Beyond the Market: Why We Must Treat Health Care as a Public Good

This editorial by James Haslam, director of the Vermont Workers’ Center, appeared in the Times Argus and Rutland Herald (Vermont) on Sunday, April 17, 2011.

Vermont is in the midst of a human rights crisis that has been brought on by allowing the market to control one of the most important parts of our lives: our health.

This crisis is visible in every community across our state. More and more people — people with health insurance — are foregoing necessary health care because they cannot afford the deductibles and co-pays. Vermonters are losing their homes to bankruptcy brought on by medical debt, or they are “stretching” medications in the hope that they can make it through the month. Vermonters are buried in mountains of paperwork, hit hard by insurers’ denials of claims, overwhelmed in their efforts to navigate through the private insurance maze.

If we accept the premise that the goal of our health care system is to provide the care that we need when we need it, we have to accept the conclusion that our market-based health insurance system has failed. Too many Vermonters are not getting the care that we need when we need it.

This “market failure” in health insurance is not an accident. This sort of “failure” is, in fact, built into the way a health insurance system works. The market fails us because its goal is to generate revenue for the insurer rather than to protect our health.

Insurance companies are middlemen who sell access to health care as a commodity to those who can afford it. As soon as we get care — which we all do at some point — an insurer starts losing money. Medical care costs are recorded as financial losses on their balance sheets. Therefore, in order to protect their income, insurance companies must restrict our access to care.

This behavior is a market imperative, not a failure. And it hurts us.

Moreover, insurance is simply the wrong way to pay for something like health care. Insurance is a way of managing risk. But health care is not a risk; it is something that we all use and benefit from using. Therefore, seeing a doctor should be a bit more like going to school: We all need to do it, so it should not depend on us being insured against it or coming up with the necessary cash.

So where do our health care dollars go, if they do not buy us better health? What we experience as market “failures” make corporations a lot of money. In 2008 “nonprofit” Blue Cross and Blue Shield of Vermont paid out $7.2 million to former president and CEO William Milnes Jr. The system did not fail him at all; it performed as expected.

We do not have to settle for a system that puts profits before health. We can make our health care dollars do what they are supposed to do: enable equal access to care for all. To achieve this, Vermont must provide health care as a public good, readily available to all. Health care belongs to all of us, just like education, and should be publicly financed, with costs and benefits shared equitably by all Vermonters. We can no longer afford the insurance industry that prioritizes private over public interests.

Some of us can’t envision an alternative to the market-based system, usually because we are skeptical about what the public sector — or “government” — has to offer. Yet we all rely on “the government” to run our court system, provide us with fire services, take responsibility for our schools, plow and pave our roads, and, of course, provide Medicare for our seniors. We couldn’t live without these essential public services. So why don’t we treat health care in a similar way, as a public good for all? The government is by, of and for the people. If we don’t like how it works, we have the power — and the obligation — to change it. This is what our universal health care movement strives for by demanding transparency, accountability, and participation.

Our reliance on markets has resulted in a profound deficit of democracy. Corporations in our health care marketplace are not accountable to us; they are accountable to their owners or shareholders. Likewise, corporations are not transparent; they deny payment of claims at will. Individuals with money can participate as “consumers” in this market, but without having a say, without control, even without a guarantee that we’ll be able to access care. We can buy their products and only hope they are adequate when we get sick, while watching how corporations have the ears of our lawmakers, and the deep pockets to spread fear through advertising and astro-turfing.

The existing health care system has failed us by placing the private interests of corporations above the public interest of Vermonters. That’s why thousands of Vermonters have stood up and fought for their human right to health care. As a result, Vermont is now poised to lead the country out of this human rights crisis by creating a system which treats health care as a public good, not a market commodity available only to those who can afford it.

James Haslam is director and lead organizer of the Vermont Workers’ Center ( and coordinates the Healthcare Is a Human Right campaign. On May 1 the campaign is organizing a March on Montpelier at 11 a.m. that starts at City Hall and will lead to a rally at the Statehouse to demand a universal health care system that works for everyone.