Mar 212010

As I write this, “health care reform” is working its way through the halls of Capitol Hill. At this point it seems assured that it will survive the parliamentary posturing to become law.

I am both glad and horrified by the news. Glad that it’s at least something, including some very necessary restraints on the private health insurance business. But horrified that (a) it really ONLY amounts to some regulation of private health insurance, (b) those reforms, without a public option or any concerted overhaul of how health care is provided in the United States, are likely to make healthcare even more expensive for many (including myself), and (c) the political posturing, even from both sides of the aisle, was so dysfunctionally entrenched, and just as frequently paranoid and obtuse, as to prevent a better solution from emerging.

I will be quite candid: I am no fan of Nancy Pelosi. Yes, the political values she represents are my values as well. But I thought both she and Rahm Emanuel were both so politically aggressive and obnoxious as to prevent good policy from emerging. On the other hand, maybe the heavy-handed strategy was necessary to get at least *something* done. The pushback by so many conservatives, and even some Democrats, against the notion of a public solution to health care provision was frightening, bewildering, and counter-productive to any of their stated agendas, and that’s what I write about here.

To be clear, I don’t think government should play a role in everything. I do not like when government interferes with private behavior that affects no one. I do not like it when it steamrolls over civil liberties. I want government to have to get a warrant when it wants to come into my house, and I don’t want it to micromanage people’s lives and livelihoods to the point of suppressing them. That said, what is government but an extension of society? Every society wants to persist and thrive, and whether it can do so depends on the well-being of its members. Sickly, unproductive people bring down the community they belong to. Therefore it’s in the community’s interest to ensure that its members avoid being so through the use of its governing functions.

That’s how health care should work in theory, anyway. And in my experience, having dealt with both the French and English public health system, it can in fact be the practice.

Critics of public health insurance point to France’s high social security tax rates. But the upside to those tax rates is that the money people do take home is theirs to do with as they like, as they do not need to devote ever-increasing amounts of their personal budgets towards healthcare, as people must do in the US. It may be that the French system is over-generous — perhaps there should be higher co-payments or user fee to discourage overuse — but these details don’t indict the whole system. The fact that no one in France needs to worry about needlessly dying, going broke, or both — as they do in the US — speaks to the French system’s value.

My encounter with the British NHS system was equally positive. On my recent travels I sustained an injury that required treatment before I returned home. I was referred by a pharmacist (in both France and England pharmacists are front-line providers of medical care) to an NHS clinic, which treated me, no questions asked, capably, comprehensively, and for free.
Contrast that with the follow-up care I received in the United States, where I was bumped from doctor to doctor, each time incurring a $140-180 charge. I do have insurance, but all my insurance got me was these relatively lower charges, as opposed to a full-retail price of the office visits. The nature of my insurance plan, and what manages to keep it even remotely affordable, is that it doesn’t kick in to provide for affordable co-pays until I’ve already paid out-of-pocket an unaffordable amount for the year — on top of unaffordable premiums.

It is unclear to me, even with the insurance reform passing through Congress, whether my insurance will get much cheaper. I fear not, so long as there’s not a public plan pulling out higher-risk people and forcing private insurance plans to be more competitively priced. Although I do applaud the new law in how it limits the portion of an insurance company’s revenue that can be diverted to profit (as well as the guarantee that everyone be able to find some sort of coverage and not be dropped, no matter where in the US they live), I do fear my rates will be increased to cover the increased payouts to the less healthy. I do not mind paying for such a safety net as part of my taxes contributing to the health and well-being of my community, but I do worry that without a public plan the safety net these reforms are supposed to herald will be illusory.
Which I suppose is what some conservatives have been arguing, but instead of arguing for a policy that better provides a safety net than this current bill, they collectively railed against the whole notion that one was needed at all. I do understand some of their concerns: I do value how in America entrepreneurialism is prized and protected more than it may be in some of these European countries. I am empathetic to the arguments that European societies are often over-regulated to the point that they dampen some of their own potential for growth. I accept the arguments made by those who want to ensure that what sets America apart on these fronts remains, and I agree with the calls to temper regulation when its perceived benefits come at too great a cost to these priorities.

But surely there are middle grounds. The abject refusal to recognize that there are times when we need to work together as a society for our mutual benefit, by and through our government — a government by the people, for the people — is impossible to fathom. Valuing what makes America unique does not preclude the American government ensuring its people’s health. On the contrary, it must be recognized that NOT doing so is antithetical to those policy goals. For the sake of our economy, and indeed our American way of life, we must shoulder the burden of health care together. America cannot be healthy when the American people are not.

 Posted by at 8:30 pm

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