Even in this economy, there are many Americans who have reserve financial resources, either a working wife, savings, valuable skills, good credit, home equity, or the ambition and desire to strike out and start their own business. At the very least, they feel they can do better at work and are ready to change careers, or start a new job somewhere else. At any time, these people can be tempted to do just that.

But regardless of one’s resources, the potential catastrophe of a medical emergency without insurance can never be dismissed. Even a relatively routine illness or accident can easily bankrupt a family, even a prosperous one. To lose one’s job, or a good benefit plan at work, can be a disaster. The fear of losing a job or health benefits is a threat, a threat which discourages the working man from looking for something better, which drives him to accept his current work circumstances rather than taking a chance on going for something else. To put it bluntly, it keeps workers docile and compliant, and less likely to be willing to take a chance.
It keeps them in their place. It is simple supply and demand.

It would be absurd to claim there was a conspiracy to inflict this state of affairs on the American worker. there is no sinister cabal of Scrooges and Warbucks plotting and scheming to do this. But nonetheless, the dynamic is there, as anyone who works and depends on a steady income to maintain a middle class lifestyle, or for that matter, any kind of dignity at all, can attest. The harder it is to recover from a layoff,
the more a worker has to lose, the less likely he is to do anything that might threaten his family’s livelihood. It is inevitable for employers to exploit this state of affairs, not because they ae evil people, but because they are under stress to increase productivity and profit as well, and they can now expand policies that allow that with less fear of pushback from the work force. Think of it again as the “invisible hand” of the market at work.

When government medical assistance is introduced into the equation, many people suddenly have the resources to just quit, or to be more aggressive in their demands for salary, benefit or work condition upgrades. Other social programs, such as pension benefit plans, private or public, public education, social welfare and safety, labor, consumer protection and evironmental regulations operate in much the same way, although perhaps through more subtle intermediate mechanisms. The increase in financial resources for the working man, regardless of their source, makes it more difficult for employers to control wages, hence costs, and harder for them to get cheap labor. When people can retire, or know they can afford to take time off and look for a better job elsewhere, they cannot be intimidated into accepting intolerable working conditions any longer.

Workers will come to see this as an entitlement. And the ownership class will come to see it as interference in their authority, especially when they feel they are financing it through their taxes. This leads to class struggle. This is not a conflict of ideologies, it is a conflict of interests.

It stands to reason that the workers cannot be allowed to be fully compensated for doing nothing. But neither can the business sector be allowed to get everything they want either.
The working class must have some form social safety net or they will be ruthlessly exploited and abused. The ownership class can also be abused and taxed to death, but they have considerable economic power already, which purchases considerable political influence. They can take care of themselves, and they usually do. Social justice is the reason we have a society, not to provide an avenue for self-aggrandizement to the shopkeepers of the world. But we must also recognize that there is indeed no such thing as a free lunch. Someone has to punch the time clock.

Somewhere in between these competing poles lies a happy medium, a compromise where both sides can reach a mutually profitable, if not perfectly equitable accomodation. Unfortunately, no one agrees to where that point is, and some form of compromise has to be reached politically. That’s the hard part. But we have no choice.

But this is essentially a management problem, not an ideological one. The economy must be managed so that free market and social considerations are in harmony, there is no set of magic principles which if applied can make this fundamental human conflict simply go away.

Pure socialism, in which the state owns everything will lead to an economy which cannot be planned by committee, where shortages and distribution problems will undermine all progress and where bureaucracy and stagnation will rule at the expense of innovation and liberty. The natural self-regulation and harnessing of human ambition by capitalism will disappear, as the best minds get seduced by political machinations and black-market corruption. But pure capitalism will work just the opposite, creating a commonwealth where riches flow in only one direction, where opportunity and freedom for the many will be secondary to the riches and luxuries of an ever wealthier and constantly diminishing elite, who will only see their own financial success as evidence of the surly inferiority and laziness of those who toil incessantly for them.

But I am confident this middle road can be found, further, I am confident that our country has a genius for finding it, has always found it in the past, and will continue to progress, with fits and starts to a more perfect and equitable union. But I am also convinced this can only happen if everyone has a seat at the bargaining table. There are no proletarian heroes, and there are no noble entrepreneurs. We all just work here.

I recently videotaped another seminar from a major health care purchasers organization. The overall theme for this year’s meeting was “Navigating Uncertainty… Sustainable Employer Actions in Turbulent Times.”

These are people from all different perspectives and from around the country who REALLY know health care. The complexity of the issues are vast, so sorry RobVG, reform wouldn’t fit on a five page memo.

The top purchaser from Intel said the company is attempting to work with other companies to use their collective leverage to force providers into more efficient forms of health care delivery. One thing he mentioned was using apps to provide service whenever possible rather than personal visits every time. This would cut costs enormously.

One of the main points made is Obamacare has in fact bent the overall cost curve of healthcare downward from where it was headed before reform. Obviously it’s still rising but at a slower rate. It is also working in the sense that more results-driven medicine is being practiced. Companies were bailing out of providing health care plans in droves before Obamacare because of the crushing costs. Really try to let that sink in. Costs were rising faster BEFORE than they are now. It’s still bad but not as bad.

Bottom line: Obamacare is far from perfect but is better than what it replaced. Health care costs were causing hiring slow downs for the last decade. What we had before was a slow motion national train wreck.

Public education is free, and yet private education and homeschooling — a response to the public system, not the other way around — is doing pretty well.

People are spending money to get a product that is not only being offered by the government for nothing, but they have to pay for the government product anyway.

Think about it.

The ability to operate at a permanent loss is something only governments can manage. There’s a limit, of course, but it takes a long while to get there. The private sector folds up a lot sooner.

And, of course, the government can also bury its “competition” in regulations.

The second-best thing is that if everyone’s success is only about luck, than nobody really earned what they have and it’s legitimate for you to take it from them or support others doing so.

You could do worse than reading some of these books yourself.

You don’t start shopping for the best deal on tires when you’re sitting on the freeway with a flat, and you don’t make your insurance choices when you’re sitting in an emergency room. Competition and choice are normally dealt with before the fact, not after.

I don’t compare fire insurance when my house is burning, or car insurance when my car has been wrecked. I have the choice of many companies, and they are fighting for my business and offering me deals. The place we are now with health insurance — employer provided — was the result of a government screwup many years ago and it’s long past time to repair it.

You might think “compassion” is creating a health care system that’s the equivalent of the Volga in automobiles, or having our own version of the British NICE. I don’t.

By the way, “40 million citizens” is not accurate, but we’ve been over that before, too.