Saturday :: Sep 26, 2009

Should Americans Have a Right to Healthcare?

by Mary

[Here is the case for universal health insurance which I wrote for the Commonweal Institute.]

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.

[A condensed version was originally published in the San Francisco Chronicle.]

Mary :: 5:21 AM :: Comments (13) :: Digg It!