health care reform

It looks as if Health Care Reform will die a slow death. That is to be expected when powerful for profit forces with ample media access stand to lose their lucrative honey pot. Health Care will forever be a problem in America because both parties stand in the way of meaningful reform.

First one would need to take the lawyers out of the picture. We need to end the malpractice lawsuits and the punitive damages. These things accomplish nothing and they cost each and everyone of us a fortune. They cost us in more ways than one. We are denied simple things because people are afraid of being sued, and we pay through the nose for other equally simple things because the liability insurance is so high. We have to fill out tons of paperwork and stand in long lines before we can participate in everyday routine activities.

Unfortunately, the lawyers are a major force in the Democratic party so don't expect anything here. And if the Republicans want to take on the lawyers, they only do so to enlarge the already excessive profit margins of the major players.

Second, we need price controls on drugs, and we need competition for private health insurers. Better would be to get rid of private insurance but that is another matter. Both of these groups are ardent Republican supporters so here is another impossible roadblock towards reform.

The problem is simply this: health care is so full of conflicts of interest that even without a profit motive, it is hard to ensure fairness and equity. If you add in profits, everything goes to hell. If your doctor stands to gain from procedures, he will perform more of them. If the drug company stands to gain from selling pills, they will sell them to everyone regardless of need.

It costs us and it costs us in many ways. We pay for it over and over again, not just directly, but also indirectly. And we get very little value in return. No American Health Plan comes even close to what Europeans take for granted.

Even the wealthy with unlimited access suffer as the profit incentives force them into unnecessary tests and procedures. And the liability issues make it so their doctors and providers practice defensive care (i.e. another incentive to do even more tests). No test or procedure comes free of risk and in most cases the cost benefit is simply not there.

Now you say, but isn't our long life expectancy proof that we have great healthcare?

Unfortunately longevity is not a good measure of success. Longevity correlates well with wealth because good food, clean water, good sewers and an ability to stay away from dangerous (job) situations promote longevity. Anything that brings you closer to a doctor or hospital on the other hand is likely to reduce your quality of life or artificially extend the duration of it in ways that are unsuited for a dog, let alone a human. Every Terry Schiavo does wonders for longevity statistics.

Apart from party politics, one other bipartisan hurdle remains: the moralists. A key benefit of medicine is pain relief. And not surprisingly, pain is grossly under-treated in this country. Not because we don't have good drugs, but because a handful of moralists feel it is imperative to prevent drug addiction. Heaven forbid that a terminal cancer patient should become addicted to morphine! For that simple reason we all have to suffer. And suffer we will, because modern medicine will make sure we don't die a quick death. Euthanasia is out of the question, even if one's condition is hopeless and one's suffering unending. How's that for first do no harm?

corporate social responsibility

To conduct business, humans have invented virtual entities known as "corporations." The word corporation derives from the Latin corpus or body. These entities are in effect legal bodies or to put it more poetically, imaginary people. They have certain legal rights and obligations. They have legal responsibilities. They can own items and make a profit. They can be sued if they misbehave. And they are responsible to their owners, known as shareholders.

In short, we have created legal persons. The brains of those legal persons are entrusted to a group of people known as the officers of the company, led by the Chief Executive Officer or CEO. To provide some oversight the company also has a board of directors. All of this is to make sure that the corporation behaves properly and that nobody cheats or steals from it, or uses it in any fraudulent manner or to conduct a crime.

In general, corporations are led by honest, hard-working people, who are well respected in their communities. These people are driven by a variety of motivations and making a profit is surely one of them. But many also desire to make a difference in their communities or the world. Yet, however well-adjusted these people are, the law is asking them to behave in a distinctly anti-social, and some have said psychopathic manner.

Just to make things clear, a psychopath is a person has no conscience. They lack of remorse or guilt and are immoral and antisocial. They have no regard for the well-being of others and only think of themselves. They do not feel empathy for their fellow man. Often they are charming, cunning and manipulative. So how does this relate to a corporation?

Corporations have to act with the sole purpose of making money for their shareholders. If that means laying off people, taking away their benefits, or unsettling entire communities so be it. If it means destroying the environment, ditto. Corporations can only think about profit and all else has to submit to this prime motive. Even if the officers and directors disagree or find such behavior distasteful, they are bound by fiduciary duty to uphold it.

A corporation has to act as an antisocial, immoral, egotistical person. Investors can sue a corporation and its officers if it deviates from this premise for whatever reason. Even if that deviation is done for social or humanitarian reasons. The corporation has a ruthless profit motive and if it has to harm people to get there, so be it. As long as no crime is committed, we expect corporations to behave in whatever manner ensures maximal profit.

It is quite surprising that smart and well-meaning humans have come up with such a legal structure. I have discussed this topic before on March 22 and suggested that shareholders revolt and demand a legal structure that is more in line with normal human behavior. If we create artificial people, should they not behave like normal people do? No society tolerates psychopaths in their middle and no society should tolerate psychopathic behavior from virtual people either.

The posting provoked quite a few comments stating how it was impractical or impossible to legalize moral behavior. Clearly that is not the case, and ordinary humans are held to such standards and promptly punished if they don't act this way.

So why treat our virtual people any differently?

It turns out others have thought along the same lines, and a movement has started to form around a new entity called the B corporation. It was started by a successful Stanford graduate, called Coen Gilbert, according to the San Francisco Chronicle. A B corporation can have values that go beyond profit. Right now, B corporations are more the exception than the rule. The story listed 23 B corporations based in the Bay Area. It is a start.

However, B corporations have no special tax status. It is also unclear how much legal protection they would enjoy if shareholders sued them for leaving profits on the table. The situation is quite complex. Some states have laws allowing companies to consider the interest of constituencies other than shareholders, but California is not one of these. However, a bill has been introduced in California by Assemblyman Mark Leno (D-SF) to do just that.

Don't hold your breath. I am sure there are many powerful opponents here. Furthermore, many sensible ideas never make it in the real world. This one however, should be welcomed by all. It is correcting a mistake we made earlier. That much is just plain common sense.