When the U. S. health care system was transferred in the 1980's from the awesome authority of physicians to the power of corporate-based managed care groups--HMO's--the new equation replaced the wisdom of doctors with the techniques of corporate management. Patients would no longer be seen as a source of revenue but as a cost that would be contained and minimized by efficiency.
This was a 'dream of reason' wrote Paul Starr in his 1983 Pulitzer prize winning book "and did not take power into account,"
"The dream was that reason, in the form of the arts and sciences, would liberate humanity from scarcity and the caprices of nature.... not least of all, the diseases of the body and the spirit."
Although more progress in health care followed, the change also cast up a new world of power that has left in its wake both growing inequality and widespread distrust of the profiteering to be had through the new corporatized health care model. A critical analysis of this power, measured by its total impact in the U. S. must deal with both healing understood as a metaphor of faith and health care corporatism's claim to deliver the most justice for dollars spent. The numbers are staggering and don't fit ordinary people's pockets or understanding about what's going on.
- The U. S. pharmaceutical industry is reported to be worth $446 billion.
- Forbes Magazine cites a CDC report that the private insurance industry is worth $900 billion.
- The Center for Responsive Politics reports 811 lobbyists in 2017 working for the insurance industry at a cost of $79 million.
- Salon cites a Kaiser Health News analysis that thirty-eight major drug makers and trade groups will spend a total of $50.9 million this year on 1,296 lobbyists (See Opensecrets.org)
You may be for or against Obama Care and Bernie Sanders' new single-payer proposal for Medicare-for-All, but you can be certain of one thing: No stone will be left unturned to preserve this huge health care corporate profit system.
Readers may also remember that they cast no votes about the rise of managed care as those major policy changes unfolded thirty-five years ago. The voting public has had to depend on the authority (the power) of other sources. "When professionals claim to be authoritative about the nature of reality," wrote Starr, "whether it is the structure of the atom, the ego, or the universe, we generally defer to their judgment." A very bad dependency if democracy (rule by the people) is to be real.
These coming weeks in Wahington citizens must weigh what it means for the future of health care if insurance company profits are subordinated to decrease inequality and pay the cost of health care for everyone. It's a justice question and a challenge to all faith communities and other community groups to enter the public square of political life to tackle the task of critical thinking about about writing new laws and changing old laws in order to give the people equity.
Without that happening democracy will continue in its mythical status. And yes, it is a question that bears on the growing threat of fascism in the U. S.
"Power, at the most rudimentary personal level, originates in dependence, and the power of the professions primarily originates in dependence upon their knowledge and competence....what makes dependence on the professions so distinctive today is that their interpretations often govern our understanding of the world and our own experience. To most of us, this power seems legitimate" [The social transformation of American Medicine: the rise of a sovereign profession and the making of a vast industry]
Or, as Ivan Illich put it many years ago, "a professional is someone who has a stake in your not knowing what he knows." [Deschooling Society]
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