"...We finally are able to make real the principle that every American should have access to affordable health care, and no one should go bankrupt just because they get sick" - Democratic Party
The debate over whether or not a universal health care system should be implemented in the United States has divided politicians for decades. Health care being seen as a right to every citizen has been fundamentally engrained in the historical context of Europe. Even in some recently developing countries do we see health care being seen as a right endowed to all citizens. With America being one of the only industrialized nations in the world without some form of universal health care, it seems that we are the anomaly among prosperous countries. The causes behind this are purely political, as we see partisan battles and inter-party squabbles over the very thought of a government run health care system, which many on the right would deem as socialist, while many on the left would deem vital to the progress of our society. Whether or not these two sides are right or wrong is purely trivial. It is more important to dive into the world of public policy to truly understand what undermines the ability of our government to enact such a social program. With the heated debates seen recently in 2009, or even the upheaval caused by former President Clinton's attempt at reforming health care in 1993, it is not too far of a stretch to say that public discourse is often muddled with ambiguity, propaganda, and more often than not, false claims of the consequences or benefits of such a system. It is very easy for us as a society to take synecdoche’s and metaphors to heart, as they are the simple means to the policy maker's defined end, a way to pin point their ideology to sell right back to you. The arena of politics is all too often a war zone of ideas, and until the politicians in Washington take a more rational and pragmatic approach, the passing of a universal health care system may never come to fruition.
As we hear in the public arena the political jargon of talking heads and elected officials, we must put all this aside to look at the true goals of passing health care reform. What is it that the proponents of health care reform seek to accomplish by enacting such a large social program? What would be the benefits and the costs? Is the fight purely political or is there an actual social motive that is genuine and altruistic?
There are many goals proponents of universal health coverage aim to achieve, and the first goal that is obvious to almost anybody is to ensure that everybody in this country has equal access to affordable quality health care. It's the idea that being a member of a civilized industrial society, we as citizens have an equal right to obtain care if we are to fall sick. How this care is supplied to the public is usually the question. As Deborah Stone notes, much in the public policy arena when it comes to equity is based on her "Concepts of Equality" (Stone) . In her Concepts of Equality list, she talks about the complications of the Polis model, and the different ways in which programs or services end up being divided in society. One of the ways in which goods are distributed in a society she says is Rank Based distribution, which states that there are internal subdivisions of society, with different people who have higher ranks receiving larger slices, while people with lower ranks receive the smaller slices, basically equal ranks/equal slices, unequal ranks/unequal slices (Stone) . People who argue about the problems with privatized health care will say in this case rank would be determined by the amount of wealth you have. The more wealthy you are, the more likely you are to have no problem in affording the health care necessary for you and your family. On the other side, if you are poor or lower middle class, you are likely to be at a disadvantage because of such high premiums and co-pays. One organization that espouses this view is the Physicians For A National Health Program or PNHP. They did a recent study that found that there was "a 25% higher risk of death among uninsured compared with privately insured adults." (Andrew P. Wilper) . This shows the lack of equity in the free market system. The study also goes on to say
"Lack of health insurance is associated with as many as 44789 deaths per year in the United States, more than those caused by kidney disease (42,868). The increased risk of death attributable to uninsurance suggests that alternative measures of access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance. Despite widespread acknowledgment that enacting universal coverage would be life saving, doing so remains politically thorny" (Healthmortality).
This is an argument liberals will talk about, saying that this is turning into class warfare against the poor, because while the rich can afford everything, the poor can hardly afford a thing. They use this as a symbol of the injustice and inequality that is perpetuated by a system of health care for profit, in which the means of denying people health care because they cannot afford it only benefits the C.E.Os running the health insurance company.
People who are for health care reform or universal health care would most likely agree with Deborah Stone's idea of Membership Based distribution, citing that we as members of American society deserve an equal distribution of the resources. They will say that as citizens of a first world country that is so prosperous, we have a right to be taken care of if we are sick, no matter what our wallets have. It is argued that the way the current system works only favors those members of society that have the funds to participate in health care programs, and that leaves millions to fend for themselves in the private market place. The idea of Membership based distribution would purport that as members/citizens of this country, we should have a system that takes care of us, that is unbiased and a system where cost is irrelevant. The public necessity for such a program is too large, and the issue is too grave to be ignored, as millions are forced into bankruptcy, and countless people have died due to denials by private health insurance companies for coverage or treatment (David U. Himmelstein) .
