a matter of great controversy that remained unresolved for years.

Furthermore, through an analysis of the racial-prerequisite cases after 1923, this study supports the view that race is a social construction.  Categories are situational.  They can alter over time. For example, the notion of white has undergone a significant transformation in the United States over the past two centuries. In the early years of the republic, white referred to those of Anglo-Saxon or Teutonic descent. Thus, the Irish and Italians were viewed as outside of the category. Over time, however, the Irish and Italians became a part of a broadened, more flexible definition of white. 

However, I doubt Mr. Buchanan had this in mind. So, I’ll simply assume for the purpose of this blog post, that ‘white’ is defined as having ancestors from Western Europe.

So then, this has been a country “built, basically, by white folks” because since ‘white folks’ ‘ first trip to the Americas, they have constituted a majority that has dominated minorities. Start with the Native Americans and move forward. The structure of society places power squarely into the hands of white people (which is not to say that there were not also poor white people — because there undoubtedly were, but Mr. Buchanan is not questioning whether white people built America, only the opposite). He then latches onto a few important American events, saying how these events featured only white people.

Yet, since these events all took place in periods in which white people still held absolute power in society, it should come as no surprise that white people were the participants in said events.

Of course “white men were 100% of the people that wrote the Constitution.” Do I really need to prove to you that allowing an African American slave or a Native American to take part in the drafting of the US Constitution would have been unthinkable at the time?

Of course white men were “100% of the people who signed the Declaration of Independence.” Again, would people of color even be invited to have any serious role in declaring independence from Britain? And, too, would they feel the same imperative British colonists felt to declare themselves independent from England?

Buchanan also claims that white people were “100% of the people who died in Gettysburg and Vicksburg.”

He’s close, but not correct. There were black soldiers who fought and were killed in both battles. In fact, in searching I even came across the picture of a memorial for black soldiers in Vicksburg –

Buchanan goes on the say that whites were “probably close to 100% of the people who died at Normandy.” Well, he’s right about this one. There were black soldiers at Normandy, but not too many. And why is that? Well, because “Most black soldiers never got a chance to fight.” You know, segregation and all.

So, its not like minority groups didn’t exist or were just too lazy to participate. Quite the opposite — they did exist and were excluded from participation.

However, let’s take this discussion beyond the examples Pat points out. What were some events that helped build America and its economy? Perhaps the railroads

And what a future. In 1830, railroads began popping up throughout the country. In December of that year, as Norfolk Southern employees will proudly tell you, America’s first scheduled railway service with a locomotive began on the South Carolina Railroad, serving the port of Charleston. It’s a myth that the South at that time was somehow “backward” in adopting new technology. Elsewhere–in upstate New York, Pennsylvania, New Jersey, and soon in other states throughout the East, Midwest, and South–railroads proliferated. In 1840, some 3,000 miles of iron routes carried trains. Most rail lines weren’t connected one with another. In 1850, there were 7,500 miles of track, with many interconnections. By 1860, about 30,000 miles of mostly interconnected routes formed a system.

Powerful economic incentives sparked and spread this explosive growth, in a chain reaction of national development. Economic historians have shown that, compared to roads and turnpikes, the new railroads cut overland time-in-transit for passengers and goods by two- to six-fold, while cutting cost-per-mile to shippers and travelers in real dollars by two- to four-fold. Compared to canals, the time was cut by a factor of eight to ten. As any hand-held business calculator today will reveal, such a combination of cost-and-time saving creates a dramatic leap in economic investment rates of return for manufacturers. The improved financial return rates are permanent, because the increased speed of economic flows is sustained thereafter. There had never before been this kind of economic leap in human history.

And while thousands of railroad employees went to work building the tracks and running the trains, railroad companies ordered huge and increasing amounts of rail, fuel, and construction supplies, which required thousands of other employees throughout American industry. The secondary impacts on the economy were without precedent. Whole ironworks were devoted to making rails, while trains consumed–and distributed–increasing proportions of the nation’s rapidly growing energy production.

Now take this description of the men who built the railroads:

After the Central Pacific (CP) started building the Transcontinental Railroad eastward from Sacramento, demand for Chinese workers increased greatly. The CP figured they needed 5,000 workers to build the railroad, but the most they ever had just using white workers was about 800. Most of these stayed only long enough for a free trip to the end of the track and then headed for the gold fields. The CP hired all the available Chinese workers and then sent agents to Canton province, Hong Kong, and Macao.

With an average height of 4’10″ and weight of 120 lbs., many doubted these men could handle 80 lb. ties and 560 lb. rail sections. But handle them they did, as well as most other construction jobs. So well in fact that by the time they joined the rails at Promontory Summit, Utah on May 10, 1869, more than 9 out of 10 CP workers, over 11,000 in all where Chinese.

Much of the work they did has become legend. Driving through California’s Sierra Nevada Mountains, they were faced with solid granite outcroppings. After the CP’s imported Cornish miners gave up, the Chinese with pick, shovel and black powder progressed at the rate of 8 inches a day. And this was working 24 hours a day, 7 days a week, from both ends and both ways from a shaft in the middle. The winters spent in the Sierras were some of the worst on record with over 40 feet of snow. Camps and men were swept away by avalanches and those that weren’t were buried in drifts. The Chinese had to dig tunnels from their huts to the work tunnels. Many didn’t see daylight for months.

At Cape Horn in the Sierras, they hung suspended in baskets 2,000 ft. above the American River below them and drilled and blasted a road bed for the railroad without losing a single life (lots of fingers and hands though). After hitting the Nevada desert they averaged more than a mile a day. But working in 120 heat and breathing alkali dust took its toll. Most were bleeding constantly from the lungs.

And then, of course, there’s the effect the African-American slave population had on the American economy.

African peoples were captured and transported to the Americas to work. Most European colonial economies in the Americas from the 16th through the 19th century were dependent on enslaved African labor for their survival.

According to European colonial officials, the abundant land they had “discovered” in the Americas was useless without sufficient labor to exploit it.

Each plantation economy was part of a larger national and international political economy. The cotton plantation economy, for instance, is generally seen as part of the regional economy of the American South. By the 1830s, “cotton was king” indeed in the South. It was also king in the United States, which was competing for economic leadership in the global political economy. Plantation-grown cotton was the foundation of the antebellum southern economy.

But the American financial and shipping industries were also dependent on slave-produced cotton. So was the British textile industry. Cotton was not shipped directly to Europe from the South. Rather, it was shipped to New York and then transshipped to England and other centers of cotton manufacturing in the United States and Europe.

In sum, the slavery system in the United States was a national system that touched the very core of its economic and political life.

The situation is much more complicated that Mr. Buchanan’s brief comment would suggest. America wasn’t simply built by one group of people. Did one particular group hold the reins during America’s more formative years? Yes, but that by no means validates Mr. Buchanan’s viewpoint — like I’ve said, it is not because white people wanted to actively build America while minorities looked on from the sideline; it is because white people were in control, they had the power. Again, please note that I am not saying all white people were rich wealthy leaders of the country, because there were poor white people as well. It is just that there were virtually no rich wealthy colored leaders.

Also, look at the numbers. White people made up the vast majority of the population. Even if you wholly ignore the essential elements of discrimination and segregation, there’s also the fact that due to their status as a majority, white people would naturally have a higher percentage of participation in things like the military.

America was built by many different people, and I would think that Americans would not try to downplay that diversity.