Universal HealthCare: A Capitalist viewpoint

     People in the United States, in general, don’t know much about economics. Upon graduation from high school, they often don’t know anything about credit ratings (and how they affect people), how to create and follow a budget, the difference between simple and compound interest, and so forth. Some people occasionally launch memes or threads talking about how schools should have a mandatory course called “Life” that teaches basic economics, basic cooking, basic laundry, basic childcare, and so forth. I think that is a great idea — but that’s not the way it currently is.

     In spite of the active use, in conversations, of the words “socialism”, or “communism”, or other political/economic system — people in the United States, in general, know even less about them than they do capitalism. They just make good scare words to toss about.

Some Basic Aspects of Capitalism

     People in the United States come to know something about capitalism because they are surrounded by it every day. They learn some the first time they get a job — or pay taxes. They learn some the first time they try to rent an apartment. They learn some the first time they run out of money before the end of the month. All of these situations are the “hard way to learn” — and why the potential “Life” course makes so much sense. But, at the end of it all, people in the United States do learn about the aspects of capitalism which affect them in their day-to-day lives.

     That does NOT mean that people in the United States all know all of the aspects of capitalism. People running businesses have knowledge of additional areas than those known by ordinary consumers. CPAs and tax lawyers know more about accounting-related aspects of capitalism. But there are aspects of capitalism (which is currently tightly coupled with consumerism) that most people just don’t think about, or understand, because they only affect them “behind the scenes”. Some of those “behind the scenes” activities affect people in external ways such as “inflation” — and the lack of understanding is taken advantage of by politicians.

     But this is not an economics course — and I am not an economist. I am just someone who is curious about, and questions, just about everything I encounter in life (which can be extremely annoying to those close to me <smile>).

     One of the basics of capitalism is the concept of “profit”. A profit is created when something is sold for more than it costs to create/excavate/manipulate it. It costs me $5 to make a widget. I sell the widget for $7 and I make $2 profit. Capitalism strives to make greater and greater profits — either by selling more or by making the difference between creation cost and selling price larger. Those profits go to various entities — employees, management, benefits, pension plans, stockholders, executives (separated from management because their situation is manipulated differently by governing boards and competition at the executive level), and so forth.

     A “non-profit” company differs from a “for-profit” company in that there is, officially, no difference between incoming money and costs for all that is needed to provide the product/service. It is not actually as different from “for-profit” as one might think — in order to be non-profit, all incoming monies must be spent and that extra money may go to larger employee/management/executive salaries, perks, and bonuses or it can be spent for more services (more wells for potable water to more people?). The money which would be called profits, and potentially distributed to stockholders, is absorbed into the daily workings/expenses of the company. A non-profit company is inherently a private company with no stockholders. That is the primary difference to people who interact with such companies.

     In the case of a charitable non-profit, it is important to know where that money goes. Sites like Charity Navigator can help donors know how much is really going to help people versus how much is being kept within the company.

A for-profit company will increase profits by:

• Increasing the number of sales

• Increasing the difference between cost to provide and price to acquire. They do this by:

  • Increasing the price to be charged for sales AND / OR

  • Decreasing the cost of the item/service to be provided

Capitalism as Applied to the Current US Healthcare System

     Now that we have a basic idea of how capitalism works, lets examine the current workings of the United States’ unique form of healthcare. As one of many for-profit companies, it will want to increase profits in the manner described above. In the US, there are multiple companies that compete to provide healthcare which reduces the number of potential customers/patients for each company. Unlike customers for other products, each customer comes with a certain amount of statistically-likely amount of services to be needed. Each company will want to attract the customers for which they will make the largest profit — charge the most and give back, in service, the least. In the near past, that could lead to the reality that NO company would want to provide service to a likely low-profit individual. The “Affordable Care Act” (ACA) addressed this in part, mandating that some form of medical care would be provided for each person who applied — if not within existing private for-profit companies then within existing government administered healthcare.

     The other aspects of for-profit healthcare still largely exist independent of the existence of the ACA. Each company will try to provide the least amount, or least expensive, form(s) of service. Each company will try to charge the most for the least service. The formulas become so complicated, and difficult for the general consumer to understand, that it is not surprising that many “throw up their hands” and just pick the healthcare option that, on the surface, seems to be most appropriate, and valuable, based on their individual circumstances.

