People around the globe are familiar, if not with the expression itself, with the real world meaning of the saying “it’s feast or famine.” The phrase has its roots in the observable annual fluctuations in crop yields within early agrarian societies. In good years, crops were plentiful and the people of that village or community feasted. In bad years, harvests were meager and food was in short supply, producing hunger or worse among the area’s denizens.
The empirical cycles of excess and shortage, however, are not limited to agricultural yields, but are part of larger cycles that both define and describe the human condition. A happy period in an individual life often precedes a period of sadness. A time of relative health and well-being abruptly ends with an illness or injury. Good fortune is replaced by misfortune.
In the commercial realm, ownership and management are acutely aware of business cycles, assiduously charting fluctuations in revenues that demarcate periods of profitability from those of loss. In commerce as in life, one’s position at any given point in time is not sustainable, but like the tide, is subject to a series of incremental, almost imperceptible changes that herald still larger changes to come.
Although external influences are almost always a component of change, each position attained within a particular life or business cycle contributes to its own demise. Over time, an individual experiencing happiness or good fortune calls his position into question and, thereby, signals its end. Likewise, accumulation of business profits inevitably results in profit-taking by those with equity interests; thereby, contributing to reversals in business fortunes.
While the cycles of nature, life, and commerce are inevitable and, in that sense, innocuous, their repercussions often provide potentially lucrative opportunities for those who would benefit from the misfortune of others. The stories of abuses by funeral services providers – from price gouging through grave-robbing – are the stuff of legend and literature. In many parts of the world, a modern-day slave trade has arisen, with profiteers trafficking in homeless, impoverished children, adolescents, and young adults for sexual and other forms of servitude. In the United States, predatory lending practices targeting low-income individuals toppled the sub-prime mortgage market and have been widely acknowledged as a major contributor to the deep recession that our nation and the world have experienced over the past 18 months.
Of course, these are but a few examples of exploitation of the disadvantaged by those in positions of greater relative advantage who would “feast” on the “famine” of their victims. Most people, I am certain, would consider such practices unethical at best and completely reprehensible or illegal at worst. Yet, they are simply the logical extension of what have come to be considered “laws” of nature and economics. The natural “law” of “survival of the fittest” dictates that individuals and groups within the animal kingdom will utilize every resource at their disposal to survive and prosper. The economic “law” of “supply and demand” instructs us that as demand rises or supply falls, value increases.
And so, in an environment completely unfettered by any form of regulation, each individual or group – whether such group be a family, village, or nation – seeks to maximize its advantage and prosperity without regard to the cost to others. This was the environment of prehistoric man – a hard, cruel life in which death could be swift and concern for self far outweighed concern for others. As man advanced, however, he grew to understand the advantage to self provided by collective effort. Thus were tribes and nations formed.
Fortunately, life for us today, at least in the industrialized Western world, is far different from that of our distant and not so distant ancestors. Defended by military and police, we live in relative peace and security within our communities. Education, both public and private, affords us the foundation for personal and professional growth and from which to develop into informed citizens and contributors to society. We are protected in the workplace and marketplace by employment and consumer laws. In short, in many aspects of life, we enjoy a safety net – a benefit provided by a more highly evolved society that comprehends and places value on its weakest, most powerless members.
Unfortunately, in the United States, that safety net does not extend to healthcare. Unlike the remainder of the industrialized world, the United States has no form of universal healthcare for its citizens. That means that its citizens must either pay directly for services provided, have some form of health insurance that will pay the provider, or share in paying providers in accordance with the terms of their contracts with health insurance providers. Today, approximately 84% of U.S. citizens have health insurance coverage; the remaining 16% do not.
The notion of paying for medical care, as well as all other needs in life, has been ingrained in mankind for millennia. In fact, the concept of universal healthcare for citizens of a nation is a relatively new one, beginning in the United Kingdom in 1948. Since that time the following nations (in alphabetical order) have instituted universal healthcare systems: Argentina, Australia, Austria, Belgium, Brazil, Canada, Cuba, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Poland, Portugal, Russia, Saudi Arabia, Seychelles, South Korea, Spain, Sweden, and Taiwan.
With so many of the developed and developing nations providing healthcare for their people, one wonders why the United States still chooses to swim against the global tide. The answer, to no one’s surprise, is money. In Fortune Magazine’s 2007 ranking of America’s largest corporations, 13 of the top 1,000 were health insurance and managed care organizations with total annual revenues of $227.3 billion and profits of $11.8 billion. In 2006, the CEO’s and other executives of these corporations received aggregate compensation in the billions of dollars. Physicians, other health services providers, pharmaceutical companies, and other suppliers also have a vested interest in maintaining the status quo.
