There’s a fair amount of fear on display these days from some of the most powerful people and institutions on the planet. Trump's afraid of Nancy Pelosi. Billionaires at Davos are afraid of Ocasio-Cortez. Microsoft’s afraid of affordable housing and homeless advocates. And the health care status quo is afraid of losing its ability to charge whatever it wants for its products and services. If history is any indication, this high-powered group of scaredy-cats will ignore their opposers or attempt to appease them with small (in proportion to their total resources) gestures.

Just look at how they've responded so far.

Appease: Trump, unwilling to admit defeat to Nancy Pelosi, agrees to temporarily not get his way.

Ignore: Michael Dell, CEO of Dell Technologies and billionaire attendee at Davos, says voluntary philanthropy is a better solution to inequality than taxing the uber rich. (Like that's worked so far.) He also falsely claimed that increasing rich peoples’ taxes hurts economic growth. Bottom line: Mr. Dell thinks that he knows better than the government how to “fix” inequality.

Appease (with a catch): Microsoft, responds to years’ of criticism for exacerbating the affordable housing crisis in the city of Seattle, by creating a multi-hundred-million-dollar housing loan program, along with a much smaller grant to address homelessness. This is a loans-to-pay-for-future-loans program in lieu of higher taxes; with a much smaller grant program thrown in to make it appear more generous. (Where does this I know how to address housing policy issues better than government attitude come from?)

Appease (latch onto): Health insurers and hospitals, in an attempt to forestall Medicare For All, are rolling out small-scale programs to address social determinants of health—‘the circumstances in which people are born, grow, live, work, and age’ that affects their health status and leads to health inequality. (Marmot, Sir Michael, The Health Gap (The Challenge Of An Unequal World): Bloomsbury Press, 2015). By making a small financial commitment now against health care inequality, which was never a major concern of theirs, health insurers and hospitals, hope the public will ignore their ever-increasing, opaque prices and poor health outcomes, on the part of hospitals and doctors.

Is Inequality On the Ropes?

American society has many inequities that will likely remain in place for some time. In the past, challenges to rich individuals and powerful organizations failed spectacularly (e.g., Occupy Wall Street). But the anti-inequality sentiment of 2019 is a lot different from the Fight For 15 movement. One, today’s challengers of the status quo are showing more commitment and belief than previous challengers. Two, more elected officials support the anti-inequality movement and are proposing policy alternatives to the status quo. Three, the rich may have made a mistake by seeking and claiming an increasingly unpopular and economically ineffective tax cut for themselves and their businesses. How ironic would it be if the Trump/Republican Congress tax cuts that favored the rich, was the essential precursor to equality of life?

Meanwhile, the health insurance and health care status quo is getting a lesson in how the economic overreach of a few can push their seemingly solid support network in the opposite direction. A recent post by health care policy expert, Bob Laszewski (Health Care Policy and Market Review Health Care Reform Blog), illustrates this point for private health insurance. In the article Mr. Laszewski asks, “At a time when many Democrats are calling for a single-payer health insurance system, are the drug companies inadvertently driving the system on a course to that end?” One of his four concluding points is, “if the health insurance industry loses the support of employer-plan participants (because of increasing prescription drug costs that lead to higher insurance and medical care costs) it will have lost the firewall that has made voters reluctant to support government-run health care.

In conclusion, the actions of the powerful and wealthy have the potential to lead to greater equality even when equality is not the intent or the desired goal. Being too greedy has consequences.

Tags: health inequality, Social determinants of health, health care , Medicare For All