On Health Care And Our Nation

Let’s get clear about the Obama administration’s plan for universal health care, which has caused such an uproar.

To clarify the issues, I offer a modest alternative: The law would require–repeat, require–that anyone who lacks health insurance would NOT be able to appeal to emergency rooms for medical care, nor be allowed to enroll in Medicaid (assuming that he or she did not meet the eligibility requirements before suffering a serious illness or injury), nor receive any other charity care. Whenever they sought medical care, they would have to pay the full price that the doctors and hospitals demand.

What would be the result of this plan? Whenever such a person suffered a life-threatening illness or injury, one of the following would in all probability happen:

          He or she would die for lack of medical care.

          He or she would go bankrupt and then die for lack of medical care.

          Or, possibly, he or she would move to some more civilized country where all persons have access to medical care.

I expect, and fervently hope, that all who read this will be repulsed by my loathsome hypothesis. For we all believe that to condemn a person to death simply because of their economic status or lack of insurance is barbaric.

The point is that we already have universal health care–through Medicaid and through the government-mandated charity of hospital emergency rooms. It is dictated by our basic human sympathies. Unfortunately, the machinery for bringing health care to our citizens is riddled with flaws. Among the biggest is the existence of free-loaders (or free-riders as the economists say). The best-known example is those who have no health insurance and rely instead on the charity of emergency rooms. They pay nothing, so their fellow citizens pay for them.

A similar result arises from the situation in which individuals, many young people for example, refuse to get health insurance because they are not ill and don’t believe they will be ill in the foreseeable future. Thus the burden of paying for health care is borne by those who at the time are least able to afford it–notably, the elderly. This contradicts the concept of insurance, which states that everyone pay a small price so that no one will have to pay a crushing price. (Consider Social Security: We pay into the Social Security system for all of our working lives, beginning many years before we receive benefits. Why shouldn’t health care insurance follow the same pattern?)

The sensible answer to these problems is a single-payer system, as it’s called–roughly speaking, extending Medicare to every citizen. But the right-wing free-market wacko fanatics have so hypnotized the American people that the sensible solution is not politically feasible.

So the Obama administration took the second-best course. They conceded the field to private insurance companies, with appropriate regulation, and required everyone to take out a health insurance policy or pay a penalty (with individual subsidies as appropriate). The requirement for universal coverage, therefore, is like a tax–a tax to support health insurance for everyone, a reasonable tax to support a reasonable measure for the benefit of all.

But Obama’s opponents were not about to lose their chance to pounce on a new and unfamiliar program. Opportunism combined with ignorance to produce an outcry that can be heard from here to the Supreme Court.

This message is addressed to veterans of World War II:

You gave two, three, four years of your lives serving your country on the battlefield, far away from your homes and families. Your experiences were uncomfortable at best and horrific at worst. Many of you were wounded, sometimes in ways that would bedevil you the rest of your lives. Many of your buddies were killed. Very few of you claimed that they liked being at war, but most of you answered the call willingly. Many grumbled about particular hardships or injustices, but no one complained that the government was a tyranny for enforcing military service on you, and no one complained that inalienable rights were being trampled because you understood that your sacrifice was necessary for the welfare of all Americans. Furthermore, your fellow citizens at home shared the sacrifice: food was rationed; gasoline was rationed; small luxuries like nylon stockings were off the market. Gold Star Mothers sacrificed.

And along with all the unspeakable horrors, there was also the deep satisfaction of living in bonds of love and respect for your comrades in arms.

After the fighting, you came home, and your memories came with you. You saw the homeland that you had left, and perhaps you wanted to make sure it was worth fighting for. Perhaps you hoped that the feelings of unity and altruism you experienced as a soldier would appear throughout the country, each person bearing whatever burden was necessary for the welfare of all.

And now, six and a half decades later, what do you find? Led by the Me-Party, our nation is dominated by crybabies and paranoids. Hypocrisy is also in evidence, as many of the Me-Party types demand severe cuts in government spending while at the same time demanding that programs that benefit them remain undisturbed.

The dominant question is not, “What is necessary for the welfare of all Americans?” but, “How can I get the most for myself?” Far from willingly sacrificing years of their lives, too many of our citizens aren’t even willing to sacrifice the cost of a health insurance policy, and far from asking what is necessary for the good of all, they instantly assume that any government requirement is a tyrannical violation of their right to happiness. “Shared sacrifice” has become a joke or a term of derision.

Is this country worth the fighting for? I think it is, for despite all the shameful developments, I believe it still has a lot going for it. But the question remains open.

(Personal self-disclosure: I spent my two years in the Army as a draftee shortly after the Korean War. If circumstances had been different, I might have been in combat. But circumstances were not different, and I never came close to combat. For that reason I don’t count myself as a veteran in the true and proper sense of the term.)