CHARLESTON, W.Va. -- The poor will always be with us, Jesus proclaimed. It's not possible, though, Elizabeth Barrett Browning notwithstanding, to count the ways that they can be and are exploited.
One of the more despicable ways is to engage in strategies designed to make the poor go away, or appear to, by shielding them from sight. We see this all the time in measures taken to hide the poor from visiting dignitaries, sometimes by blocking off avenues where they live, other times by creating phony facades to convince the unsuspecting that here, everyone is doing well. Some term this the "Lake Wobegon Effect." Remember President Bush's Jackson Square speech in the French Quarter 17 days after Hurricane Katrina? From what we could see, recovery in New Orleans looked complete. It wasn't.
In today's debates about everything from health care to utility rates, cable rates to wireless, mortgage rates to APRs on credit cards, there is one truth that's hard to deny -- rates will increase, but only after provision is made to protect those in our society who can't pay. We see it locally in PSC hearings on proposed electricity rate increases, in debate over hikes in turnpike tolls, telephone and wireless rates, hospital charges, in virtually every situation where a business involved in providing a public service seeks to raise its rates. Make provision for the poor and you effectively disarm critics who would point to citizens who cannot pay as an argument against rate increases.
But you do much more here than simply inflate cost. You distort it. You widen the gap between true cost and the price tag you ultimately hang on it to a point where cost no longer means anything. Per-diem rates, deductibles, reimbursements, cost-per-unit, budget plans -- all are products of an out-of-control cost system that bears less and less resemblance to reality. Cost control is impossible, because the key factor that drives it -- the growing number of people served who cannot pay -- is virtually a moving target, an unknown.
In health care, today's hottest issue, there is no shortage of examples of provisions that cover the uninsured -- no one is ever turned away from emergency rooms, the CHIP program covers most children of the working poor, the private sector offers $4 prescriptions on generics to make certain that no one misses needed medication, pharmaceutical companies will step up to assist seniors, etc. In a system driven by private insurance that fewer and fewer can afford, a system that has already helped force two major automakers into bankruptcy, the principal case against universal coverage is that those who can afford services will be forced onto waiting lists and into long lines with those who can't.
In truth, this is all a perverse shell game -- see if you can pick the shell that hides the pea! In this case, the pea is the true cost of health care. How can we reform a system when no one can determine true cost? Oh, we know what charges are. We know what reimbursements are. But the hidden pea in all of this is true cost -- the real value of services to those who can't pay added to the value of services to those who can! The result? Debate tends to focus on how best to pay for escalating costs rather than on whether those costs are really legitimate.
Providers of public services, be it health care, electricity, natural gas, heating oil, insurance, all of it, regularly pass on the costs of services for those who can't pay to those who can. Those with insurance pay for those without it. And who wins in this game? Certainly not the poor. If the true costs of services were the amount billed, even with a fair profit added, many of our poor would no longer be poor. Some still couldn't pay, of course, but many who can't pay inflated rates could pay fair rates. Insurance companies? They pay, but they pass escalating rate increases on to paying customers with apologies to regulators and assurances that the poor will be accommodated.
The only way to get a handle on total cost is to let the market determine price. Doing that means that only those who can pay for a service -- heat, light, water, sewer, phones, cable, health care, wireless -- get it. That would bring costs back to earth, but at substantial political risk. It would reveal to all just how many of our citizens would be lacking basic services without subsidies -- how many "poor people" we truly have in our society. Perhaps we confuse means and ends here -- we obfuscate real poverty numbers in our society by hiding them behind a free market structure that really isn't free. Peter is being robbed to pay Paul, but few realize that a crime is even being committed.
The real winners here are private sector providers -- those who set the rates. And those who use government to shield them from the wrath of consumers [Peter] by perpetrating the illusion of fairness. Why? Because there is no ceiling to cost increases, so long as we have concern for the poor [Paul] to justify them -- and so long as we make provision so that those who can't pay don't have to.
Isn't this socialism? Or something that looks a whole lot like it? I thought it was Karl Marx who advocated taking from each according to ability in service to each according to need? We hear all the time that governments that would take from those who have in order to provide for those who don't are socialist. And that a system like this would deprive all of us of our freedom to choose. In fact, our biggest corporations are engaged in exactly this same kind of theft, justified for the very same reasons -- to provide for the poor. In fact, all of us are witnessing Marx in action. The difference is that the private sector is the culprit, government regulators are the enablers, protecting us from Marxism is its rationale, and out-of-control cost for public services is the result.
The real issue here is not fairness. Neither is it justice, nor any kind of genuine concern for people in any form. It's greed, and access to the power to satisfy it -- the desire to preserve, under the guise of freedom, a profit system based on gouging the customer and using the poor to justify it and government to rationalize it. It's freedom all right, but for whom? The greatest threat to this freedom? A government that would seek to do exactly the same thing -- protect the poor -- under its constitutional mandate to promote the general welfare.
In effect, the private sector continues to claim that it, rather than government, is best positioned to promote the welfare of the people -- provided that its freedom is protected. Rarely are stockholders ever mentioned here; to do that would expose the hypocrisy and dishonesty of this effort to sell social consciousness as the private sector's No. 1 priority. There is a perverted form of wealth redistribution going on here, but the benefits seem always to flow up, never down.
O'Brien is the retired director of Concord University's Beckley Center.