In a Benevolent World

In a benevolent world, people are well meaning and kindly to each other.

The implications of a benevolent world are more people having a better life and a generally happier planet.

Most of us consider ourselves benevolent.

Most of us try to be nice and kind and helpful.

Most of us believe we are empathetic, sympathetic, and well-meaning in our actions to others.

So why is the world so cruel, mean and unfair to so many?

There just ended debate  about "the affordable care act" versus "the American healthcare reform act"  with a goodly portion of us actually wishing we had "medicare for all".(no profit, just a simple system in which we all get the same benefits--our whole life--and everyone pays by ability--our whole life, no maximums, no deductible, no pre-existing conditions, that's it,  only cosmetic and vanity surgery and meds are on your own dime.  And yes, plastics for cleft lip, burn scars and breast reconstruction are covered, butt implants and Viagra--not so much.)  

The new law failed for a two-pronged reason:  It was going to pull coverage for millions of people that would no longer be able to pay for their private insurance thus creating a sh__storm of calls to governors and congressmen against voting for it (its all about the next election and always is) AND a group felt it was still going to cost the federal government way too much money. (call them the "DIE, losers, DIE", group that think the government's purpose is to pay them money for helping rich people become richer).

In a benevolent world, people should be able to see a healthcare provider when they are sick--and they can right now, thanks to EMTALA--which allows anyone, no matter their ability to pay--the right to a medical screening exam in any emergency room if they are seriously ill or injured or in labor.  

Many hospitals have the pregnant women go directly to the labor and delivery of the hospital for their exam to prevent 2 exams--1 by ER doc and one by an OB person--cutting out the middleman and saving time, resources and money.  

Many hospitals will actually treat people--to a degree--after they are in the emergency room, even if they are not so sick that it is an emergency.  (that is going beyond the law, which only says they have to treat if it is emergent, i.e. endangers their life or limb--and, in this case, we have multiple limbs, like your eye is a limb.  Got it?)

Emergency rooms do NOT have to provide routine prescriptions.  They could, in fact, only provide services that have a payor source or cash, once the screening exam is done and it has been determined that neither life nor limb is in danger.

Most of the emergency providers in my state go ahead and make some attempt to intervene.
Those people that show up in the ER for minor illnesses and injuries usually have no one else available to see them. (let me assure you, they do talk bad about those uncovered patients using the emergency room like a free clinic--amazingly, most of those working there don't get that they are the only hope for receiving healthcare).

Those patient's without insurance, medicaid or medicaid or some federal coverage like veterans or Indian benefits, have no access to preventative care--at all.

They have no access to care for chronic illnesses unless someone has helped them to get one of the available federal, state, or charitable organization accesses--which frequently only occurs after an emergency situation when an ER diagnoses a problem that is terminal or lands them in ICU or Surgery.  It's not altruism so much as finding a way to treat them and get paid--so sort-of-altruism.

In my home state, which declined the Medicaid expansion that was offered with the ACA, our rate of people with no payor source has decreased from over 18% dependent on EMTALA for childbirth and all their medical care, to just under 14%.  (so 4% obtained insurance via the insurance exchange). Texas is now down to 17%.  Mitt Romney's plan would have helped those of us that declined the medicaid expansion.

Do I consider it benevolent to force people to only seek care through the emergency room?  
They are not full service.  There is no chronic illness education, management  or prevention services offered.  They do refer, but the places they refer to do not have to see people without insurance or a payor source.  If you tell them you want to pay cash, it may or may not be an acceptable solution--many won't even set up the appointment without the payor source information.  People that could actually pay cash, have platinum level insurance.

Emergency rooms provide some of the most expensive medical care we can offer.  The only thing more expensive is Critical Care and Emergency surgery, both used more by people with poor access to preventative medicine and and no chronic illness management.  The ER sends them to those areas when they really did have an illness or injury that was a danger to life or limb.  

That is how homeless people, very poor people, and undocumented aliens get into the hospital.  When they are made well enough to discharge, they are discharged to home and with a referral.  Even if they have no home.  Even if they can't buy their medications to maintain that newly acquired level of health.  Even if that referral won't get them an appointment---no payor source.  
And from there, the cycle starts again.

Doesn't seem very benevolent of us.

We also want people to get a good education to better themselves, but don't want to provide money for a good education--not to kindergartners and not to college students.

In my state, there was some blame, 40 years ago, that education wasn't better here because we had crappy teachers(isn't it always who is blamed? and with no evidence at all), so this little state upped the standards to higher than pretty much everyone.  To teach you had to jump through hoops.  They tried to get professionals to get those high-hooped certificates, and had some success--there are always a few altruistic people around.  They even periodically approved raises.  Unfortunately, the budget rarely covers those raises.  Quite a shock to take a job after being shown your starting pay and the currently state-approved pay grid, only to discover that the last three raises were never instituted so your reality check (pun intended) will be based on the grid from 6 years ago.

So the new answer is going to be vouchers.  Vouchers, so that parents don't have to put their kids in public schools.  Vouchers where the new charter, nonprofit-church school, or for profit specialty school may actually require parents to pay more than the voucher.  Vouchers to places with various admission criteria that poor students may not meet.  Co-Pays that poor people may not have.  Places that don't send buses and don't serve meals. And the goal--get those pesky, public schools off the public dole.  "Those that can--do, those that can't, teach--right".  Somehow, I can guess who the losers in this drama will be, and as usual, they won't be rich.

We want people to earn their own way, make their own opportunities, and well---"look and act like an American".  (that translates to some version of a white, christian, man, woman, or child with a conservative, tasteful wardrobe--no tattoos or piercings or colorful hair--with a heterosexual parents and heterosexual tendencies, ---and money, preferably lots of money!)  

In other words, we want to consider ourselves benevolent people--but only to our kind of people.  We want to live in a benevolent world.  But we don't like diversity.  And we don't like any evidence that our system might be flawed. We certainly don't want to be actually competing for money, power, jobs, education, healthcare, or even good food with anyone that is not "our kind of people". 

Perhaps, competing is the actual problem.  Capitalism is and always will be about competing.  And the scorecard is dollars.  

If everything, even such basics as clean food, clean water, childhood education and healthcare are part of a competition where only winners win, and our scorecard is dollars, then rich trumps everything else. (no pun intended--truly, it was a card game reference.)   The other rest of us will just be vying not to be the biggest losers.  

To change this; to truly work toward being a benevolent world, we will need to do more than go to Sunday School a few times.  We need to look at other forms of economics.  Capitalism is made to create winners and losers.  It's a competitive system aimed at creating hierarchy of power with the top 1% (now owning over 50% of everything) and the bottom 50% struggling to meet their basic needs.

If we would provide actual opportunity to all people, we would, in a truly benevolent act, insure basic needs to us all; enough food, safe homes, useful education, and actual healthcare--the kind that prevents those devastating effects of chronic illness and unsafe environments so that we are not wasting money on emergencies that never had to happen.  It will also decrease the money spent on people so devastated by their childhood that they now require a lifetime of care--and no, they aren't being lazy.  They are being brain-damaged and mentally ill and otherwise impaired by a lack of parental education and available healthcare when it could have provided them a chance at a better life.

A benevolent world is not out to put people in their place as losers.  Its goal is to help every single one of us reach our full potential, not as workers, but as self-actualized souls.  

We need to change the scorecard from money to those life-goals that are harder to define and impossible to place in order (end the hierarchies).  Attributes like happiness, contentment, loving-kindness, and just plain helpfulness.

We need to create a benevolent world.