With healthcare currently consuming approximately 15% of our gross domestic product (GDP) and growing in scope, opportunities to “feast on the famine” of the American healthcare consumer are expanding concomitantly. Consider the culture of health insurance and managed care companies. Their interest is to maximize profitability, not provide those insured by their firms with the best possible healthcare outcomes. All of these firms employ physicians as medical managers to review and authorize or deny claims. In an industry in which payments to providers are viewed as “medical losses,” the pressure is on such personnel to deny as many claims as possible. Policies, written with a mind-numbing combination of exclusions, pre-existing conditions, deductibles, co-pays, lifetime maximums, and other provisions, are beyond the understanding of many of those insured. The end result is that often people are denied care to which they are entitled, sometimes with fatal effect.
Doctors, hospitals, and other healthcare providers today can often work “miracles.” Those “miracles,” however, come with a very high price tag. A single procedure or hospital stay can easily cost in the tens of thousands of dollars; perhaps, even hundreds of thousands. The total cost – encompassing doctors, hospitals, therapies, and medications – of immediate and ongoing care for an individual with a chronic condition can be in the millions of dollars. These sums are beyond the ability of all except the very wealthiest of our citizens to pay.
Given this state of affairs, it is time that we as Americans stood together and with one voice demanded that those who govern us understand the following:
a) that the measure of a great society is not in how its most prosperous citizens live, but rather in how it treats the least among its members;
b) that the dignity inherent in human life dictates equal access to healthcare for all of our citizens regardless of ability to pay;
c) that access to healthcare should be constitutionally recognized as a right of citizenship; and
d) that the government of this great land should extend and finance universal healthcare for all of its citizens.
America has long been recognized as a beacon of hope, a land of opportunity. It has been a refuge and melting pot for people of every culture. In our own unique way, we have taken the best of every culture and improved upon it. Our domestic wines rival and often best their renowned French counterparts. Our international cuisines surpass those found in the capital cities across the globe. If we can import and improve upon the products of French vintners and Italian chefs, why not their systems of universal healthcare?
As Americans, we value – perhaps more than any other benefit of citizenship – our freedom. We love our liberty and are wary of governmental actions that we believe will limit it. And so, we are peculiarly subject to the scare tactics employed by the forces that would impede progress for their own self-interest – in this instance, health insurance and managed care organizations, physicians’ associations, and hospitals and healthcare systems among others. Branding universal healthcare as “socialized medicine,” they cloud reasoned public debate with images of physicians shackled by governmental bureaucratic control over individual medical decisions and the specter of an America slipping and sliding toward totalitarianism. Nothing could be further from the truth.
We are a society of laws and not men. Some of these laws limit our freedoms. None of us, for instance, have the freedom to act irresponsibly, to the detriment of our neighbors. And so, our society has deemed that we do not have the right to murder, rob, rape, or otherwise harm others and has codified punishments for violators. Likewise, as a society we have established limits and controls over the commercial conduct of individuals and operation of businesses. These limits have been established for the greater good. None of these laws or regulations, in my opinion, have transformed America into a totalitarian society.
In fact, collective societal actions have enhanced individual freedom by relieving us of concerns that we must continually guard our persons and property. As societies become more advanced and civil, protections for the most vulnerable members grow. In America, this has led to promulgation of child labor laws and the institution of Social Security providing a modicum of financial support for our senior citizens. While these measures are – in the simplest possible meaning – “socialist,” they do not signify that America has changed from its republican form of government to socialism.
And so, what does it mean for medicine or healthcare to be “socialized?” It means simply that we as a people have finally chosen to take the inevitable step of providing for the healthcare of our citizens in the same manner in which we provide for “socialized” public education, military defense, and police and fire protection. And, in a world in which the enemies of freedom can employ bioligical means to accomplish their ends, the advent of a universal healthcare system may well be a national security imperative.
The actions of health insurance carriers in withholding treatment authorizations, denying claims with impunity, refusing to cover pre-existing conditions, and adding to the stress of illness the additional burden of completing myriad forms have all contributed to denial of needed medical care for their policyholders while padding the corporate coffers and compensation of their executives. With the institution of universal healthcare, we will remove one more opportunity for those who would “feast on the famine” of their victims.