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The ‘lite beer’ election: Infrastructures

The Long View

Part 2

In a previous column, I asserted that our choices in the forthcoming presidential election are not only too narrow, but that the parties and candidates are refusing to deal with the really difficult problems that confront us. Among them are three sets of crumbling infrastructure: the physical infrastructure of roads, rails, bridges and public facilities; the health care system; and the higher education system.

These problems did not arise overnight.

For decades, budget tightening has put off needed repairs to public facilities of all sorts. Now bridges are starting to fall, poor conditions on roads are being cited more often as contributory to fatal accidents, and railroad stations are being shut just as demand for non-highway transportation rises. If we don’t act now, there will be disasters and slowdowns that will impact our economy. Recently, we’ve been told that the choices are of the ‘lite beer” sort, between paying the salaries of firemen and teachers, and fixing the highways. That’s nonsense; we need and must have both. Everyone knows that the solution on physical infrastructure lies in new taxes and bonds — which are anathema to voters, and so are not discussed.

Our cowardly public officials don’t dare tell voters this difficult truth for fear of losing their jobs. The fact remains that the overall U.S. tax rate is lower than that of many other Western countries, and that in those other countries public facilities are not only keeping pace with the times, but positively influencing development and trade — Europe’s rail system is one example.

As for health care, most families in the USA are one serious illness away from bankruptcy. Yet neither party has an overall plan for lowering health care costs and raising health care delivery. Our current system is just a gold mine for the insurance companies, with everyone else suffering: the doctors, nurses, hospitals and nursing home workers on the supply side, and the patients, especially the elderly and the very young, on the demand side, along with non-health-care company employers who must foot the bill for a good chunk of the insured.

We pay more, per capita, for our health care than the citizens of any other Western nation do, and have worse outcomes — our people die younger, our infant mortality is higher and our physical health is lower. American medicine does have some top of the line facilities, doctors and equipment, but for the majority of the population, the general quality of our care is spotty and in some areas is downright shoddy. To fix this will require radical reworking of all elements of the system. That cannot happen when for-profit insurance companies are at the center of the system and the problem.

Providers must also be reformed. A Los Angeles hospital recently admitted that it charged an insurance provider $1,000 for a scan for which it would have charged the individual $250 in cash. What is the true price of the scan? More likely at the low end than at the high. Medicare, the largest underwriter of prescription drug purchases, is forbidden by law to negotiate lower prices for consumers by obtaining quantity discounts from pharmaceutical manufacturers. With restrictions like that, no wonder our costs for care are so high.

But the pharmaceutical companies make a profit on the same drugs sold in the United States in, for instance, Canada, where governmental bulk buying discounts are the rule, and they haven’t all stopped doing business in India, where they are forced to provide generics at low cost. Nor are consumers without blame; most health-care consumers would lower their costs if they would take advantage of preventive care and address conditions before they become severe.

As for education, if our economy is going to require that to be eligible for a middle-class job you must first obtain a college degree, then the astronomical cost of obtaining such an education must be brought down, among other reasons, because it is killing the economy. The full effects of having several generations of young men and women graduating with tremendous burdens of debt has not yet been felt, but it should be clear that young men and women carrying large college debts will not be able to buy new cars, new homes or the other goods that our hyper-consumer-driven economy needs them to do in order for that economy to continue providing jobs.

In a third article, I’ll tackle a few other matters that our major parties and candidates will not adequately address, such as the deterioration of our environment and the pernicious effects of too much money in politics.

Salisbury resident Tom Shachtman has written more than two dozen books and many television documentaries.