Winston Churchill
once said, "You can always count on Americans to do the right thing ...
after they've tried everything else." We keep trying, but we haven't done the right thing yet on a
certain subject. Let's review a little history.
In 1912 former President Theodore
Roosevelt ran on a third-party party platform that endorsed it, but he lost the election.
In the 1930s it was proposed numerous times, but special interest groups
objected and the effort was abandoned. President Truman failed when he tried it.
Kennedy didn’t have time. Johnson took two major steps but only got part way
toward the goal. Richard Nixon tried and might have succeeded, but the
Watergate scandal intervened. Seniors shot down President Reagan’s idea. Bill
Clinton had a big plan that failed miserably, although children got some help.
George W. Bush added a narrow provision. The latest attempt passed in
2010 under President Obama, but even that doesn’t go all the way.
“It” in this history, of course, is
a health care plan that covers everybody. Nearly 130 years after
Germany, the first country to do so, adopted a plan to cover its citizens’
medical needs, the United States remains the only developed nation on the face
of the planet that does not provide for this aspect of the general welfare. And
as high school students and citizens throughout the land will remember,
promoting the general welfare is one of the six purposes of our national
government. It’s right there in the Preamble to the United States Constitution,
as written by the Founding Fathers.
This is where hypocrisy
comes in. Politicians and some commentators often say we shouldn’t mess with our healthcare system because it's the best in the world. But that’s simply
not true. We have the best healthcare in the world— for those who can afford it—but we don’t by any means have the best healthcare system. It’s not a good
system if tens of millions of our fellow citizens do not have insurance
coverage and must go to emergency rooms when they need care. As medical
technology gets more expensive and our population grows older, the costs of
this so-called “system” are going to bankrupt us if something isn’t done. On
this both liberals and conservatives agree.
One state recognized this a few
years ago and enacted a health plan that covers all its residents. The key
provision of that plan is a
requirement that everyone who is not otherwise covered must buy private health
insurance or pay a penalty. That’s the same as the “individual mandate” of the plan Congress passed
in 2010. But the governor of the state in question is now trying to distance
himself from the law he once enthusiastically defended. As a Boston Globe article points out,
“Basically, it’s the same thing,’’ said Jonathan Gruber, an MIT economist
who advised the Romney and Obama administrations on their health insurance
programs. A national health overhaul would not have happened if Mitt Romney had
not made “the decision in 2005 to go for it. He is in many ways the
intellectual father of national health reform.’’ [Emphasis added.]
Numerous others, including Governor
Rick Perry of Texas and former Governor Howard Dean of Vermont, agree that
“Romneycare” and “Obamacare” (the Accountable Care Act, ACA) are very similar.
[See www.politifact.com/texas/statements/2010/dec/05/howard-dean/dean-howard-says-health-care-bill-prseident-barack/
For a detailed comparison of the two laws, see http://familiesusa2.org/assets/pdfs/Elections-2012/RomneyCare-ObamaCare.pdf
]
But candidate Romney now wants to
repeal the national plan that is based in large part on the state law he signed as
governor. He says he wants to repeal the ACA but keep in place some of its
commendable aspects:
People who want to keep their
current insurance will be able to do so. We will help each state assure that
every American has access to affordable healthcare. People with preexisting
conditions will know that they will be able to be insured. [These lines were
taken directly from news clips of his speeches shown on TV.]
He especially wants
to repeal the individual mandate, a provision that he deems a tax—in supposed contrast to the "penalty" that supports the individual mandate in the Massachusetts law. But whether you call it a tax or you call it a
penalty, the effect on your wallet is the same.
Furthermore, economists
and healthcare experts agree that we all pay a hidden tax now: it’s called the
“cost shift.” Uninsured people show up in hospital emergency departments and the
costs are borne by government programs and through higher premiums for private
insurance. No matter what, the rest of us pay for the care uninsured individuals receive.
By the way, some conservatives would deal with rising costs by promoting a "free-market" solution: vouchers for private insurance. This is not a viable answer. Private insurance companies need
to make a profit, and profit = more hidden cost. A better idea is to promote health, wellness and prevention programs, as the ACA does.
Demagogues are also
obsessed with the claim that the ACA is a “federal power grab.” But apparently
they haven’t actually read the law. I have, and I found that there are more than 25 sections—scores of pages—devoted to state-based
demonstration programs of health, wellness and prevention. There are
39 pages devoted to state programs for the
uninsured: programs like insurance networks that spread the costs
fairly. There are state-based pilot projects, assistance to states for
medical student loans, funding to expand state centers for the aging,
grants to states to improve the health care workforce, and provisions
for state alternatives to malpractice lawsuits. And now that the Supreme
Court has ruled on Medicaid expansion, there is state flexibility on
whether to cover the poorest among us (the cost of which will be covered by
federal money).
Finally, and even
more fundamentally, there are moral questions at the heart of this
debate. For decades society has paid the extraordinary costs—the hidden tax—of
emergency room care and chronic illness because our health care “system” does
not cover everyone and provides few incentives for wellness and prevention.
Rather than bloviate about emotional triggers like “states’ rights” and
“federal takeover,” should we not be asking again what truths we hold to be
self-evident?
If it is
self-evident that the general well-being of our citizens is important and that
life is one of our “unalienable rights,” wouldn't it be the highest form of
patriotism to provide all of our citizens with equal access to health care? (Switzerland
and Germany do it ... for considerably less than the nearly 20% of GDP it's
costing us.) Or are those concepts no longer part of our common mission? Is a
basic human good such as healthcare only for those who can afford to pay for
it?
Winston Churchill
was “spot on” when he said Americans always do the right thing ... eventually.
It just takes us a long time to figure out what that is.
We’ve been trying
for a hundred years. We haven’t quite figured it out yet, but the ACA is a step
in the right direction.
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For a fascinating contrast in perspectives, see this discussion on CBS between Governors Walker and
O’Malley: http://www.cbsnews.com/video/watch/?id=7413500n&tag=api
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