By: Michael Lighty
Director of Public Policy at California Nurses Association/National Nurses United

Money equals speech is like getting all the healthcare you can afford. And not in a good way.

Essential social goods – political participation and access to necessary health services - are allocated based on ability to pay. When that happens, it’s easy to see who wins and who loses. The gains go to the top and the rest of us have to fight for what we need.

It’s a system worsened by the dynamics of a finance-dominated economy, where such inequalities drive the system. The incentives for big wins, based on big bets, create the search for the most exotic financial instruments. The few who possess the unique asset or the inside knowledge, or the fastest algorithm, win.

Except when they don’t, and when they lose, they lose big. The winnings go to the few, the losses are spread around. Private gains, socialized pain. It would sound familiar to a nurse on the front lines of today’s healthcare “non-system.”

Those with the best private plans get access to the latest technology, the newest drugs, the private rooms in the elite medical centers. Those on Medicaid wait for the few doctors who take it, and often pay more for necessities such as eyeglasses.

Nursing homes are the most expensive form of end-of-life care and are mostly paid for by public programs. The most expensive, and “needy” patients – seniors -- are covered by the social insurance program, Medicare. Except for the wealthiest seniors, of course.  

These are the direct result of a political system that allocates rewards based on ability to pay. Nine out of ten times the candidate who spends the most, wins. The biggest political donors come primarily from a faction of the wealthiest 1 percent.

Court decisions by judges, who themselves usually come from the wealthiest political class, and appointed by politicians funded by those donors, have expanded the equation of money equals speech to the nth degree. Congress responds accordingly.

Though passing social legislation, or other policy changes is difficult and optional, the one item that most pass is the budget. Appropriations is the game in Washington. And the wealthy and the corporate class pay dearly for the access to get their share.

So when it comes to access to healthcare, the insurance companies, the big hospital chains and academic medical centers related to bio-tech and medical research, the pharmaceutical companies all come first.

The system is built around their “needs,” not the patients’ needs, not the needs of society. Costs are for taxpayers, profits are for the corporations and wealthy. It’s the natural order of a pay-to-play system.

And it’s why we have to change this system once and for all. Two good steps would be to improve and expand Medicare to cover everyone so we have a system based on patient and societal need, not on profits.
 
And by reversing the money equals speech lunacy with clean money elections -  public financing of candidates based on showing real constituent support. We need to end the fiction that corporations are people, by constitutional amendment if necessary.

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