I received one such flame this weekend, however, that I do want to address, though not directly. Basically I was told in not-so-nice terms that I was for healthcare reform so I could sponge off my healthier peers. The belief that universal health care is some plot for sick people to lay back, do nothing at the cost of the healthy is, I believe, at the heart of the health care debate. It is a belief that has been exploited by insurance companies for decades.
The irony is that the basis of insurance is exactly the same basis of universal coverage: insurance is based on the principle that if everyone pays a little when they do not need whatever the insurance is covering, then when something happens and they do need it, the fund will be there to help. If the group is big enough and has enough diversity, the bet is that it will be unlikely that the fund will be depleted because only a small percentage of those paying will need help at any given time. Of course, there is a certain understanding that each member of the group has to pay enough to cover that expected collective need for a given time, but for the most part the amount paid to the fund is supposed to be significantly less than any individual's need if it arises (making it more appealing to pay into the fund rather than just save for a rainy day).
Of course, one of the reasons for last years collapse in the credit market is that large companies offered "insurance" against default on debts without adhering to the basic principles of size and contribution and the system collapsed. But the idea behind insurance is an old and tested one and when done soundly it is not a bad idea. It is, in fact, one of the benefits of collectivity.
So why has the idea that the public option would be something new and different been so easy to sell to a good percentage of the American public? I believe it is because of the fear of collectivity and the cult of individualism that pervades our culture. It is this knee-jerk reaction to anything that smacks of collectivity that has made it possible for this current system of cutting off the access to good care for as many people as possible to exist. Because Americans accept the cult of individualism we are willing:
- to blame individuals for their illnesses;
- to understand when doctors get richer because we are ill (after all each person is obviously responsible for their own illness);
- to buy into the lifestyle myths that eating and exercise means we can live forever (thus leading us to buy billions of dollars in diet and exercise products);
- to stand by when insurance companies and HMOs discriminate against sick people by refusing to sell coverage to people with pre-existing conditions, by denying coverage to sick people, even when they have paid premiums, and by canceling their coverage when they get sick;
- to support pharmaceutical companies even though they continue to make obscene profits by selling their medications to Americans at extreme prices to make up for the reasonable limits on their profits in other countries;
- to yell "socialism" when any remedy to this racket is suggested.
So I propose another way to look at all this. I suggest that life is risky and that any one of us could get sick, disabled or incapacitated just by living a normal, every day existence, no matter how "good" we are or how much "care" we take. Life is risky, but we can face these risks and these troubles better together than apart.
So here are seven reasons to consider why one should not view universal health care as supplementing the sick, but rather as a basic right that each individual should have guaranteed under our law, as our founding documents suggest:
1. All people can get ill no matter how "healthy" their behavior.
Yes it is true that eating enough nutrients and moving often seems to help create a healthier life. But this does NOT equate to A GUARANTEE that one will never be sick. Health and illness is complex with genetics, environment, behavior and just plain germs all calculating into the mix. Many of the illnesses that people experience have no apparent cause and have little understanding by the medical community at this point. So deciding that one "is healthy" means that one will "stay healthy" is a costly naivety.
2. The Healthy/Sick Dichotomy Does NOT Exist.
Health is not a binary function where it is obvious that one is either healthy or sick. Health is a continuum at least and probably more like a web structure. One can have a chronic illness but live a fairly fulfilled and active life. One can have something affects one's body but leaves one's mind sharp or vice versa. One can believe they are healthy for months or even years before a symptom of problem shows up. The belief that the healthy would be supplementing the sick is based upon a false dichotomy that cannot be worked out in the real world. All of us are dying from the moment we were born. So in a sense, we are all sick.
3. Many diseases are contagious and germs do NOT discriminate.
A really fundamental reason to work towards collective health is that the less people carrying germs around, the less chance other people will carry germs around and the benefit grows exponentially. We have a public health system in the United States right now. Universal coverage will enhance this system by ensuring that it is not a matter of money that people get immunized.
4. The question of "health care costs" is complex.
The concept of supplementation is based upon all these "cost" figures bouncing around. Costs are basically arbitrary and negotiable since most of what is involved in health care is service not raw materials. Because of economies of scale and because early intervention will help prevent more involved treatments, coupled with the power of the collective to negotiate prices and simplify administration, the overall cost of health care will get lower. This lowering of costs has been shown to occur in every country that has adopted universal health care and it has not been taken into account by those who are estimating the costs of various programs because it is hard to predict when and how much such reductions will occur. Thus, as with good insurance practices, the size of the pool and the sufficiency of the contribution will help reduce the costs for every individual and be there for each of us when we need it.
5. Public Health approaches can lead to cures and preventative measures that individual health care misses.
One of the big advantages other countries have over the United States is the ability to see big pictures when it comes to health because there is a collective understanding of data collection and analysis. Understanding epidemics, environmental factors and other kinds of risk factors comes from big picture analysis. Thus, universal coverage will make it possible to know what the health of the population is and to see patterns and gain information that will lift up the health of us all.
6. All people have the potential to make contributions that will enrich our lives and illness does not discriminate among the best and worst.
By keeping people in sickness, we may be wasting human resources that would make our lives better. Equality of access is something that has been recognized as important to the strength of our country by many of our founders and leaders. Discrimination on the basis of illness is one more wasted result of xenophobia.
7. Justice demands it.
You may consider this trite but universal health care is JUST in the most fundamental sense of the term. Rawl's basic principle of justice calls on us to imagine a world that we would want to exist if we had no idea who we would be when we were born into it. If we didn't know whether we'd be dark or light skin, a just world would treat people the same no matter what color their skin. If we didn't know whether we would be male or female, a just world would not discriminate on the basis of gender. If we didn't know whether we'd be rich or poor, a just world would not discriminate against the "have-nots." So, if you imagine yourself to be one of the "healthy" and do not want to "supplement the sick," I ask you to consider how such an attitude is any different than racism, sexism or classism.
Universal Health Care is a basic human right that has been recognized by others around the world for hundreds of years. It is time Americans join the free world and put an end to discrimination against the sick.
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