     The advantage of this situation, within the US capitalistic society, is that stockholders can invest and expect large returns — basically a transfer of money from the pockets of the served to those who have invested in the companies.

     It has another advantage to the executives of stockholder-owned companies in the way that executives obtain their salary/perk/bonus/severance packages. For public stock-providing companies (not just healthcare), in spite of stockholders having some control (usually unused), the governing boards decide these financial aspects and they have incentives to keep it as high as possible. The primary one is “bragging rights”. Very expensive executives must be worth it, or they wouldn’t be paid such, right? That is the assumption, and governing boards use that assumption to justify increasing amounts.

     It is extremely strange if one steps back from the situation. They are “worth more” because they are paid more — and they are paid more because it gives external companies/stockholders/people the feeling that they must be worth more. Whether they truly are worth these extremely large financial packages is a matter of opinion. Their financial packages certainly raise the prices of services/products produced by the company.

Capitalism as Applied to Universal Healthcare

     We have seen that aspects of private multiple for-profit healthcare are strongly against the benefit of the customers (patients). Why is a centrally administered universal healthcare better for the customers (patients)? Note that this could still be a non-governmental non-profit company. However, the administration of the medical system by existing sections of the government is also possible — and might be easier than setting up a new non-profit. It is essentially still following the capitalist formula.

     A Universal HealthCare system doesn’t have to keep track/authorize use of healthcare. Some ID is still needed to make sure all providers get the money they deserve for providing their share of the services needed by the patient but many aspects of authorization and benefit calculation/matching becomes moot — no need of that extra overhead (which amounts to a very large amount of time, money, and frustration within the US system). Imagine a doctor saying you need something and not having a need to check through your insurance policy to see if it is covered!

     A Universal Healthcare does not have to be concerned about short-term, or long-term, profits. All decisions can be made based upon the needs of the patients. If the cost of services rise (averaged from the needs of a very large number of people) then the price to the consumers goes up — whether it is provided directly by the customers (patients) or whether it is provided through their tax money funneled through the government.

     A Universal Healthcare still has employees/service-providers/management & executives. But there is no platform for justifying huge packages for executives.

     All-in-all, staying within the capitalist political/economic system, a Universal Healthcare lowers the cost to the customer (patient). It lowers overhead, it provides a direct connection between services provided and cost, and it eliminates very large executive packages. This is true no matter what entity provides the services — a non-profit company outside of the government or a non-profit company run within the government structure.

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What's Happened to our Educational System (cont'd)?: Quantitative vs Qualitative

      All parents want their children to attend “good” schools. “Good” or “bad” is an answer to a set of questions that we would like to have quantifiable. And that isn’t easy to do. In the first place, all schools do not teach the same things. Secondly, they may not all evaluate the students’ progress in the same manner or use the same scales. Lastly, there are many types of educational achievements and many of them do not have “scores” associated with them.

     So, it was “decided” (in a rather arbitrary manner), in the US, to make schools comparable. Require schools to teach the same materials, in the same ways, and evaluated in the same way. And just eliminate (from the scoring at least — possibly completely from the curriculum) all of those “messy” areas that are difficult to assign numerical evaluations to. “Messy” areas like art, music, physical education, creative writing, and such. In addition, there are many “messy” areas that CAN be evaluated to a score but, in order to do such, much time and effort is needed. Such areas include non-fiction essays, book reports, topical research papers, and such.

     The “No Child Left Behind” Act had admirable goals but, in order to achieve much of it, all schools needed to be comparable. Doing such required the above methods. Teachers had to start “teaching to the test”. Things that would be on the standardized national tests were important to know — everything else was not.

     “No Child Left Behind” still might have worked — but not in conjunction with reduced resources and exploding class sizes. (I think around 12 to 15 students per teacher would be optimum — but those numbers are certainly up for debate.) The quantifiable “teaching to the test” stuff could be a part of the day’s curriculum. But most of the time should be devoted to material that fosters the creative, analytical, and investigative sides of their education.

     The “whats” and “whens” have become even less important in these days of information access. It is those “hows” and “whys” (and whether it is true or not) that humans most need to be able to do.