With these goals of providing affordable health insurance and creating a more equal and just society, it is hard to see how anybody could object to such benevolent proposals. How is it that anybody can say that people should not be covered when they are sick? How can anyone honestly say that by supplying health insurance to everyone would actually be detrimental to society? Just because people don't agree with the passing of a universal health care system does not make them amoral as much as it makes them skeptical of the benefits of a large system like this, and this is where the politics come in. Once the people who are trying to better society for the disenfranchised espouse these selfless goals, the distant drums beat as free market libertarians and dogmatic capitalists come in to denounce the system in what they call a 'socialist takeover'. Groups like the Tea Party and private health insurance companies have all done well in their efforts to paint a harmful image of what could be beneficial to the public, but here is where the real debate begins (Jacobs) . Whether or not the system would truly be beneficial for society as a whole, or would be the stepping-stone onto the path of an intrusive government. It's these values that are put to the test in the public policy discussion, as we will see once we discuss the actual politics behind health care reform.
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Senator Chuck Grassley (R-IA) Giving A Speech in 2009
Claiming President Obama's Health Care Reform Would
'Pull the Plug on Grandma' |
In order to understand the problems associated with passing legislation that would enable a system that would cover the 32 million uninsured Americans and drive down the overall costs of health care, we must look at what the politics surrounding health care reform really entail. It is important to understand that politics is just the middleman between the idea and the implementation, as ideological battles break out everywhere from the senate floor to town hall meetings. As we saw in 2009, heated debates broke out all over the country, with politicians like Sarah Palin and Lindsey Graham claiming Obama's health care reform would create death panels. Sarah Palin went on to say "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil" (Huffingtonpost). There was also Chuck Grassley, the Senator from Iowa who said, "You have every right to fear. You shouldn’t have counseling at the end of life, you should have done that 20 years before. Should not have a government run plan to decide when to pull the plug on grandma” (iowaindep). These little tag lines or synecdoches are used as a figure of speech to encompass the entire debate down to one line that is easily disseminated to the mass public and understood almost immediately by anyone listening. The claims of socialism taking over America, and the all powerful overreaching government would actually decide whether you have the right to live or die scared and shocked millions across the country, and brought rise to anti-government political movements around the country. While these all may be clever, they are simply products of public discourse, the weapons used by politicians and fear mongers alike to push a particular agenda in their own favor.
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| Protesters Against Universal Health Coverage |
Opponents of health care reform also look to current government run programs and deem them as inefficient and too costly as it is, claiming that both Medicare and Social security, two of the largest government run programs are going bankrupt. They believe the government cannot run as efficiently as the free market, especially when it comes to providing goods. Rep. Michelle Bachman (MN) said in a speech to a small group of constituents in February 2010, "We’re $14 trillion in debt, but that doesn’t include the unfunded massive liabilities. That’s $107 trillion, and that’s for Social Security and Medicare and all the rest. You add up all those unfunded net liabilities, and all the traps that could go wrong we’re on the hook for, and what it means is what we have to do is a reorganization of all of that, Social Security and all" (thinkprogress). Other opponents of health care reform will agree, saying government ran programs have never worked the way that they should, and by creating another large government run program you're only adding to the problem. These are all simple taglines used by the opponents of health care to symbolize their disapproval of a government run health care system. It is very appealing to a broad section of the public to hear 'less taxes, less government', as it should, because not many people are actually for higher taxes. Whether or not creating a government run health care system would actually infringe on the free market is a whole other question, as proponents of health care would like us to believe.
