The Conspiracy

The Global Citizen: Competition or Fragmentation?

The Global Citizen is a joint project of New Voices and the American Jewish World Service (AJWS). Throughout the year, a group of former AJWS volunteers will offer their take on global justice, Judaism, and international development. Opinions expressed by Global Citizen bloggers do not necessarily represent AJWS.

Once again, healthcare reform is at the forefront of the American news repertoire loop. On Dec.9, the front page of The New York Times ran a story entitled “Reid Says Deal Resolves the Impasse on the Public Option,” and began with the lead:

“The Senate majority leader, Harry Reid, said Tuesday night that he and a group of 10 Democratic senators had reached “a broad agreement” to resolve a dispute over a proposed government-run health insurance plan, which has posed the biggest obstacle to passage of sweeping health care legislation.”

Being a skeptic by nature, I’m dubious about how much will actually change if this bill does get passed. There are no specifics yet on what this bill entails, but when the intent of the actions is described to “sideline but not kill” the bill and that there is “no immediate end in sight,” a girl has reason to remain cynical.

Problems with the bill aside, it may be the proposal in its entirety that is the problem. A while back, “This American Life,” a radio show provided by Chicago Public Radio, coproduced a two-part show with NPR about the healthcare system in our country and its pitfalls. It’s a great, interesting, and easy to understand piece that I recommend to everyone (simply click here). In the show, it explains that putting another insurance plan contender on the market, namely the public option supported by President Obama, is considered by most economists to be a very caustic move.

To put it simply, the primary way healthcare costs decline is with the bargaining power of insurance groups. The larger the consumer base at stake, the more say they have in the setting of the prices. In a counterintuitive way, insurance carriers have the same interest as the consumers in lowering prices. I know, with the way we are used to vilifying insurance companies, it’s not the way we are used to thinking about it. And healthcare providers band together in conglomerates to shore up their bargaining power as well. Therefore, many economists point out that further breaking up the collective consumer base with another insurance provider, whether public or private, will only serve to further dilute the public’s bargaining power against healthcare conglomerates.

But why is something as important and fundamental as our health up to a battle between interests at all? At one point during the show, it notes that our current healthcare system was formed by happenstance and a long, disconnected series of events and decisions over a long period of time. It was not thought through as a cohesive whole system at any point in time, thereby making our current mess an unsurprising consequence.

Now I’m not saying I know what the solution should be by any means. And I know the aforementioned critique of putting another insurance competitor on the market is just one facet of a highly complex issue. It’s the democratic way to embrace all things competitive, with the belief it will lead to highly evolved forms of innovation and drive prices down. Its hard to believe it could not only work another way, but work in the reverse.

The same may be true of healthcare initiatives in the developing world. Though I admire all the initiatives out there and the millions of people behind them, I have to wonder if the fragmentation is hurting development. The Gates Foundation, Oxfam, World Vision, The Smile Train, Partners in Health, and WHO programs are just a few of the wide plethora of organizations and programs out there at the moment. Not to say they aren’t doing amazing work, but unintended consequences of actions and inactions, such as collaboration or lack thereof, are always important things to consider in development (or in anything at all, for that matter).

For instance, I know from first-hand experience that some nonprofit organizations track the news mentions of another organization doing similar work and compare them to their own numbers. This stems from a certain recognition of the reality that another organization doing almost identical work could detract from their own funding. Majority of the population selects a one or two causes they feel  strongly about and pick a place they feel is doing the most effective work; rarely do people donate to multiple organizations with the same vision.

I find it strange that ‘competition’ in the human rights sectors is, in effect, organizations with very similar ideals. This is something I greatly admire about AJWS; they their aim is to work with other organizations internationally and to help them grow. It’s a collaborative approach over a competitive one.

Moreover, when it comes as basic a human right as health care, it should not come down to competition and warring factions. All sides should be fighting for the same goal rather than each other. Our society is infatuated with the competitive spirit, and I conceded that at times it pushes our limits and expands our potential. But from consumer clout in insurance bargaining to healthcare initiatives in the Global South, are we too ambivalent about the consequences of dividing up our collective power?


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3 Older Responses to “The Global Citizen: Competition or Fragmentation?”

  1. Deeba L. Zivari
    December 28, 2009 at 2:42 am #

    Very well said. Thank you.

    Many people are still questioning not just the quality of health care but whether the right to health is one that belongs to every individual!

    The Michael Moore film Sicko (2007) suggests that instituting the legal right to health care can behoove America’s health care situation. In his criticism of the American health care system he claims as follows: “We’re the only country in the Western world that doesn’t believe it is a human right to provide free universal health coverage for every one of its citizens.” But would what Moore supposes improve our system or add to the problems which already exist?

    As usual there is a paradox concerning the right to health. Because of limited resources, distribution must discriminate. In other words, health care is rationed. While ideally the right concerns all individuals, its execution does not.

    Things to consider: How is limited health/medical care to be distributed (evenly?) ? Who will pay (thing is…those who can afford end up exercising the most power and influence decision-making regarding health care) ? Do we have the means of making health care accessible to all? If health care availability increases, how will we meet the resulting increase in demand? Will lowering compensation of medical professionals discourage people from entering the field?

    The odd thing is that while the right should belong to all, as an individual right it should not disregard the fact that even as an individual right it has implications on others.

    You are certainly right about collaboration. Health is a matter that concerns every human and it must therefore be addressed collectively. Presently, we are facing the consequences of our poor practices and realizing the interdependence of the earth’s health and our health. It is time we realized that human health is interdependent in and of itself.

  2. Faigy E. Abdelhak
    January 6, 2010 at 1:08 pm #

    Thank you! And those are definitely challenging questions. I found the The American Life two-part look into our current health-care system really enlightening on at least some of those questions as well.

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    February 4, 2010 at 9:03 pm #

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