David Sirota has a nice column advocating a not-for-profit health care system. As he says, studies have repeatedly found that non-profit hospitals deliver better care than their for-profit brethren, the VA delivers the best care in the country, and Americans believe medicine shouldn't be dominated by the quest for profit. So why don't we make that into a reality? Well, the money:
No, as with everything in Washington, the real answer to the question is found by following the money. Politicians don't talk about creating a not-for-profit health care system because they operate in a pay-to-play culture — one that rewards their silence.
Since 2000, the health industry has donated more than $370 million to the lawmakers of both political parties. The No. 1 recipient of that largesse last year was Republican Sen. Rick Santorum — the third-ranking Republican in the U.S. Senate who has ardently opposed a single-payer health care system. No. 2 was Democratic Sen. Hillary Clinton — who, just 12 years removed from her attempt to reform health care, is now giving speeches apologizing for her previous efforts. Also bathed in health industry cash has been Senate Majority Leader Bill Frist. He has been a key opponent of health care reform — not surprising, considering he is also one of the heirs of HCA, the largest for-profit hospital chain in America.
These campaign contributions and conflicts of interest guarantee that false debates substitute for a discussion of serious health care reform that might end health industry price gouging.
Points granted. It is, however, a bit more complicated than Sirota lets on. Nationalizing an industry that accounts for a ninth of our entire economy isn't an easy or obvious process. What do you do, for instance, with the pharmaceutical companies? How do you calm Americans happy with their current insurance and fearful of seeing their insurer dissolved? What about those who don't want the government plan? Can we have boutique medicine? What does the non-profit system look like? What does it pay doctors? Do we buy the for-profit hospitals? At what price? Etc and so on.
This country isn't moving towards non-profit care any time soon. What may happen, however, is the creation of a parallel non-profit care structure within the current context, one that Americans can look to as a model for what truly nationalized medicine would look like. Imagine if anyone who wished to could buy into Medicare. Or the VA. Or even a reworked FEHBP. That's what Pete Stark is proposing, and it's not a half bad idea.
It's also worth saying that a literally non-profit system isn't a particularly desirable outcome. The profit incentive does much good in medicine, and we enjoy more than a few breakthroughs, treatments, and advances bearing its imprint. What we want to do isn't end the incentives and innovations of profit, but sublimate them, use them where and when they make sense rather than letting them overlay the entire system. The either/or impulse is destructive on both ends. The hunt for profit can be part of American medicine without exerting total control over it.
