March 04, 2008
Our WikiLeaky Health Care System

What I know of history seems to fit the proposition that power hierarchies thrive on secrecy and information management, while populist reforms tend to wither and petrify without the sunshine of open exchange.

The Wookie Leeks

In that light the court decision in the Wikileaks case is an encouraging sign in a couple ways.

First, the existence of a site that posts documents that governments and corporations would prefer to hide has in a sense been affirmed as within the law. But it wasn’t just a victory for the First Amendment; the judge was impressed by the argument that the information was already being mirrored in a variety of countries around the world, so publication could no longer be enjoined. The geekosphere is crowing about the impotence of government as against our beloved and all-providing internet. And people in government and corporate bureaucracies who occasionally find opportunities to inform the public have an outlet to help them do that, one that’s survived its first court test.

Second, the whole legal contretemps brought a lot of attention to Wikileaks, a relatively new site happy for the news coverage, whose mission statement begins:

Wikileaks is developing an uncensorable Wikipedia for untraceable mass document leaking and analysis. Our primary interest is in exposing oppressive regimes in Asia, the former Soviet bloc, Sub-Saharan Africa and the Middle East, but we also expect to be of assistance to people of all regions who wish to reveal unethical behavior in their governments and corporations. We aim for maximum political impact. Our interface is identical to Wikipedia and usable by all types of people. We have received over 1.2 million documents so far from dissident communities and anonymous sources.

We believe that transparency in government activities leads to reduced corruption, better government and stronger democracies. All governments can benefit from increased scrutiny by the world community, as well as their own people. We believe this scrutiny requires information. Historically that information has been costly — in terms of human life and human rights. But with technological advances — the internet, and cryptography — the risks of conveying important information can be lowered.

Wikileaks opens leaked documents up to stronger scrutiny than any media organization or intelligence agency can provide.

That will help. If we read the documents.

Canada: More Valuable Dollars and Better Health Care

It doesn’t require an extensive search to find an example of power heirarchies and information management: we don’t have single-payer health care like all the other so-called grown-up countries because private industry is making huge profits by failing to keep us as healthy as citizens of other countries who pay a lot less. And even with all that money we pay, our health-care system makes more errors than other countries experience, our record-keeping and coördination is worse, and more of us go without health care for economic reasons. Long story short: our health-care system is so far from being the best in the world that the opposing position can only be maintained for ideological reasons. I expect our system’s the best advertised, though.

Certainly there are other influences pushing the debate away from government-managed health care. The philosophical position that the federal government shouldn’t manage things has a lot of supporters, and it’s a philosophy with some sense. I too prefer to minimize government activity, and to keep as much of what must be done local as is reasonable.

Still, there’s more that needs to be done at the federal level than defense and air traffic control. The overall superiority of federal single-payer health care in the real world has been demonstrated in other countries; the study I just cited considered Australia, Canada, New Zealand, the UK, the Netherlands, and Germany, plus the US, the only country without government-run health care. We’ve seen it work here in the proto-socialist Medicare program as well, which everyone nowadays knows is more efficient than the private health-care industry.

Universal single-payer averages the risks and costs across the greatest number and the most accurate cross-section, namely everyone. Expenses can be spread out over larger bases, and reduced by high-volume shopping techniques. Results include a higher level of care overall and somewhat more controllable costs, but perhaps most importantly a system focused on getting and keeping people healthy, rather than on maximizing profit for parent corporations.

If the goal of single-payer is obvious, the path toward that goal is less obvious; the opposition will be fierce, and extremely well funded. I kind of like the two-pronged attack on the problem, prong one creating a single-payer Medicare-like system, and prong two providing a framework for private industry to compete against the government through private hospitals, HMOs, insurance, and all the familiar tools. Citizens can choose either system. Let the market decide, and may the best system win.

The realization that government could have a positive impact on our health care seems to have sunk into the American consciousness quite broadly. Despite the nearly complete absence of reporting on successes of single-payer systems from major US media outlets, Americans have heard of this, and they understand that Medicare works. They know you can’t count on the government, but how much less can you count on the insurance company? Which one has an inherent direct interest in screwing you?

It kinda depends on what we want. If keeping the population healthy is the goal, universal single-payer is the method. If insurance companies are built into whatever health plan this country designs, then the point of the plan will be to profit them.

But even more it depends on what we’re willing to fight for.

Whoever we vote for in the primary or the general election, we should pressure all our elected representatives to create a decent health care system like everyone else has. They won’t be able to do it against entrenched opposition without an overwhelming push from below.

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Posted by Chuck Dupree at March 04, 2008 05:58 AM
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You are correct that single-payer should be the ultimate goal and the opposition will be "fierce, and extremely well-funded". Of course, as we saw with the Clinton health plan, opposition will be fierce even if the plan bends over backwards to protect the interests of the insurance and pharmaceutical companies. What that tells me is that it makes little sense to propose a compromised plan. If you're going to encounter stiff and well-funded opposition anyway, grab for the gusto and propose single-payer.

I favor a system that covers everyone for everything and everyone with the federal government as the only payer. If there is a demand for a commercial system to serve the unique needs of the wealthy, then it will be created and they can choose to pay for care they could receive for free. No problem.

Posted by: Charles on March 4, 2008 9:50 AM

I hadn't looked at anything on Wikileaks until you challenged "if we will read the documents". I'm suprised at the material they've got online already. I suspect that a new age in journalism is being opened uup, which should make for some interesting times in the years ahead. As to the health care debate, I suspect it's going to be a lot different this time around.

Posted by: Buck on March 4, 2008 10:31 AM

I've been visiting this website and looking at some of the material, but then something just hit me that strikes me as unusually odd about the timing of all this. Mike Huckabee was mysteriously in the Caymans a few weeks ago. Strange no bloggers have picked up on this fact or tried to discern any connections.

Posted by: Buck on March 6, 2008 12:18 PM
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