Random Thoughts
Health Insurance, Intermediaries and Disintermediation
The Internet is touted for its e-commerce potential because it leads to an open and transparent market and eliminates the need for middle levels and intermediaries. Thomas Sowell in a number of his books touts the role of intermediaries in distribution of essential products and thus justifies their usefulness and percentage of profit in preventing mal-distribution and bottlenecks. There is a clear necessity for middlemen where transport and distribution of physical goods is required. All these diametrically opposite views have broad basis, but are often misused by biased propagandists to justify wrong policies to a naive, uninformed and unthinking public. Two commonly quoted quips need to be kept in mind. 'There are truths, half truths, lies, damn lies and then there are statistics'. 'Statistics are like a woman's bikini; what they reveal is alluring and interesting, but what they conceal is vital'.
The philosophical arguments that span the political spectrum range from whether we want to live under the aegis of a nanny state or exercise our own free will? The debate is spurious if we can clearly agree on what is a right and what is a privilege. A driving license is a privilege and it imposes on us constraints, that we pass a test of proficiency and follow the constraints or have our privilege revoked. Thus all state or federal licensing agencies invariably confirm that activities requiring a license are revocable privileges. Furthermore the newest research in economics and the most recent Nobel Prize in the subject and the delineation of human nature not being a 'tabula rasa' by evolutionary psychologists, confirms that our behavior is not always rational, and there is no such animal as a consistent 'Homo Economicus'.
The debate and battle between two parties with an aspiration to govern and compete for the minds, hearts and souls of any electorate should be the place, where a line in the sand needs to be drawn. Unfortunately, both parties have succumbed to the virus of self-interest, which has emasculated everything noble, to the goal of instant gratification and left all the elected, to betray their principles for pecuniary benefits and self-aggrandizement. Thus Clinton betrayed labor by passing the free trade agreement and Bush is insisting on a prescription plan to assign more profit and control to the drug companies. America is still in the throes of a battle whether health care is a privilege or a right and whatever the philosophical merits of the issue, it is obscene that a Republican administration proposing privatization of social security should not accept a single payer plan for health insurance and drug benefits and in the process, enrich insurance and drug companies! Obviously the intermediaries have no altruistic motives and exist to make a profit for their shareholders and executives and that profit can only be made at the cost of reducing the health care benefits to the general public. I could make similar cases for all insurance, mortgage loans and temp agencies, but I will refrain from churning the problem and muddying the debate. The 45 million lacking health insurance bodes ill for the prognosis of the people.
The sad irony of the reality is that the Democrats have ceased to be a party of the downtrodden and the Republicans have become the purveyors of a behavior influencing pheromone with the collaborating conspiracy of a conniving media, to turn the people, supposedly the rulers of the Republic into the unquestioning workers of an insect society, who unlike the insect societies, have neither the economic or evolutionary interests of the ruling class. They have abandoned the policies of free enterprise to shower benefits on their political contributors. It is not the religion, tenets or the principles of the American Revolution, which are wrong, no matter how debatable their honesty may have been even at the outset. The saving grace of the Anglo-Saxon character is its pretentiousness to high principles, which reins in its wayward tendencies and constrains it to an unintended noble path. The tragedy is how long will the myth endure, once the truth becomes pervasive that the prophets of this great religion continue to speak with a forked tongue and betray their religion and their congregation? Ultimately this is a battle between self-interest and decency and the limits of self-delusion that America can practice between the acceptance and practice of Christianity on the basis of morality which is inconsequential, and short-term gain which is often detrimental to future well being.
19-Jan-2003
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Gaurang Bhatt, MD
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