In all of the rhetoric, ideological chest thumping, and political gamesmanship that surrounds this country’s debate over health care reform, it is easy to forget the reality that in the world’s richest nation, a great many real people are suffering and dying because of our failure to fix things once and for all.
In the years prior to Obamacare, 45,000 people died every year because they did not have health insurance. That’s an incredible number. I’m not aware of a comparable statistic since the advent of Obamacare, and I suspect it’s a much more difficult number to come by. There are still some 20 million people who lack insurance. But also, many people today who do, in fact, have health insurance, still cannot afford or get access to the care they need because of high deductibles, complicated prior authorization processes, and inadequate coverage.
But there is also a distinction today that makes our health care crisis all the more troubling. Many years ago, before we had the miraculous diagnostics and treatments of the modern era, people didn’t get care primarily because it didn’t exist. But today, we are withholding readily available care. So the suffering and dying at this time is completely avoidable and entirely unnecessary. It is a clear choice we are making—an immoral one.
And the American political response has been painfully inadequate. Both Democrats and Republicans attempt to fix things by increasing the number of people who are insured. As a patient of mine recently stated, “We pay for health insurance, not health care.” But Obamacare was inadequate because so many people remained uninsured, and as it was pointed out already, so many couldn’t get care or afford it despite having insurance.
The Republican response represents a huge step backwards. What is most troubling about this is that this appears to be just what they intend. Insurance, even lousy insurance, is no longer the top priority. Having a choice to purchase insurance, an odd nuance, has become paramount. They have taken to using the word “access” as code to imply that, if their plans are enacted, that more people will have the choice and the freedom, from a technical perspective, to purchase health insurance. Paul Ryan says “access” to buy insurance with a sly wink and a nod.
But that is the new goal, even if such “access” is meaningless for the many millions of people who, in fact, won’t reasonably be able to afford health insurance, especially the types of policies that would adequately cover the care they need. But it also implies that people who do not get medical care have made that choice, and that they should be personally accountable for the poor outcomes that ensue. They will own their pain and suffering, so it is ok.
But it is not a “choice” when people have no good ones. And it is not typically a choice to be injured or to develop a serious illness, or to be bankrupt over such issues. What it represents is a level of cruelty almost unheard of in modern American society. And it is especially cruel when Mr. Ryan smiles into the TV cameras and says that people will have more “access” when he knows it means so little.
What are also inadequate are the free market/anti-government arguments underlying such cruelty. In an entirely “free market,” if such a thing actually existed, for-profit insurance companies do have an incentive to offer insurance at lower prices. But to maximize profits, they would also naturally want to offer less coverage. It is very likely that without the government’s help, insurance won’t provide the coverage that many people need. And the suffering and dying will continue.
And many who favor this mythical “free market” approach also hate the idea that their taxes or insurance premiums are “redistributed” to others, especially to the unemployed, the poor, to immigrants, or the sick, for that matter. They don’t seem to understand that that is exactly how insurance functions, balancing the risks of many to pay for care for those who end up needing it. It represents more cruelty. It reflects the fear and despair so many people feel in this zero-sum world of haves and necessary have nots.
But there are better choices. We can choose to give everyone the care they need. We can choose to end the needless suffering and dying. It is the moral choice to make. It would be the best thing for American businesses and employees. Healthier citizens and universal access to good health care are two of the building blocks of a more successful American society.
The new president made headlines a few weeks ago when he said that health care was more complicated than he had previously understood. It is not. It would take a simple commitment to make things better.
These Republicans had best be careful. Not only are they imperiling their political position, but their continued failure will almost assuredly bring calls for the simplest fix of all—a single payer system that would provide health care for all and once and for all end this needless suffering.