So today the Supreme Court upheld the Affordable Healthcare Act and allowed the individual mandate that all people of the United States must have health care insurance or they will be “fined” or taxed. And, like I expected, there has been lots of discussion, applauding and complaining on Facebook and Twitter, and, no doubt, around water coolers and coffee pots all day.
If I listen carefully to the criticisms of the decision, I hear a few major themes. The first is about the requirement to have health insurance or be penalized; the second is about the huge debt this plan will create for us. Some are focussed pretty myopically on the anti-obama rhetoric that he “lied” about not taxing the working class. And others don’t think it’s their responsibility to be forced to give “charity” through government health plans.
I’m intrigued by the notion of independence in this country and its connection with freedom and “the American dream.” I realize we were born with a DNA of rebellion and individual rights. And I can relate to the “you can’t make me” kind of mentality around how we spend our money and the choices we make in our lives. I remember when my husband had to register for the draft in the early 1980’s, and I thought, how can this be fair? I wondered why women weren’t also required to register, and, at the same time, whether I would ever allow myself to be drafted into a militaristic mentality that I believed was at its root sinful. Yet, being a member of society means we have to require sacrifice for the common good. I’m still an idealist, but doesn’t age also make us more pragmatic?
The health care issue is intriguing because there are some pragmatic realities. The medications, the surgeries, the “cures” and the “cares”, are relatively recent technological innovations. The routine care that my insurance company helps provide for me didn’t exist 100 years ago … daily thyroid replacement hormones, medications to counter high blood pressure or high cholesterol or arthritis pain or pre-diabetes … is providing this care for me my right? a privilege of class or financial status? What about cancer or end of life issues? As the pharmaceutical industry continues to advertise newer medications to correct medical issues we didn’t even have a name for 10 years ago, how much of this is basic care and compassion for human life? Am I entitled to a $100 cream for the rosacea on my face? what about the psoriasis on my ankle that keeps me awake at night? Or are these mere “comforts” of the privileged class? In end of life care, are we entitled to nursing home care through government subsidies? What about hospice? Is everyone, no matter their age or mental capacity, entitled to medical subsidies for wheelchairs, power chairs, c-pap machines? Do we continue to pay for X-rays or blood tests or other expensive tests when we expect a patient is dying? And in the beginning of life, are young parents of premature babies entitled to government aid when their child amasses hundreds of thousands of dollars of bills for neonatal care? These are the hard questions we still have to deal with. And it’s tough for a society to work through these tough questions; it’s easier to say, well, we all have the right to choose for ourselves and we can only choose what we can pay for. Yet, the compassionate side of me says everyone should have equal access to the care that will allow a level of human comfort, health, and wellness that we all dream possible for ourselves, especially if the technology and medical treatment exists.
The pragmatic and compassionate side of me is mostly in favor of the health care act and its principles: that all boys, girls, women and men are entitled to basic health care, and that it’s our responsibility as fellow human beings to participate in the system which provides for it. Some people say they have “paid” into medicare all their working lives and deserve its benefits. Yet, most of us have not paid in nearly the amount Medicare will likely pay out on our behalf. I have been observing my mother’s medical bills as she has spent the past four and a half months being supported by Medicare in an intensive care unit, hospital rooms, operating rooms, imaging labs, rehab units, ambulances, and skilled nursing centers; I don’t know how much money she “put in” to Medicare, but I’m sure it wasn’t close to what the government is paying on her behalf. It’s the contributions of the younger workers today that are paying for my mother’s care, and I’m grateful. We couldn’t do it ourselves.
None of us know if we’ll be one of those in skilled care for years or die quickly in our sleep at home, if we’ll slip off a ridge while hiking or sneeze while changing lanes on a highway, if we’ll be one of those who develops MS or a rare cancer. We can’t plan for it or save for it. We can’t pay for it ourselves; we have to rely on the mutuality of our civilized society. We have to rely on each other … and that means we have to give and sacrifice for each other.
A mandate for insurance is a vote for responsibility and for everyone giving our share so that we can rely on each other as we find ourselves in need. Personally, it seems much easier to me if we had one system in which we all participated … expand medicare to cover everyone … create a new single payer system … but that goes against our capitalistic priorities and belief that economic competition holds us all accountable. So we have the system we have … a hybrid system of socialism and capitalism … my hope is that it’s compassionate, just, and accessible to all who need it.
Will it put us in debt? probably yes … but the rising cost of healthcare will put us all in debt with or without it. How do we reduce that cost? Many suggestions are in the health care act … centralized records reducing paperwork and mistakes, birth control for all women (and men) who desire it to reduce unplanned pregnancies and childbirth, a focus on preventative health care and healthy lifestyles. I would add a cap on corporate profits from health related industries (including pharmaceutical and insurance companies) … I don’t deny anyone the right to make money, but I do think that exploitation of the aging and diseased populations by corporate executives whose moral obligation to next quarters profits takes priority over compassionate care is not the ideal we hold dear as a people or nation. And if we’re not going to offer one single payer system, then require insurance companies to act more like co-ops … sharing whatever profits with members/customers by reducing premiums.
Then again, we’re going to have to come back to the big questions … the more we advance medically, technologically, pharmaceutically, we need to advance ethically, spiritually, and socially … why is the cost of medical care so high? because we can do so much and we believe that if we know how to cure, we should … that’s the right thing to do … and that requires us all to give.