Proponents of health care reform tend to use some of the horror stories that come out of the privatization of the health care industry. They often look to statistical data to show how inefficient, low quality and lacking in coverage private health insurance companies actually are. An example of this is on Barack Obama's website, where he actually has an entire page dedicated to the stories of bankruptcy, denials of health insurance, and complications caused by the bloated and inflated private health insurance market (Obama). One story submitted by a man named Randy from Kansas City, MO says
"I have no health insurance and I am considered uninsurable because I take anti-depressants. I have taken this medication for nearly 25 years now with incredible results... I'm a success story here. But it keeps me from getting health care coverage now that I am self-employed. If I have to go to the hospital for an operation tomorrow, I will be bankrupt! I will lose everything I have worked the past 49 years to achieve. I live everyday in fear that I will get sick and I will be left with nothing but debt and despair. You must fix this problem for the American people. We cannot continue to live this way. It eats away at me everyday. Please help us!" (Obama)
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| Protesters For Universal Health Coverage in 2009 |
This is a great example of some of the stories we hear from around the country. It shows how Democrats, liberals, reformers, and average citizens alike believe the necessity to reform health care is an imperative. It is because of stories like this that Democrats and policy makers can depict an image of how free market capitalism has halted the advancement towards a socially just society. This means of political gain noted by Deborah Stone as “stories” gives progressives and social-minded justification in calling for universal health care, to prevent tragedies like this from occurring (Stone).
They claim the free market does not fill in the void aka the 32 million Americans left uninsured by health care companies because it is not profitable for the businesses to cover these people. They look at the private industry as only working in their favor and not for the good of society as they are a for profit business. Liberals will bring in people who testify before congress the tragedies them and their families suffered, with stories of the inability to pay off mounting health bills, the lack of coverage for medication, and the too often denials handed out by health insurance companies based on pre-existing conditions. They will say 'if it was not for the profit motive, the sick would be cared for, and nobody would be denied coverage'. They will also look to the fact that because of such burdensome costs, many don't go to the doctor to get their routine check ups, which could prevent the sickness they would eventually get in later years.
Proponents also believe that some things just shouldn't be privatized like health care. Their political mantra is that government is a necessary institution in order to provide a just and prosperous society (intellecttakeout). Organizations like the "Intellectual Take Out" share this progressive ideology, referring to the "New Deal" proposed by President Franklin Delano Roosevelt as the platform in which society began to look to the government to provide public necessities (intellecttakeout). Intellectual Take Out and other liberal minded think tanks believe the government is there to provide for the common good and to help people in an altruistic way with no profit motive behind it. This leaves government as the watchdog of society and is there to ensure the well being of society (intellectualtakeout). They look to the government to cure the woes of society and see government as the impartial body, while the private companies are in it for the money. While all this may be true in some aspects, it is hard to say whether or not government is truly impartial. In defense of the liberals, at least the government can be held accountable by the people, while many health insurance companies are not held accountable for their actions, for they are not receiving tax payer dollars.
Physicians for a National Health Program will cite increasing rates in bankruptcies as a result of burgeoning health care and hospital costs as a primary causation of the current dilemma in privatized health care (PNHP). Physicians for a National Health Program recently did a study that purported that "As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem. By contrast, our 2001 study in 5 states found that illness or medical bills contributed to about half of bankruptcies" (bankruptcy). Meanwhile bankruptcy rates as a whole have gone up almost seven times the amount they were in 1980 (intellectualtakeout). The graph below shows the dramatic increase in bankruptcies since 1980, provided by the Intellectual Takeout organization.
This is an example of how consumer bankruptcy rates have multiplied seven times over the past 25 years and is accelerating. According to PNHP, 50% of these bankruptcy claims were due to piling medical bills, as costs in hospitals have gone up while worker wages have remained stagnant (PNHP). On top of this, the 32 million Americans who do not have health insurance are even more at a loss, as all of their expenses come out of pocket (PNHP). As Deborah Stone said "Every number is an assertion about similarities and differences. No number is innocent, for it is impossible to count with making judgement about that characterization (Stone P. 167). PNHP and people who support a nationalized health system will judge these numbers as the primary cause of poverty in the country, inadequate access to resources, lack of quality care, and ultimately the problems associated with the free market based health insurance industry.
Another problem that has been addressed by policy makers is the high costs of medical coverage and the lack of quality that is actually given despite the expensive price tag. According to PNHP, "Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($8,160 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 51 million completely uninsured and millions more inadequately covered" (pnhpsinglepayer). This is a concern as we see the inadvertent causes that come from this; bankruptcy, lack of preventive care due to lack of affordability, and an overall rationing of resources because of such inflated prices in which hospitals and tax payers end up bearing the burden of.
