Most people by now have probably heard from someone or other that the American health care system has major problems. You might have heard it from me, when, working for the 2004 Democratic campaign, I might have spouted something to you on the streets of Boston or San Francisco about what President Bush was doing to our nation’s health care. Well, I hope you didn’t listen too hard, because I didn’t know what I was talking about. Since then I’ve learned a bit, and I’ve decided to write this column as a way to share some information and perspective on a topic I believe many of us don’t know enough about. To those who do, I hope you’ll write in and tell me where I’m wrong.
I won’t indulge in a political or theoretical diatribe. I’m certainly a liberal. I’ve learned most of what I know from Wesleyan professors. But health care is important because it affects us regardless of politics. I graduate college in May. I lose my health insurance in October, when I turn 23. My parents are going to pay for catastrophic insurance, but I will no longer just be able to “go to the doctor.” Jobs with decent benefits are disappearing. Part of this column will try to answer simple, practical questions like, how will someone like me pay for antibiotics without a health plan? What does catastrophic coverage actually cover? Twenty-somethings constitute one of the largest fractions of the American uninsured population. I think we should know what we’re headed for.
The other side of the column is my take on the bigger picture. What are these “problems” with the health care system? Why have they developed? Whose interests perpetuate them, and who do they hurt most profoundly? Would we be better off with a national health care system, something that every single other industrialized country, other than South Africa, currently has? If so, how can we realistically imagine one here, and what compromises would we have to make?
The problems with our health care system run parallel to the deepest imperfections of our country and society. They are born from the dark sides of democracy and capitalism, even as those systems continue to enable our greatest achievements. How our society defines “problems” in the first place reflects an immersion in the American ideals of financial freedom, elite scientific accomplishment, and bootstrap democracy. But the health care story reveals, forcefully, how inadequately those ideals have served tens of millions of our citizens.
I’ll crack open this Pandora’s box with a simple question: Should health care be a right – or a privilege? Should we simply have it, like the other services our taxes pay for, or should we earn it, as we earn the ability to purchase goods and services through hard work. Currently, in this country, health care is a privilege. A few are given it because they meet certain qualifications, and everyone else pays for it directly or with private insurance.
I can’t help thinking of the fire department. How nice is it that, when your house catches fire, you can reasonably expect a fancy truck with all manner of hoses and expensive gadgets to arrive, packed with skilled professionals who will risk everything to carry you out to safety.
We pay for the fire department, of course, but because government taxes are progressive – that is, scaled to one’s resources – the financial impact is proportional. And yet the service is (hopefully) uniform, no matter the individual price. Not so with health care. With health care, you get what you can pay for.
What makes health care different? Why do we get the firemen at our beck and call, but scrimp and budget for the doctor? Why don’t we have national health care?
You know the replies: It’s too expensive. It won’t be up to the patient. It’s against freedom.
I can respect these fears. People want elite care. It’s expensive. Surely, the market is the best tool to weed out under-performers and deliver the best care for the buck. Just whisper the words socialist state and watch the staunchest Wes liberal go all queasy at the thought of the dusty, ill-lit halls, the clunking bureaucratic machinations, the huddled masses yearning to spend free.
And it’s true – many Canadians fly here for their riskiest surgeries. When studying abroad in London, my girlfriend and I waited nearly three hours in a crowded, shabby NHS clinic for a mere streptococcus culture.
But it’s also true that we have over 45 million uninsured citizens. Compared to the majority of industrialized countries, our system ranks lowest in patient satisfaction and general life expectancy. What coverage we have is delivered unequally depending on ethnicity.
So there is no perfect answer. But there is a more perfect answer, which in the coming weeks I hope to help partially illuminate.
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