Are We Too Small to Succeed?

The logic behind the government bailouts in the financial and automobile industries goes like this:  some institutions are so large and interconnected that their failure could collapse the entire economy.  They are considered to be too big to fail.      The notion of too big to fail implies its opposite, that some individuals and businesses are too small to succeed.  Of course, that includes most Americans.

Author, commentator, and former Republican strategist, Kevin Phillips, uses the near economic collapse to illustrate current reality regarding American values.  He calls the government bailouts welfare for the financial sector.  Conversely, he points out that whenever topics like universal health care or national pensions arise, they are invariably described as too expensive or socialistic.  The same arguments were made about the bailouts, but they did not prevail.  Thus, we can afford to bail out large corporate entities in self-made crises, but we cannot afford a basic level of health care for all Americans. This has been true for nearly a century.  Prior to the Great Depression, government took a hands-off approach to economic bubbles, allowing the ‘invisible hand’ to work its magic.  Since that time, government has taken a hands-on approach to economic crises.  In the current case, everybody must pay for the greed of a few, some of whom continue to be rewarded for their behavior.  The invisible hand seems to have become the visible finger.

In contrast, universal health care has been proposed and defeated repeatedly over the past century (in 1915, 1935, 1948, and 1994).   With the exception of the old and the infirm (Medicare) and the young, the disabled, and the poor (Medicaid), we as a society have not defined health care as a public good like education or police and fire services.  The Social Security Act of 1965 that created Medicare and Medicaid is attributed to the masterful legislative skills of LBJ.

Unlike comedian Jack Benny, our leaders don’t have to think much about the question, “Your money or your life?” With the exception of the SSA of 1965, financial security (money) has always trumped health security (life).  In effect, the acute condition (economic crisis) gets action while the chronic condition (health insecurity) does not.

For those with health insurance who have not tested its boundaries, health care is not a crisis.   It might be costly.  It might be time consuming.  It might be infuriating to navigate the insurance and health care labyrinth.  But it’s not a crisis.  It will probably take a catastrophe like the collapse of the safety net hospitals before universal health care becomes public policy.

Many Americans believe the fix is in, the system is rigged. A friend refers to members of Congress as “the whores in Congress” and suggests they should wear sponsor patches like those worn by NASCAR drivers.  To be fair, we the people don’t seem to have a problem with outsourcing political campaigns to the private sector.  That’s the game we allow to be played in Washington.

If health care were a product, this would be the current offering.  Pay twice as much as other industrialized countries, waste 30% to 40% of that payment due to a highly inefficient system, get lower overall quality (33% less value in terms of outcomes), cover only 80% to 85% of the population, and put 15% to 20% of those with insurance at risk financially if they fully use the product.  According to the Business Roundtable, this product puts American business at a competitive disadvantage globally.

One wonders if Yankee ingenuity has died or has simply been co-opted by a collection of balkanized special interests.  If we Americans are unable to create a sensible health care system out the current mess, we really are too small to succeed.

Don Lindstrom is a business strategy consultant.  His firm recently recommended a redesign of the Florida Medicaid program.  He can be reached at don@OrionResearchInc.com.

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