For all the right-wing rhetoric about the importance of running government like a business, most of the pundits here in North Carolina know precious little about that line of work. Getting paid by contributions from the Pope Family Foundation to manufacture opinions as part of a tax-exempt non-profit organization doesn't quite fit the bill, if you catch my drift.
If government today were being run like a business in the area of health services, two things would happen. First off, we'd outsource things that the private sector could do better and cheaper. For example, we'd outsource the vast majority of actual service delivery. The government wouldn't set up hospitals and clinics except when private enterprise fails to fill the need. We'd also outsource drug development and production. That means we'd enter into agreements with private companies for goods and services using contracts with incentives (and penalties) to reduce costs and improve performance every step of the way.
Another thing we'd outsource is transaction processing. We do that already for programs like food stamps. To do this, we'd accept bids from private companies, looking for the most efficient operations in the country. Then we'd hire one or more companies to manage the flow of money and information in order to ensure a high level of accountability. We would outsource auditing to a large public accounting firm. Our contracts all companies would have punitive termination clauses, including severe penalties for misconduct, fraud and abuse.
We would not outsource pricing. Like Walmart or Lowes, a government-managed health plan would have enormous buying power, enough clout to not only negotiate with suppliers, but to actually set prices in some cases. Nor would we outsource governance and strategy. No business in its right mind would ever outsource these two functions. Instead, we'd create a formal and structured collaboration with suppliers that would tap their knowledge of how to operate more efficiently, reduce costs, improve care, and add value. Suppliers to Walmart do that every day.
It's too bad the free-market extremists have drawn a line in the sand on this most basic of human needs. Instead of continuing their siren song about Adam Smith's magic hand, they could be helping pull our country toward the rest of the civilized world by removing personal wealth as the measure of who lives and who dies. But no, that's not in the cards. Ironically, free-marketeers would rather have government impose new regulations on how insurance and drug companies can conduct their affairs.
The United States of America should be in the business of administering a universal health care program to ensure that people have access to the care they need to live healthy lives. No person should be required to take advantage of that care, but everyone should have it available.
Bill Moyers agrees.