Have you ever wondered what a nation would look like that put the economy of the nation as more important than the well being of the individual? Or, wondered if the wealth of the ‘ruling class’ is more important than the health and well-being of everyone else? What about a nation where one out of every five people gets their income from the illness of the population? This was the transition, “markets before mandates in health”, that America begins to make during the 1930’s at the height of the Great Depression. Now the healthcare segment of the economy is close to twenty percent of GDP.
It is difficult to imagine a community where one out of every five people gets their income from health. Think about a farming community of one hundred people. Now imagine that twenty of those people are medical workers, medical insurance workers, makers of drugs, and support people for this effort. This is what America has come to. In order to keep the medical workers busy, it means that there has to be a significant amount of illness. If the illness is maintain or increased, then the medical workers lively hoods are safe. But this very ill population has difficulty thriving in other sectors of the economy because there is no feeling of well-being. There is low energy and the illness means that the crops do not get harvested for food to feed the people.
These two things, health versus economy, held in juxtaposition of each other can only have two results. Like two waves coming together, they will either add together to get very large. This is the belief of our current leaders in government. Or, the energy will be neutralized as trough adds to ridge and flatness results. I believe this is closer to our present reality. The economy and health both fail.
Consider how the Department of Health and Human Services is operated. Here are the general principles on which decisions are made:
- National standards, neighborhood solutions.
- Collaboration, not polarization.
- Solutions transcend political boundaries.
- Markets before mandates.
- Protect privacy.
- Science for facts, process for priorities.
- Reward results, not programs.
- Change a heart, change a nation.
- Value life.
Please note that the first three are about politics and the fourth about the economy. There is polarization, political boundaries have been drawn with the passing of the Affordable Care Act, and national standards have prevented neighborhood solutions. And yes, markets have been sustained and increased as the greatest transfer of wealth ever from the Treasury to the pockets of medical insurers has been the result. But, have these actions actually created wealth in either the economy or health. Note that to value life or the general purpose of this large agency is last.
What if we picked a state that has done well economically and looked at its principles of operation in health care? Let’s pick Texas because it has created the largest number of jobs since 2008. Here is its number one principle for operating the Texas Health and Human Services Commission:
- We place the concerns, interests, and well-being of our consumers and constituents at the center of our attention.
What is valued first in Texas is last at the national level. That is to value life and well-being. Texas economy is booming. Could there be a lesson here for national decision making. I am not going to take the time to look up the chronic disease rate in Texas, but being a southern state with higher UVB, I suspect it is less than the national average. I suspect it could be much better if Texas did not have to meet the requirements of the Federal laws. It is no wonder of the hint of Texas wanting to secede.
To paraphrase the words of M. Scott Peck in his book “People of the Lie”, an institution that does not have empathy for the ones it serves is evil. – Pandemic Survivor