These problems have left millions in America to offer solutions to the looming debt crisis due to medical bills. The fear of a society that is indebted to the banks because of medical bills, and the idea that C.E.O's of a multi-billion dollar corporation deciding the treatments you can or can not receive based on your financial situation is one that progressives and the public are beginning to resent. It's the tug of war between Republicans and Democrats that have stymied progress in what seems to be a common sense solution to a very serious problem.
One solution that has been proposed by policy makers is the idea of a single payer health care system. According to PNHP, a "Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private" (singlepayer) . This would essentially create a system that is still largely privatized, meaning the production of hospital tools and machines would still be privatized, but the way in which hospitals or private corporations would be financed would be through a public agency ran by the government. This would in turn keep those who aim to profit in the business of producing medical machines and tools for hospitals to remain a privately owned business. The difference would be that the middle man, the health insurance industry, would be ran by the government, hindering the private insurance companies from manipulating the price at which the public pays for their coverage. One senator who has been a leader for the fight of a national single payer system is Senator Bernie Sanders of Vermont's. His recent proposal in the form of a bill called the American Health Security Act of 2009, would create a single payer system that would cover the currently uninsured 46 million Americans, would eliminate co-pays, and restore free choice for physicians (sanderspnhp).
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| Senator Bernie Sanders (I-VT) |
Senator Bernie Sanders (I-VT)
1. Patients go to any doctor or hospital of their choice.
2. The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.
3. Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.
4. While federally funded, the program is to be administered by the states.
5. By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.
6. Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.
7. To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals. (sanderspnhp).
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| Rep. Paul Ryan (R-WI) |
This solution seems common sense to many, but others like Rep. Paul Ryan (WI) would propose an entirely different approach, revamping the entire way Medicare currently works, and effectively privatize it (Bloomberg). "The budget crafted by Ryan would slash U.S. spending by $6.2 trillion over a decade by cutting Medicare and scores of other programs, including Medicaid, food stamps, farm subsidies and Pell college tuition grants." (Bloomberg). Many on the left and even the President have challenged this solution. Barack Obama said in a response to Paul Ryan's proposal, this would "Put simply, end Medicare as we know it" (rueters). While both sides of the aisle have challenged this solution by conservatives, the appeal of the free market solution in America usually prevails. Many would argue this would further enhance our liberties but at the same time would reduce our security, as millions of uninsured senior citizens would no longer be covered by Medicare, and would be tossed into a system of uncertainty as they search for an affordable plan in the free market.
Health care is one of the most personalized political issues in American public policy, as it affects each and every one of us on a level that frightens most people; the uncertainty of life and death. It's this instinctive fear that drives millions of otherwise politically apathetic people into overnight political activists the moment health care is brought into the debate. It is something that we as Americans will have to decide in the coming years in how to approach such current large-scale problems posed by the private health insurance industry, and the future dilemmas we will face as a nation if it is not addressed soon. The imperative placed on reforming this system only comes about once every decade and then ends up dying down once some other large issue comes into the public policy arena. When the issue does arise again, emotions are poured out from both sides of the aisle as to the moral implications of the current system, and the fears of an overly intrusive system that reformers try and propose. Until civil discourse can come to a conclusion to this very personal debate over the way we as a society should take care of our citizens during their dying days, we will see millions still left uninsured, others falling into bankruptcy, and many receiving inadequate care that could ultimately lead to death. The burdens these issues place on society are tremendous and when it comes to domestic issues, health care reform should be a top priority. We can only hope that within the public policy debate we can come to a consensus to put to rest this debate that raises doubts about our values as a country. Until then, America will be seen as one of the most prosperous nations in the world, but just couldn't come to terms with the idea of providing a public service that is viewed as an inalienable right by many. How will history judge America if we are to deny our citizens the basic rights the rest of the world seems to offer unquestionably? Progress is inevitable, and I do believe that one day we will create a system that will cure the ailments of a faulted system, and in turn, better American society, and the world as a whole.
Signing Out- John Thomas
Works Cited
Deborah Stone- Policy Paradox
