VOICES: Businesses get their way when it comes to making health care a nightmare

Stanley Hirtle, retired attorney at Advocates for Basic Legal Equality.

Stanley Hirtle, retired attorney at Advocates for Basic Legal Equality.

Last week’s contributed columns from the ERISA Industry Committee (ERIC) and the Greater Dayton Area Hospital Association are instructive on what has happened to our system of government. Except for culture war issues, the governing between businesses, customers, workers and the general public has been taken over by the businesses at the expense of everyone else.

The Greater Dayton Area Hospital Association writes on how insurance companies and medical providers renegotiate their contracts that determine the terms under which insurers pay medical providers for providing health care. Patients have no seats at this table and no power over the outcome. The laws governing health care are complicated and do not achieve the goal of making health care work for the people who need it. This is because the political system responds to campaign contributions, and the big players, providers, insurers and employers, can out-contribute patients to shape laws to increase profitability at patients’ expense. Insurers profit by insuring the healthy, dumping the sick, shifting costs to patients and denying claims. Providers want to charge as much as possible, and are rapidly consolidating into a few powerful networks. This has not made Americans healthier. The article notes that 62% of households have faced coverage hurdles and their health has gotten worse. Despite being one of the most expensive and burdensome of any industrialized country, the US system does not perform any better than those in other developed countries, and actually performs worse in some common health metrics like life expectancy, infant mortality, and unmanaged diabetes.

Michelle Goldberg points out a reason that the political system is unresponsive. The dominant coalition of businesses, social conservatives and disaffected working class whites have worked the system to “lock us into a crisis of minority rule”. On economic issues like health care, this means businesses get their way in conflicts with customers, workers and the public. The books “Tyranny of the Minority” and “How Democracies Die” show that minority rule happens because the US Constitution was designed in a pre-democratic era, and the restraints on majorities, intended to prevent abuse of minorities (and protect Southern slaveowners), have been taken to excess. These include the Senate, which gives more votes to small rural states, the Electoral College, the filibuster, and the Supreme Court, now captured by an unaccountable rightwing majority which has declared campaign contributions uncontrollable and authorized gerrymandering for political advantage. Thus, over the past 20 years the ruling coalition has won the presidency and shaped the Supreme Court with minority of public support. The businesses get their way when it comes to making health care a nightmare, taking advantage of customers and workers, or avoiding the costs of protecting the environment.

The result is that democracy is being replaced by a system dominated by the ever smaller number of very rich whose share of the nation’s wealth has drastically expanded, This comes at the expense of the middle, who lose status, security and sometimes health care, and the poor, who struggle daily to survive. Goldberg sees no easier solution than “a glacial slog of constitutional reforms” to create a system better for all stakeholders.

To work, government must involve all the stakeholders, balance power to prevent abuse, provide accurate information to all, provide a civil environment to discuss alternatives, and provide justice that is available to all and that no one is above. All of us have a duty to work to improve our system, and to make the dysfunctions in housing, health care, education and politics better.

Stanley Hirtle is a retired attorney, formerly at Advocates for Basic Legal Equality.

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