Vitality Versus Security

I read David Brooks column by that title in the Key West Citizen recently and it's premise won't go away. Grrr! I have to lance the boil...

Funnily enough I don't disagree with him on this one because I have long since viewed health care reform (insurance reform whatever term suits you) as a step away from the devil-leave-the-hindmost attitude of Reaganomics. What the Right calls the rising tide that lifts all boats, dinghies and gin palaces equally. Early on when it became clear that health care reform was a possibility, and noise started to be made about a true public option, I too saw this as a step toward a more social-democratic state in the US. Social democracy as defined by Western Europeans is, broadly speaking a mixed economy as defined by some people in the US. Essentially social democracy offers the population at large a protective safety net of benefits, economic and medical below which the bulk of the population need not fear falling. It can consist of government paid for child care so mothers can work, extensive sometimes permanent unemployment benefits and of course free health care for all. Free in the sense that taxes are twice as high as they are here. In motorcycling terms I read in a magazine recently that a Harley Sportster that sells in the US for less than $10,000 might cost three times that much in Denmark. That's just another way to pay for government programs. We hear a lot of noise about extended European vacations, but Europeans have to pay back their free education with a lifetime of work to garner a modest government pension at the end. Making a sudden (albeit well earned) fortune in Europe is next to impossible compared to the US where large sums of money (used to!) routinely change hands in corporate buyouts and as rewards for creative thinking and hard work...

Brooks's point, and it's a good one, is that by seeking to provide coverage for all in the US we are starting down the path to government oversight in much more than just our health care. It is, as he says, a civilizing effort. As we try to remove the terror of illness or bankruptcy from the lives of ordinary people we inevitably increase costs and thus increase the need for more...taxes! He's right, I don't see how universal coverage can be obtained without increasing costs not matter what they tell us, but here's why I think it is fundamentally necessary, even though my wife and I have adequate coverage as I write (and low taxes in penurious Florida!)

The problem for me lies not with the notion of universal coverage, but the reason why we don't already have it in our free market system. If our private insurance based system worked I would stand alongside all those who sought no change- "If it ain't broke don't fix it!" But it is broke! There are too many horror stories of insurance companies failing us, too many and too well known to go on listing them here. Our system costs more per capita than universal coverage systems underpinned by other industrialized governments, our lives are constrained by lack of health care, by insurance tied to our jobs, by unaffordable premiums and by insurance companies who set the terms that cannot be debated. If you get an unfair or illegal bill to whom do you appeal? This system tortures Americans of good faith and less financial means. It tortures decent families and people forced not only to suffer illness and catastrophe but financial ruin. Something has to change, Senator Lieberman and the Catholic bishops notwithstanding. I have yet to hear a non-coverage horror story from a member of Congress or their families. We deserve no less than they.

And if, in so doing we take one small tentative step down the path to social democracy and away from free market piracy, so be it. If the insurance companies understood how badly they have mauled us we wouldn't need to fight tooth and nail for a strong public option. If I could shop for an insurance policy across state lines to find the cheapest competition we wouldn't need change...If a life flight helicopter to Miami didn't charge $23,000 for 40 minutes in the air...or a ground ambulance $800 for a five mile ride across Key West...If a heart attack didn't cost $70,000 to treat...If insurance companies had to present timely detailed explanations of charges...If co-pays were capped by law....If the chronically ill got government help...If...if...if. Instead we face medical and financial catastrophe like no other industrialized nation and our leaders won't lead us out of the wilderness. Universal coverage is sensible and compassionate, not socialism. And if it is the first step to socialism let the insurance robber barons shoulder the blame, not the sick.