     Back to reality, however. Class sizes are NOT reasonable. Teachers are not well rewarded or recognized. When classes overflow, “teaching to the test” is what survives. The teacher is considered “good” if their students get good test scores. The school is considered “good” based on their test scores. These numbers affect school funding and teacher retention. Great teachers can lose their jobs in a manner that is parallel to the situation of dedicated school cafeteria cooks being replaced by less healthy pre-processed foods.

     Great teachers teach for the benefit of the students and not for the benefit of a numerical score.

     Being able to check the correct box on tests becomes more important than being able to write — or to read beyond recognizing the questions and answers. The numbers become more important than being able to create the next important “widget” for a future business. The numbers become more important than being able to research, and verify, what is correct and what is a falsehood. The numbers win. Education loses. Society loses.

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What's Happened to Education?: Effects of Income Inequality

     By almost all measures, as an overall average, our children in the US are not emerging from the education system (public or private — but more so with public) as well prepared for the world as they were 40 years ago. This is true in most measurable areas — but especially true for the non-measurable areas. Education (public, private, home schooled, or self-schooled) should end up with people able to use knowledge, able to research knowledge, able to evaluate knowledge, and with a desire to continue to grow in knowledge and the ability to use it. For most, that’s not the case.

     Overall, people have not changed that much in their potentials. This is true for all humans no matter the gender, ethnic background, nationality, or other qualities. There is, of course, a range of abilities from not so capable to enormously capable. We have now also recognized that there are different types of intelligence and each type is most useful in particular situations. Often we emphasize intellectual (or academic) intelligence but other types of intelligence are often more important in the pursuit of happiness and “success”.

     Assuming (though not likely to be something upon which all agree) that this is true, what has happened? What has happened over the past 40 years to lend support to such a trend? There are many things that are possible causes — environmental contamination and change, educational methodologies, social support, and societal expectations, and on.

     I propose that one of the primary reasons for our faltering educational system is that of greatly increased income inequality.

From the Pew Research Center:

     Okay. These are the numbers, but what does it mean for the general populace in the US? It means that a much larger percentage of people in the US find it difficult to support themselves within our economic system. Note especially the widening gap between middle-income and upper income. Some specific outcomes, for lower and middle income people, are:

• People are spending a higher percentage of their income on rent or mortgages.
• People are having to tightly prioritize expenses.
• There is less of a cushion available in case of emergencies or fast changes in income (such as layoffs). 
• Parents are working more hours — sometimes more jobs — and spending less time with families.
• Due to lack of time and energy, parents are also interacting less, with teachers and schools, in a direct manner.
• In regards to education, one direct result of income inequality affects tax support of schools. Funding for schools is different for each state in the US but they all involve some combination of property tax, local taxes, state taxes, school levies, and federal support. Increases in taxes must be approved, directly or indirectly (through representatives). As budgets tighten, there is a desire to reduce taxes and expand classes.

     An example of the direct effects of the expansion of class sizes could be an example from my wife’s situation as a teacher within a much-too-numerous student class-size. During the last year that my wife taught 5th grade, she had 39 students in the class. Assuming six hours in the classroom (it varies from state to state and district to district), that allowed less than ten minutes to be spent with each individual child. Of course, that is not how classroom time is structured. Most of the time is allocated to the class as a whole and the amount of time, to be allocated among those 39 individual children, might not even be an hour (or less than two minutes apiece) and the majority of that time will be spent with children who have attention-seeking behaviors (usually via misbehaving).

    With less time available to get to know the teachers and the schools, parents are left with what is said by their children, and by other teachers and groups, to determine what is going on in the classroom. Not a surprise to the children but, somehow, a great surprise to the parents is that the children do not always tell the truth or take responsibility for their own behavior and actions. And other parents and groups are not always a good source of information as they may be responding to things said to them — with similar lack of direct interaction with the teachers and the schools.

     This lack of adequate awareness of what is really going on within the classroom can lead to an antagonistic relationship between parents and teachers/schools. After spending a 60-hour workweek (40ish at school and another 20ish at home grading papers and preparing lesson plans), it is difficult for teachers to find time or energy to disentangle parents’ misbeliefs.

