September 26, 2009

Should Americans Have a Right to Healthcare?

[Here is the case for universal health insurance which I wrote for the Commonweal Institute. A shorter version was originally published in the San Francisco Chronicle.]

One hears: “Why should I have to pay for healthcare for people who don’t take care of themselves?” Many complaints about extending healthcare access to the uninsured are grounded in the longstanding argument about what role government should have in our lives. Nothing defines the difference between the formal worldviews of the conservative right versus the progressive left more than this: the idea that individuals are solely responsible for their lives versus believing we have a shared responsibility for the communities and societies in which we live.

From the conservative right’s point of view, the failures and successes of one’s life are one’s own – sometimes matched by a conviction that God marked you for failure or success based on His plan. For the progressive left, our personal failures and successes are determined by how we’ve applied our blessings or faced our trials within this life shaped by our inherent luck, the support we have from those around us, and the benefits provided by our communities. Progressives see government as a tool for enacting our shared responsibility for people far beyond our family or tribe because we see all our fellow citizens as our brothers and sisters. We know that we are stronger and our lives are enriched when we take care of our shared obligations to each other. We see access to affordable healthcare in this light.

Recently the founder of Whole Foods, John Mackey, wrote that there is no inherent right to healthcare, and indeed, that the majority of Americans have only themselves to blame when they get sick. Mackey believes that healthcare should be no different than food or housing and is best left to the market and personal choice. And he believes Americans “consume” too much healthcare because they don’t know what it costs. The lack of charity inherent in these remarks seems to be particularly resonant in America where the culture of individualism and personal responsibility align with the belief that the free markets do the best job of distributing goods and services, even when those services are caring for the sick – and even while our private healthcare system costs more per person than any other industrialized nation and still delivers worse outcomes. But just what type of community are we building if we refuse to help someone who gets sick through bad luck or even their own personal failings?

And so many of us know someone who is desperately ill through no fault their own, and how that affects their entire family. They are like my friend Tess who was diagnosed at the age of 14 with juvenile diabetes inherited from her paternal grandmother. Her grandmother died in her early 30s from this deadly chronic disease. Now tell me, how, exactly, should Tess take personal responsibility for having diabetes? Or cut back on her use of expensive medical care?

Today, Tess has outlived her grandmother by a couple of years but only with a long struggle, significant bouts of near-death experiences, years of dialysis after her kidneys gave out due to complications from the disease, and yet with deep courage and perseverance. Indeed, knowing Tess makes me aware of what it means to have true courage despite tremendous challenges. Nevertheless, Tess is one of the lucky ones – she’s someone who is covered through our shared generosity by government-funded healthcare (Medicaid). And yet, because she is sick, her mother has spent most of her working life not being able to work. Tess’ mother has acted as the primary caretaker of Tess and her family, with scarcely a time when she was covered for healthcare herself. My friend’s mother should not have to worry about whether she can go to the doctor when she feels a pain in her chest. But today she does. And everyone wonders what would hold the family together if my friend’s mother fell ill herself.

The latest Senate Finance healthcare bill sponsored by Max Baucus (D-MT) incorporates the same faulty belief that we spend too much on healthcare because people aren’t aware of the cost of their health services. Clearly this is a fallacy because there are many people who don’t have health insurance or don’t have adequate health insurance who are completely aware of the costs, because when they are seriously ill they must get treatment, even if it means going deeply into debt. And because our system is so dysfunctional, they will spend most of their time fighting to get care and staving off the calls of the bill collectors. No wonder 62% of personal bankruptcies arise from someone getting sick.

Furthermore, how would making healthcare a consumer choice work? Michael Moore’s film SickO showed that many underinsured people already have consumer choice: remember the fellow who had two fingers chopped off in an accident and he decided that he could only afford to have the cheaper finger reattached? That is consumer choice in today’s world. And that type of choice shouldn’t be one we wish on our worst enemy.

We need a strong public option so that we can have a healthcare choice that matters. One that makes it easier for people to get the care they need without having to haggle for every penny of coverage. We can have more effective, more humane and sensible healthcare when we realize “I am my brother’s keeper.” And we could have some peace of mind knowing he is our keeper too.

