Health Care Must Be All Heart

What's It to Be: the Commonweal or Me?

APART from comments that the health-care bill is Marxist, which are sheer nutball, can we please tone down the rhetoric? This is a complicated issue, and a complicated bill. Let's try to contain the confusion.


Details

Individual health care taxes, despite charges to the contrary, will be raised only for people earning more than 95 percent of Americans and have "Cadillac" (think "Mercedes") policies, and this does not go into effect until 2013. Then for those making $200,000 and up their medical taxes, deducted or prepaid, will increase from $2,900 to $4,700 (tax rate 1.45% to 2.35%) -- a rise of $1,800 a year or $34.61 per week. (The self-employed are taxed at 2.9% but the rise to 3.8% amounts to the same increase -- $1,800 a year.) That's seven bucks a day -- a cocktail at a motel bar, lunch at a fast-food drive-in. I'm sorry, not outrageous.


Bigger picture

Opponents of this bill, please confront several facts: First, the current system is a mess, giving far too much money and power to middlemen such as HMOs and insurance companies, as well as to certain suppliers such as drug companies and device makers, meanwhile under-serving or outright disenfranchising those with pre-existing or chronic conditions, the unemployed, and the poor.


Second, limiting medical coverage is far more expensive in the long run. Why? The uninsured  don't get checkups or do preventive care, which means small, cheap, fixable problems grow big and expensive before they are addressed; then they use emergency rooms, which is very costly; and pregnant poor women don't get good prenatal care, increasing the risk that their babies will be born with problems society will have to pay for the child's whole life.


Third, since somebody has to pay to cover the uncovered, that  should be those who can best afford it. People making more than $200,000, for example – or $4 billion as in “b,” which the top hedge fund manager copped last year. Corporations. The very profitable drug and device companies. Insurance companies and the HMOs.


Health Care and capitalism

It's become a common refrain that capitalism is efficient, that private enterprise is better at solving problems than public institutions. Why, then, are administrative costs for Medicare and Medicaid much lower than those for privately run health care? Yet some insist that patients be given full choice and become consumers, informed (presumably) buyers in the free market of health-care insurance. The way to such choice, they say, is vouchers, which patients will be free to spend on the health-care provider they select. Beyond the certainty that government vouchers will almost by definition fall short of need, how can a sick person possibly choose intelligently and carefully? The array insurance companies is bewildering. And the medical field is an expert system guided by a powerful code of honor, not an open market ruled by caveat emptor. Such an environment will benefit only owners, bankers, entrepreneurs and possibly shareholders.


That outcome used to be unthinkable in this generous, just country. What happened to fairness? To compassion? Indeed to the medical imperative, Primum non nocere (first do no harm)? Widespread commitment to the common good seems to have succumbed to greed and self-interest. If all we care about is money and stuff and our neighbors be damned, American democracy is over and the American dream is dead.
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Update 4-24-11: A proposed insurance "interchange" passed by the Oregon senate seems a step in the right direction. It puts all insurance providers on a largely federally funded exchange for Oregonians to visit and chose among. But it still does not address those without and probably unable to afford health insurance, some 600,000 residents according to Portland's leading daily, the Oregonian.