     Expanding upon the last three bullet items stated above, income inequality can directly lead to fewer resources to the schools, unworkable increases to class sizes (and a decrease in the amount of time available for the teacher to work with individual students), and lack of positive communication between the teachers and schools with the parents. Another large factor in educational performance is a shift in emphasis from qualitative experiences to a hyper-focus on quantitative experiences. I will expand on that in the next newsletter. Ideas & Interpretations is a reader-supported publication.

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Gifting: An Intersection of Desires

     ‘Tis the season (although, fairly, this newsletter’s topic may be a bit on the late side) for gifts and giving. Together, they create a situation of “gifting”. To gift someone is to give and for it to be accepted. Just giving is not sufficient. You might say, “well if I have given something to them then they have accepted it, haven’t they”. No, not really. To just take possession is not quite the same as acceptance. acceptance is a combination of receiving, possession and acknowledgement.

     Giving is also not quite as clearcut as many might tend to believe. If you give there are no attachments. It is no longer “yours” and any preconceptions you may have had about how that gift would be used or appreciated is no longer in your hands. They may throw it away, ignore it, sell it, put it into a “white elephant” sale, or put it onto a pedestal as their newly favorite possession. Whatever they do with the gift is fully their right.

     Nor is a gift necessarily appreciated — although that is the goal. When choosing a gift, there are at least two people’s desires coming into play. (It is possible that it must also be appreciated by a third party or parties.) High priority is giving something that the recipient will want. However, highest priority is to give something that the recipient will want AND something that you will enjoy giving to the other — an intersection of desires.

     If it is something that only the recipient will enjoy, it may still be a good gift — but it is somewhat of an anonymous gift. The gift could have come from anyone — or even could have come from themself. When you give something that you want to give, it means that the gift means something to you also. There is a much better chance that the gift will act as a mutual experience between the two of you. This can foster greater closeness and increase the likelihood that the gift (if kept) will remind the recipient of you.

     It is sometimes said that a true gift is “something from oneself” or “a gift of the heart”. Certainly, in the Christian tradition, the gifts to the Christ child from the Three Magi are of less importance than (in modern tradition — not noted anyplace in the Bible) those gifts from “the little drummer boy”. They are still of import — not because they are expensive, precious, items of the time, or as they may be interpreted as representing — but because of the long, and difficult, journey of the Three Magi. It is the journey, and recognition, that is the true gift.

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Perseverance: Life One Step at a Time

     There is a Christmas movie (yes, there are lots of Christmas movies) called “Santa Claus is Coming to Town”. In it, there is one musical scene where a song called “Just Put One Foot in Front of the Other” (and soon you’ll be walking out the door). It isn’t quite an earworm but I find myself singing it to myself when I am faced with something difficult, terrifying, or frustrating. Guess what? It seems to help. In this, I am not alone as many people find inspiration and solace in music.

     Still, this song embodies a true situation. How do we get through the door to inside (or outside)? One foot at a time (or one turn of the wheel on a wheelchair). There may not be much observable progress after that first footstep but it is what gets you to, and through, that doorway.

     Perseverance and Inertia seem to be bookends. As long as you don’t move (physically, spiritually, or any other way) then you are “safe” within where you are used to being. You may tell yourself that you don’t like where you are but, as long as you are not moving, you must be sufficiently comfortable. Once you do take that first step, think that first thought, or agree to that first point of advice then you can progress towards your goal as long as you keep “putting one foot in front of the other”.

     Often, we start feeling impatience. We want to arrive at our destination as quickly as possible — the old “are we there yet?” situation. Not only is it required that we go from the origination to the destination “one step at a time” but is to our advantage to do such. This gives time to enjoy the journey as well as providing “checkpoints” that lets us verify that we are still heading towards our goal — or to give us second thoughts as to whether we still want that original destination.

     But, I primarily start singing the song to myself when I find myself afraid to take that next step. It seems to ease the anxiety by reminding me that it is ONLY the next step. It doesn’t have to be perfect and it doesn’t even have to be in the “right” direction because there will be yet an additional “next step” and I will have a chance to reposition it.

