So-called health care reform is in the news because of the impending battles over what’s going to be in it and who’s going to pay for it. One of the more outrageous funding proposals is to tax people for excessive medical insurance. That is, if you have an insurance plan that provides more coverage than some defined norm, you’ll be taxed on the value of the excess coverage. Don’t jump to the conclusion that fat cats will be hard hit. The group that will be hit the hardest are members of unions that managed to fight successfully for good health benefits.
What is wrong with the awful little people promoting this idea? And what is wrong with the many Democrats who are taking the idea seriously?
At the same time, another major initiative moved forward when the House passed legislation intended to reduce greenhouse gases. A centerpiece of this legislation is a so-called cap-and-trade system that enables the government to establish emission standards and then allows companies that produce below that standard to sell the pollution rights to companies that produce above the standard. This happens to be an instance in which most economists agree it’s a bad idea. A carbon tax would work much better: more efficient to administer, more effective in achieving the goal, and less prone to corruption of the standards. A case in point being the coal industry, which received a bundle of pollution rights free so they don’t have to reduce emissions.
Last month, an article in Environmental Health Perspectives described the health effects of climate change and how funding is grossly inadequate to respond to those effects. Last week, the EPA approved a proposal by the Tennessee Valley Authority to transport millions of tons of coal ash 300 miles to a landfill site in Perry County, Alabama. The coal ash is from the famous collapse of lagoons in which waste for coal-fired power plants was stored. Thirty-one percent of the citizens of Perry County live below the poverty line, illustrating the issue of environmental injustice. And according to a report issued by the Center on Budget and Policy Priorities, the social safety net is unraveling, driving more and more people below the poverty line with fewer and fewer resources to help. One, two, a thousand Perry Counties.
Since prevention is a big issue in health care reform proposals—that is, doing things that identify people at risk of illness and taking actions that reduce that risk in order to avoid medical costs—I wonder why eliminating coal as a fuel isn’t part of health care reform? You would be right, of course, to think “money:” money that conditions us to accept the word “health” as appropriate to refer to medical treatment (both conventional and alternative) with all its science and technology; and money that fertilizes the halls of government, academia, and the mainstream media in order to put a rosy blush on the coal and other industries.
In my opinion, money is not the real problem. That honor goes to a culture whose motto is “More!” It turns out that money is the perfect feed and fuel for such a culture because money is abstract value. That “More!” is an empty promise is demonstrated by a wide variety of surveys in which the increase of stuff over time is matched by measures of health, happiness, and well-being that are unchanged. It seems that “More!” isn’t better.
One of the principal themes in our book Too Much Medicine, Not Enough Health is the idea that health care is in crisis because it’s not about health. Instead, it’s about medical practices prone to overdiagnosis and overtreatment. “More!” More technology, more procedures, more drugs, more tests, more patients. “More!”
With medicine appropriating the word “health,” we’re left with no positive idea of what health actually is, only that it is the absence of disease. Instead, we argue in the book that health is the capacity to lead a full, rich life—which is about better, not more. The culture of “More!” has conditioned us to see using coal as an energy issue, coal mining and coal waste disposal as an environmental issue, and poverty as an economic issue. All of them create medical costs. If we saw things clearly, we’d see that energy technologies, natural environments, and political economies suited to our human ecology and its capacity to provide us with full, rich lives are all health issues.