How The University Works

In the very unscientific polls I placed at DailyKos and the Chronicle of Higher Ed nontenure-track forum, a 3/4 majority responded, “neither–we need a single-payer system.” This seems to reflect at least one of the candidate’s own judgments: Clinton appeared to acknowledge in the last debate that single-payer was preferable, just not in her view politically feasible.

The best overall conversation on the subject was held on ADJ-L, the very important discussion list on which major contingent organizers such as Jon Curtiss, Joe Berry, Craig Smith, Keith Hoeller, Elizabeth Hoffman–and AAUP past president Jane Buck–all weigh in regularly.

One ADJ-L correspondent, Steve Street, himself a faculty member serving contingently and a cancer survivor, who understandably calls this “his issue,” pointed to the timely Paul Krugman column that strongly favors Clinton’s plan which is, he notes,

more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.

But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn’t.

Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.

After all, we already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up. And many of those eligible fail, for whatever reason, to enroll.

I have to say that I find Krugman’s observations regarding the absence of mandates in Obama’s plan convincing. On the other hand, a Daily Kos correspondent observed accurately, that “Congress, not the President” will importantly shape the plan that either candidate brings to the table. While in theory this means that single-payer or universality could be scripted into an Obama proposal after election, I guess I’m a bit skeptical. That said, I’m none too enthused about the “consumer price consciousness” built into the multi-tiered care made in the Clinton proposals. Um, yeah, I’ll choose the “kill me quick” plan for a 10% discount, please.

My favorite moment in the ADJ-L conversation was sparked by the evidently well-meaning forwarding to the list of the “free market cure” videos by frequent Fox guest commentator Stuart Browning, who describes himself as offering “health care commentary from a pro-capitalism perspective.”

In response, long-term Michigan AFT organizer Jon Curtiss wrote:

This bit of free-market propaganda by Stuart Browning does not change my
mind about the need for a single-payer health care system in the USA.

Does this little film even make an argument? Not really. “One guy in
Canada might have died if he hadn’t come to the USA for an MRI”? (Or
maybe it’s “A well-off white guy who could afford to pay $30,000 for
surgery didn’t get treatment the moment he demanded it.” That’s a scary
one!)

But let’s break it down. Even if the anecdote were presented openly and
honestly, does it really tell us anything about the Canadian system?
Does it tell us anything about the US system? (See
http://tinyurl.com/22ftz9 on the details of the story.)

A charitable summary of the logic of the film would be this: “People may
suffer or even die when health care is rationed or subject to government
policy. We do not want people to suffer or die. Therefore, rationed
health care is bad and government should not play a role in health care.”

I’ve heard worse arguments, I guess, and I certainly don’t want people
to suffer or die. But let’s take the next step. How do we do it in the
USA? We don’t “ration,” technically, because there’s no *thought* put
into it, but the fact is that heath care in the USA *is* rationed; it’s
RATIONED BY THE MARKET. You have the money, you get the treatment; you
don’t have the money, you’re out of luck. The bottom line is that in the
USA, about 18,000 people die a year because they don’t have health
insurance (http://www.iom.edu/?id=17846).

So which is a better system? The free-market *feels* better because no
one takes responsibility. In Canada, and all other industrialized
countries, though, the Government, yes, takes responsibility for the
health of citizens, and formulates a rational policy for how to ration
health care resources. That means you it’s easy to point a finger: “This
man suffered and almost died because of *your* policy!”

But ethically, it’s the right thing to do, of course — the same way
that we use our government to formulate all *kinds* of rules and
regulations that protect us from all kinds of things. In the end, you
don’t have to agree with that philosophy, you just have to want to
*reduce* suffering and death to the greatest extent possible given the
resources we have.

Thanks to everyone who contributed to this thread.

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