     Do you proceed one step at a time? Do you find yourself reluctant or afraid? Many do, so you are in good company. Remember that all you can do is keep moving — everything else will happen according to many factors, most of which are not even close to being under your control.

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Leadership: What it is and what it isn't

     I’m going to start off with the core of this newsletter. Leaders have goals and leadership is the set of skills and methods that encourage, persuade, and/or entice others to work towards that goal (or goals) together.

     So, what are goals? Goals are anything beyond the status quo — something that has not been achieved before. Goals can be applied to individuals, families, companies, cities, states, and countries. There can be good managers, even great managers, who succeed in maintaining a healthy status quo (a situation where the best possible situation exists for things as they are NOW). They can be admired and appreciated — but they are not leaders.

     Here in the US, the last President that I know of who put a goal into motion was John F. Kennedy — and he was assassinated. He said “we will put a man (no thought of women participating at the time, alas) on the moon by the end of this decade (the 1960s). This goal, which had to be pushed forward by his successor, Lyndon B. Johnson, required a joint effort of Congress and the people of the US. And they did it! There were coordinated efforts which boosted the educational system towards the sciences. The process of making the physical elements happen had all sorts of side-effects which affected the country then and beyond. These include (but the list is enormous) solar panels, heart monitors, water purification technologies, lightweight building materials and methods, improved computer capabilities, and search and rescue methods, among many others. They provided a boost to technology which can be followed to everyday technologies such as GPS and smartphones and Internet capabilities.

     The 60s were a good time for trying to put goals into motion. Martin Luther King, Jr had a “dream” — a goal where all people would work together and respect one another no matter their external appearance or beliefs — and he was assassinated. At the time of his death, he was expanding the breadth of his concerns to that of the global community. Mahatma Gandhi had similar dreams two decades before (and, once again, he was assassinated for them).

     Martin Luther King Jr’s dream has not yet been achieved but his efforts, and those of many others working with him and alongside him, have achieved some significant progress. When I was around four years old, according to my mother (I don’t really remember), I brought home a young girl, whose skin color was not the same as ours, to play with. I was told “we don’t play with these people, the neighbors will see and we’ll never hear the end of it”. Later, in the 70s and 80s she took care of children of all external appearances but my mother, though she did have many positive qualities, did not have the courage of MLK Jr and the folks alongside of him.

     In short, among the many improvements has been the reality of people being able to associate with others who are not directly similar to themselves. Being allowed to associate is the first step to accepting others as people — it allows empathy, understanding, acceptance, and growth. But, as said before, it is only part of beginning steps towards the “dream” of MLK Jr — as “allowing” does not mean the same thing as everyone “doing”.

     There have been goals created by business leaders. All of the “new” businesses have been pushed forward by someone with a goal. Some such have already been mentioned — such as GPS and smartphones — but just about every “new” business has been achieved by striving towards a goal.

     Note that word “striving”. We haven’t reached MLK Jr’s “dream” yet. The goal is hopefully a worthy one (there are instances in history where the goal was NOT a worthy one) but the process of getting people to work together and attempting to make that goal happen is still worth the effort and brings many benefits. Even if we had NOT succeeded in putting a man on the moon, what benefits would we still have achieved?

     Was it a coincidence that the two people I mentioned from the 60s (and there are many others globally) were assassinated? Personally, I don’t think so. The reason that there are not more goals set, and worked towards, is because a goal inherently means CHANGE. There aren’t many people that take change calmly. Some may be positively excited but there will be many who will be terrified. For businesses, it is primarily a matter or risk and a likely hit on short-term results. For political and economic systems, any change will affect the profits and livelihoods of corporations and many wealthy individuals. Isaac Newton talked about inertia in terms of physical systems — but the inertia of groups of people can be even more difficult to change. The more people that are affected by a change, the more likely there will be someone who will, under strong negative emotions, do something violent.

     As politicians show us every day, a terrified (or angry) person can be persuaded to do things that they would never even consider if in a calm situation. Scared or angry people can easily be persuaded to do things that are not at all for their long term benefit — “to shoot themselves in the foot”. As Frank Herbert said in the book Dune, “fear is the mind killer”. In addition, there are many people, and corporations, who greatly benefit financially by keeping to the status quo.

