Monday, October 7, 2013

Nothing healthy in the health care 'debate'

The US government has shut down because a group of right-wingers doesn't want the Affordable Care Act to go into effect.  Indeed, as even they, amazingly, say, there's a danger that people might actually like it! So, these right-wing radicals want to save us from ourselves.  They know better!  They don't want us to get addicted to, well, a lesser version of what Congress has voted for and long enjoyed itself: guaranteed free (to them) health care provided by the taxpayer.  Despite the fact that we've had elections which have been, in effect, referenda on Obamacare, and a Surpreme Court decision ruling that it's constitutional, the Tea Partiers have decided they know best what the rest of us need and want.  Would it help if the issue were framed differently, or is this primarily a divide based on racism and other similar considerations?  Let's try reframing. 

Insurance: what is it?
Everyone who owns a home or a car must have insurance, if they want a mortgage or a driver's license.  The Tea Party and other ignoriscenti are not out in the streets protesting these forms of insurance.  Yet such forms of insurance does just the same thing that health insurance does: they are not 'free' and they distribute risk and cost across the whole pool.  Yes, we are paying car insurance premiums in part to cover the accident or home-fire costs mainly of somebody else!  And those somebodies may not be of the right color or ethnicity or even religion (they might even be atheists!).  But the reason we accept this awful implication is that if by some fluke our house burns down or we rear-end someone or run down a cyclist, others will help pay the cost--so we don't go into bankruptcy and have to live on food stamps (if, that is, the government still provides them).

The same is true for health insurance.  It's not free, even under the Affordable Care Act!  The law requires that we all pay in, sick or well, so that everyone is paying a lower average fee.  That way, people who happen to draw the disease short straw don't end up bankrupt and having to live on food stamps (perish the thought!).  Yes indeed, we are all paying for those lazy louts of the wrong color or language or religion to actually have surgery if they get cancer.  If we're lucky, we'll personally never have a Big Bill to pay and we'll be lucky to end up in a pine box just having helped our neighbors with their surgery bills.

BUT, if we do happen to draw the short straw, somebody else is going to help us cover our costs. And that somebody else is everybody else. 

We bear the costs already!
As things now stand, something that even Republicans should be able to understand (or have the decency to state clearly to their Tea-slurping masters), we already cover each other (even those of the wrong color or religion or neighborhood). When people without insurance go to a hospital emergency room, not only do they get ad hoc care often too late and with no follow-up, but the cost is something like 3 times what it would be in a doctor's office or if they'd had preventive care.

The hospital has to cover that cost somehow.  The government subsidizes some of it (via our taxes), but not all by any means, so the hospital must compensate by charging those of us who are insured more than the cost of our own care to cover the rest. And, of course, your and our taxes pay for elders, military--and Congressmen.  The current state of affairs buries this unsavory, inefficient and costly sharing, so people somehow think they aren't already involved. 

Living and dying with imperfection
No major social system is without its problems.  Health care is complex and a mix of guesswork, knowledge that's imperfect, bureaucracy and fallible personnel.  People in countries with nationalized health care, whether private or publicly financed, always complain about its imperfections.  Any such system will have imperfections.  But they would not give up the idea that they're covered, one way or another.  Rather, complaint leads to improvement in any complex system.  Even, we hate to say it, universities have imperfections (but professors, at least, don't want to close them down for that reason). 

Could we as a public be educated somehow (it won't, apparently be in universities, given our track record) to understand this, and to realize that our salary is not just for buying a Lexus and very big flat-TV, but for food and health care and other necessities of life?  If so, this debate would not be happening.  We might have public or private health care, but it would be for everybody.  It won't be free.  But no matter who you are, if you get sick, there will be someone to take care of you.

Or maybe that's the not the issue at all
Perhaps if we were told, openly and honestly, what insurance actually is, and how it works, this debate could move on. Though, if it's in fact a thinly disguised racism or other form of intolerance, there's little hope of moving beyond. 

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