The standard argument against third wave universal
birthrights is that, while they might be nice in theory,
in practice they are too expensive. They impose an
unbearable burden on “the economy” —
that is, on the winners in unfettered markets. Much
better, therefore, to let everyone — including poor
children and the sick — fend for themselves. In
fact, the opposite is often true: universal birthrights,
as we’ll see, can be cheaper and more efficient
than individual acquisition. Moreover, they are always
fairer.
How far we might go down the path of extending
universal birthrights is anyone’s guess, but
we’re now at the point where, economically
speaking, we can afford to go farther. Without great
difficulty, we could add three birthrights to our
economic operating system: one would pay everyone a
regular dividend, the second would give every child a
start-up stake, and the third would reduce and share
medical costs. Whether we add these birthrights or not
isn’t a matter of economic ability, but of attitude
and politics. ...
Health Risk Sharing
Pooled risk sharing, or social insurance, has several
advantages over individualized risk. One is universality:
everyone is covered and assured a dignified existence.
Another is fairness: when risks are individualized, some
people fare well, but others do not. There are winners
and losers, and the disparities can be great.
Social insurance principles have been applied in
America to the risks of old-age poverty, temporary
unemployment, and disability. In every other capitalist
democracy, they’ve been applied to these risks and
ill health. The United States provides universal health
insurance only to people age sixty-five and older.
Extending this coverage to all Americans would be another
pillar of the commons sector and make us more of a
national community.
For the benefit of U.S. readers, it’s worth
describing how universal health insurance works. Take our
northern neighbor as a case in point. In 1984, the
Canadian Parliament unanimously passed the Canada Health
Act, designed to ensure that all residents of Canada have
access to necessary hospital and physician services on a
prepaid basis. Each province now runs its own insurance
program in accordance with five federal principles:
* Universal. All residents are covered.
* Comprehensive. All medically necessary services are
covered.
* Not-for-profit. Each provincial plan is
not-for-profit.
* Accessible. Premiums are affordable or
subsidized.
* Portable. Coverage continues when a person travels.
The act also bans extra billing by medical
practitioners. As a result, the system is incredibly
simple. For routine doctor visits, Canadians need only
present their health card. There are no forms to fill out
or bills to pay. The system is financed by a combination
of federal and provincial funds. The provinces raise part
of their funds by charging monthly premiums.
I compared monthly premiums in 2005 for families of
four in California (through Aetna) and in British
Columbia (through the provincial health plan). For the
California family, the rate was $1,045 when the head of
household is age forty-five; for the Canadian family, the
rate was $88 no matter what the age of the parents (see
figure 7.1). Discounts are available to low-income
families.
| Figure 7.1: HEALTH CARE BY THE
NUMBERS: UNITED STATES AND CANADA |
| |
U.S.
|
CANADA
|
| Estimated per capita expenditures (2004;
US$) |
$6,040
|
$3,326
|
| Percent spent on administration (1999) |
26%
|
10%
|
| Monthly premium for a family of four |
$1,045
|
$88
|
| Male life expectancy (years) |
75
|
77
|
| Female life expectancy (years) |
81
|
84
|
| Infant mortality (per 1,000 births) |
6.4
|
4.7
|
It’s important to note that in Canada, unlike
Britain, there’s no National Health Service.
Medical providers work for themselves, or for private
clinics and hospitals. Customers can freely choose their
doctors, hospitals, and other practitioners. The only
thing that’s been added to the commons is the
risk-sharing system.
Here’s the bottom line. All Canadians get health
care and peace of mind at a per capita cost that’s
about 45 percent lower than ours. Canada lays out less
than ten cents of every health care dollar on
administration, while we spend nearly thirty cents (and
that doesn’t include the time and energy patients
themselves spend on paperwork). What’s more, our
health care system doesn’t even keep us healthy.
Our infant mortality rate is higher than Canada’s,
our life expectancy is lower, and we have proportionally
more obesity, cancer, diabetes, and depression. To top it
off, forty-five million of us have no health insurance at
all.
What can we learn from this comparison? Social
insurance enables members of a community to reduce common
risks more cheaply and efficiently than private insurance
does. It’s thus a vital piece of social
infrastructure. This is especially so when we want
coverage to be universal. Some of the savings result from
economies of scale and low marketing and administrative
costs. Others result from simplicity and the absence of
profit. ...
read the whole chapter
Patently Unscientific
Enclosure of the commons has also been occurring in
the world of science. Here, too, the Founders’
intentions were clear. Ben Franklin, no slouch when it
came to the dollar, never sought a patent on his most
famous invention, the Franklin stove. “As we enjoy
great advantages from the inventions of others,” he
wrote, “we should be glad to serve others by any
invention of ours.” Thomas Jefferson, who served as
first head of the U.S. Patent Office, believed the
purpose of the office was to promulgate inventions, not
protect them. He rejected nearly half the applications
submitted during his term. (Eli Whitney’s cotton
gin made it through.)
As with copyrights, this stringent approach to patents
worked well for a long time. America didn’t lack
inventiveness in the nineteenth and early twentieth
centuries (and let it be remembered that we stole much of
our early technology from the British). But from
midcentury to the present, patenting has become a
national pastime. The Bayh-Dole Act of 1980, which let
universities get patents on taxpayer-funded research and
license those patents to corporations, opened the
floodgates. Corporate money rushed into academic labs,
and with it came a corporate mindset. Where scientists
once shared their discoveries openly, many now fear to
discuss them, lest someone beat them to the patent
office. Today, some say, the secrecy is so intense and
the thicket of property rights so dense that the
advancement of research has noticeably slowed.
The U.S. Patent Office has gone along with this,
issuing patents for everything from one-click shopping on
the Internet to genes that are 99 percent nature-made.
Often, companies get patents not with the intention of
developing them, but rather with the intention of suing
someone else who might (a practice known as patent
trolling). Figure 8.1 shows the dramatic rise in number
of patents issued over the past few decades.
Consumers and taxpayers are burdened as well. Thanks
to patents, pharmaceutical companies can charge monopoly
prices for up to twenty years after introducing a new
drug. This is said to benefit society by providing
incentives for research, but according to the Center for
Economic Policy Research, the benefit is greatly exceeded
by the cost. Pharmaceutical companies spend about $25
billion a year on research, of which about 70 percent is
for copycat drugs that mimic competitors’ brands
and add no significant health benefits.
The federal government could fund 100 percent of
noncopycat research — and place the resulting drugs
in the public domain — entirely from cost savings
to Medicare and Medicaid. On top of that, the savings to
consumers from lower drug costs would amount to hundreds
of billions of dollars each year.
To release science from corporate control, we need to
take a twofold approach: apply more stringent standards
for issuing patents, and provide more public funds for
research (with the proviso that publicly funded
discoveries stay in the public domain). The track record
for publicly funded research has, in fact, been
phenomenal. The entire computer industry was spawned by
the U.S. Army Ordnance Corps, which produced the first
digital computer in 1945. Similarly, the Internet emerged
from the Defense Advanced Research Projects Agency and
the National Science Foundation in the 1980s. It’s
hard to imagine the modern world without either of these
breakthroughs, or with the Internet being owned, say, by
Verizon or TimeWarner. ...
read the whole chapter