Posted by Mary at September 26, 2009 10:29 AM | Health/Medicine/Health Care | Technorati links |

Just like on global warming, this issue seems out of your league. Never has this been a right and more and more people are getting coverage for their healthcare needs. How many people had healthcare coverage in the 60's? Why has that popular eye surgery price come down so drastically? Could it be that insurance doesn't cover its cost? People have to pay for it themselves. One could ask, isn't seeing a right?

You want to make the insurance companies the villain. But you don't seemingly want to contain their cost. Tort reform, caps on malpractice law suits and damages. Reduce the malpractice insurance cost that our doctors, nurses, and institutions have to pay. Open heart surgury used to cost $8,000 in the 80's, now its well over $50,000. Same two doctors, two nurses, and the anesthesiologist involved in both operations, where does that increased cost come from ... malpractice insurance. Certainly not from inflation. Some states have come to this conclusion and we've seen insurance cost drop 45% in four years in Mississippi; And 35% in Texas. We've also seen coverage increase in each state, more people covered at the cheaper cost. And we've seen institutions add more doctors to their staffs(that's another problem with your approach).

Hey, I agree, we're only a serious illness away from the poor house. I also agree to getting rid of pre-existing conditions and making your insurance portable. How about making insurance available to be sold across state lines?

Where in this debate has eye care been discussed? Where in this debate has dental care been discussed? I sure haven't heard nor read anything in the multiple plans including either. Over 100 million Americans without dental insurance! Over 150 million without vision coverage! Where's that discussion? Both can be done cheaper than trying to deal with healthcare. Less than $200 per family for vision and $900 per family for dental per year. Mouth problems are the gateway to more serious health issues. And how far can you go if you cannot read.

Next, you want to add twelve, thirty, fifty million patients to our insurance rolls? Who are going to see them? Where are the doctors going to come from? Are we to import them from other countries? In Canada, they have a doctor shortage. There's a reason why some nearly five million Canadians don't have a family doctor. there's not enough to go around.

(Please refer to page three, second column for my reference. Page twelve has all the specialties involved in this report card.)

No family doctor, no access to preventative care. Sure you can still go to any ER, can't we too? Nearly five million of a country of some 33 million don't have access to a family doctor. What's that ratio? What's our ratio? How are we going to make it easier to become a doctor? Nurse? What, in any of the plans currently in consideration deals with doctor shortages? Education assistance? Student loan forgiveness?

Facility cost: In the Provence of Alberta, Canada, in 1989 they had some 13,600 beds. Please remember this was just after the 88 Olympics. Now they have only 6800 beds throughout the Provence. Why has this capacity shrunk as the population grew? I've read it because of budget cuts. How does that bode for us?

Max has done a remarkable job dealing with this tough issue. He deserves our thanks. I would prefer breaking this issue up in multiple parts. Let's do one thing this year and another next year and so on until everyone can be covered. Maybe start with the doctors issue, expanding our doctoring numbers and nursing numbers.

"I am my brother's keeper." has always had religious connotations. I fully endorse President Obama's continuation of President Bush's Faith Based Initiatives. Let's allow those who know their community help their neighbors. Doesn't it "take a village?"

Posted by: peter at September 26, 2009 05:33 PM

Perhaps you missed this one in the LA Times (,0,5111855.story). Amazingly Canada seems to prize having a private healthcare option that they don't have currently. It's either that or traveling and paying for faster treatments in the US.

"Hoping to capitalize on patients who might otherwise go to the U.S. for speedier care, a network of technically illegal private clinics and surgical centers has sprung up in British Columbia, echoing a trend in Quebec. In October, the courts will be asked to decide whether the budding system should be sanctioned."

""What we have in Canada is access to a government, state-mandated wait list," said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. "You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list.""

Read the article, truly amazing!

Posted by: peter at September 28, 2009 09:32 PM

I'm continually amazed at how many people will demonize Mackey for the 1% of his views they disagree with.

Posted by: Kevin at October 4, 2009 08:58 AM