Last week I asked myself how a great nation, comprised of free men and women, humans who value

their freedom, came to be enslaved to a system of health insurance that serves no one but the companies that provide insurance and the owners of those companies? It is a good question and one that deserves a better answer than I can offer. I have heard that when a program of national health insurance was politically possible during Trumanʼs administration and, again, in Johnsonʼs, both Presidents backed off because the labor unions did not want the program. It seems, as the story goes, the unions provided health insurance. That insurance was seen as a major inducement for non union labor to vote to join the unions. Later, after the rise of the right in the last half of last century, the bias was for an expanded private sector role. After Johnson, there was no real political will to enact a program of national health insurance until the Clinton administration. Most of us know what happened then, though I am not sure anybody knows precisely why it went down the way it did. Of course, we all know the pitched battle that was fought and how the very idea of such a program was demonized. What I do not know is why we, those of us, the great and vast majority of Americans, who would benefit from such a national program bought the demonization. Why did we allow that to happen? It was every bit as clear then that there was an great and demanding public need for such a program. We all knew then, as we know now, either from direct personal experience or from somebody who had direct experience with a national health delivery system in England or Canada or France or Japan or any other developed nation. We all knew those systems work well, delivering care every bit as well as our system does. Yet, we all just ate what the industry fed us and made no one suffer for selling us out. As we sit on the cusp of yet another attempt to do something, even if it is only the half baked Obama proposal to keep the insurance industry alive while removing a few of the most egregious assaults on the populace by the insurance industry, we appear to be ready to again consume what we are fed. We appear to be ready to allow the industry to buy our Representatives and Senators and just, once again, take it. Before we do, letʼs take a moment and look at some of the non medical, non personal costs of continuing to keep the industry well fed and happy. Not all the costs are costs associated with giving and receiving health care. Indeed, when President Obama speaks of the impact the current system has on the economic health and well being of the nation, these non medical costs are some of the ones most important. When foreign car manufacturers tally up the cost of building a single unit for sale, one item not included in the personal services cost component is health care. It is not included because it is not a cost. Oh yes, I can hear the gas bags of opposition now. “But these manufacturers have to pay higher taxes. Those taxes get factored into the cost component of the automobiles,” they will say.

This assertion does not have the advantage of being true. It may be effective but it is not true. In the first place, even if taxes were a cost component in manufacturing, the tax for health care delivery is spread throughout the national tax base. In the second place, taxes are a component of expense only after all costs and revenues are determined, not before. Taxes do not even factor into the calculation of profit. Taxes are something you pay when you make a profit. Taxes only effect the calculation of profit after taxes. However, in the United States, this embedded cost for health care is a true expense for every American manufacturer making anything that faces a foreign competitor. Where is the outrage from the right? Where are all those people who are constantly bewailing the embedded costs of environmental regulation? Where are the condemnations for an unfair cost to American manufacturers like the outrage at OSHA regulations? The cost of the minimum wage is assailed, why not the cost of health care? Having a health care component built into every gadget, widget and doohickey made in America, is an unfair trade advantage benefiting all our foreign competitors. Every Republican in the United States should be outraged. What about the unnecessary additional costs to provide an education to those children who develop learning disabilities from untreated, chronic maladies? It is well known, in no way speculative, that chronic, untreated allergies, for instance, can lead to hearing impairments and speech impediments. Either, and both, for they are frequently fellow travelers, of these “environmental” learning disabilities demand special services if the child so afflicted is to receive an adequate education. Even if you assume that such a child is not due and will not receive an adequate education, his or her presence in the classroom will drain energy and attention from the teacher at the expense of the other pupils. What about this cost? This is a cost that falls on the public schools as well as the private ones. This is a cost that is no respecter of that demarcation in education. Is there a relationship between crime and untreated, chronic disease? The study of the inmates entering prison would indicate there may be. Inmates, particularly young inmates, seem to have one or more chronic maladies in a greater, statistically significant degree than the larger population of similarly situated; that is, ethnic, social and economic status, persons in society. Perhaps, there is a direct correlation between crime and the lack of a functioning national health delivery program. Perhaps, this disparity may, partially, explain why the United States has the highest percentage of its population incarcerated of any developed nation. It is time to ask if the opponents of a national health delivery system are sincere in their love of this nation and its people? It is time to ask if these opponents prefer a high incarceration rate? If they think it is a good thing for chronic disease to go untreated? Do opponents believe it is a good thing for the education system to be forced to deal

with unnecessary learning disabilities in students? Is it, in the opponents opinion, a good thing that the unfortunate students be afflicted with these unnecessary learning disabilities? Perhaps, the opponents believe, the unnecessary and permanent disabilities being inflicted upon these children is good for them and good for society. It is time to ask why opponents of a national health delivery system hate American manufacturers and workers? The opponents of a national health care program seem to believe there is only one category of costs that is significant to Americans. They seem to believe that we are all so simple minded that we only fear taxes. They seem convinced that our only concerns for the present and the future is the amount of tax we must pay. Yet, in the matter of health care, we are assailed by a wide variety of costs. When the totality of costs, direct and indirect, of health care, and the lack thereof, are tallied, these other costs costs dwarf taxes. Many of these costs are avoidable. For some other costs, no matter the system, one way or another they must be paid. What is not necessary to pay, is the twenty to thirty percent the insurance industry rakes off without adding anything of value. What is not necessary to pay are the long tail costs associated with trade disadvantages, untreated, unnecessary chronic illnesses, environmental learning disabilities, illness induced crimes and a host of other costs endemic in the current system. The national debate is not so much a matter of costs as the old question of whoʼs ox gets gored and who gets invited to the bar-be-que. The nation is perilously near the end of its herd. I, personally, am not a big supporter of Obamaʼs plan. I would much prefer a single payer system. However, as our President says, when he is not making statements about police that are even dumber than the things George Bush used to say, the current system is unsustainable. It is unsustainable because the health insurers are a giant leech, sucking the life blood from the nationʼs economic body. I am not sure how they were allowed to sink their teeth into us, but we must free ourselves from them. It needs to happen now.

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