     As I said, in my opinion, JFK was the last US President who succeeded in initiating a goal (but would have failed if LBJ had not taken over the initiative). In the US, in my opinion, we have had one other President who tried to be a leader and who initiated some change — but was soon thwarted by others who virulently did NOT want change. Thank goodness, he was not assassinated but might he have been if he had succeeded in initiating the changes he envisioned and that the country so badly needed? We’d have to move over to a parallel universe to find the answer to that.

     In my opinion, we have also had one President who showed that he (once again, that pronoun — but accurate) was a very good manager. He succeeded in having a balanced budget in the US. But that balancing of the budget was not appreciated by those benefitting from a continual increase in spending (or the decrease of taxes in a disproportionate manner). Certainly no one following has succeeded in doing such. It is not likely that it will happen in the near future unless a disaster (such as happened with the Great Depression) forces change. A balanced budget requires reduced spending and/or increased income (for governments, primarily from taxes). Such requires consensus and consensus requires a very good, or better, manager.

     To summarize, leadership is the set of skills and methods needed for a leader to get people to strive for a goal. A goal is something that goes beyond the status quo. Although the status quo can be maintained by a good, or better, manager — such is not leadership or being a leader. Setting a goal, and working towards it, can be frightening, as it means change and those benefitting from the status quo will resist with existing economic constraints providing them support.

     But, in a world that is undergoing constant and accelerating changes, goals are mandatory. And leaders must exist to take us towards those goals. As a caveat, remember that it is also possible to work towards negative, or regressive, goals. Let us, globally, support leaders to take us towards a positive, better, future.

https://charlesksummers.substack.com/p/leadership

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Unfocused: Are you doing what you want to do?

     I continue to be an old-style “classics” cartoon person. In spite of the extreme predictability, I love watching Scooby-Doo. But one aspect calls out to me more and more. If they are trying to protect something, why do they hold it up in the air to be grabbed? If I were to want to protect something I had, I would put it under may shirt and hold on to it with both arms — make it as hard as possible to grab. It’s not just Scooby-Doo, of course.

     Or watch a movie. Someone is driving along and they turn their head and talk to the passenger (or someone in the back seat) for a couple of minutes (even if it were to be ten seconds, it would be way too long). Shoot! They SHOULD be in an accident. If not, it is definite proof of someone, or something, watching out for them. If they do get in an accident one can only say — “of course. Why did they want to behave that way?

     It doesn’t have to be as brazen as looking a different direction while theoretically in control of a 2500 pound cage of metal. It can be walking along on the sidewalk while looking at the little box that society seems to currently mandate we all be manacled to. Crossing streets? Walking on a sidewalk with potential open personhole covers? Approaching an unsafe area of town? Walking onto, or off of, a wharf and into the water? Whoops.

     Once upon a time, in the modern “dark ages”, I was called by a survey person who wanted to know how much I would pay per month to carry a phone around with me to be in constant contact with the world (this was before anyone envisioned a mobile computer as part of that phone). I replied that I was willing to pay $20/month to be without that “privilege”. I could (and did) look into that and see an invasion of work into my everyday life and a disconnection from society and possible privacy. Not that this situation HAS to be — but avoiding it while possessing a “smartphone” requires a much greater degree of self-control than most have (and I will admit to personally taking out my phone at the table, while eating out, to check an incoming message or settle a question on a topic of the table).

     If you ask people to write down a list of things important to them — and the priorities thereof — they will probably be able to do such. But, if you then ask them if they actually follow that list, they may well look “sheepish” — even more so if you start asking for specifics.

     In a novel (or movie), the characters are told that “time is of the essence” and then they spend minutes talking among themselves about things which are not central to the time-restricted thing. Have you ever watched a movie where they had five minutes to disconnect the bomb and then spent 15 minutes of film time doing other things before they disconnected the bomb with seconds to spare? Of course, this is a problem with the continuity monitor on the film but a similar thing happens in real life where focus is lost in time-critical situations.

     If you are supposed to protect something, protect it the best you can. If you have a small amount of time to do something, do it — do other things after the time- critical item. If your focus should be on one task (with penalties involved for not focusing), then focus and isolate other non-critical items. If conversation and social interaction are truly important, don’t let other items get in the way.

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