Last Thursday night, the Greater Bennington Area Interfaith Council and the
Vermont Workers Center sponsored a community forum on health care. It was billed
as "an opportunity for Bennington residents to share about how the health care
system has faltered or failed in its care of Vermont citizens."
People told heart-wrenching stories. Of losing insurance when they lost a job;
being denied coverage because of pre-existing conditions; choosing between
buying insurance and affording college for their kids. Shouldering huge co-pays.
At the forum consumers and health care providers agreed: The system is not
working for us, and it has not been for a long time. As a country we spend the
most and have middle of the pack results. At least 15 percent of our population
has no insurance. Those who do have insurance pay not only for their care, but
to subsidize those who don't, yet need care.
Any hard-headed businessman would say that we're not getting what we should for
our investment.
Aside from the human tragedy of lack of access to health care, the cost has an
insidious effect on our economy. In our employment-based system, it adds cost to
every product we produce, hurting our international competitiveness. Health care
costs have been documented as the reason several auto plants were located in
Canada rather than in the U.S. In Canada, health insurance for the population is
financed by taxes,
not by employers.
At this point, let me make it clear that this is not a column that will advocate
for a single-payer versus our current system. I agree with what President Obama
has said about reforming our insurance system. To paraphrase him: "If we were to
design a health system from scratch, this is not what we would do ... but given
the investment we have in it, we should be to change it incrementally, working
within that system and infrastructure."
So
instead of advocating for a particular way, I am trying to lay out themes, facts
and questions. We are approaching a serious national dialogue on a serious
national problem. (Some might call it a serious national disgrace.)
To those in health care or interested in public policy, it will seem that we
have been talking about "health care reform" for decades, and in fact we have.
FDR agonized over including it in the New Deal, but pulled back. Harry Truman
worked with Congress to introduce a bill that would create a national health
insurance program run by the federal government, open to all Americans, but
optional. It failed, a victim to charges that it would be "socialized medicine."
Twenty years later, President Johnson overcame some of the same rhetoric and was
able to get Medicare passed. Almost 30 years after that, Hillary Clinton's
health care task force fell victim to the "Harry and Louise" campaign. Yes, it
has been a long slog.
Given that history, why should there be hope that we are finally ready to get
serious? Why believe that the time is finally ripe? Stuart Altman, a professor
of national health policy at Brandeis who has been an advisor to several
presidents, once said (paraphrasing again): "When it starts to really affect the
middle class, that's when you'll see it change."
It's affecting the middle class. Employers are dropping insurance because of its
cost. People are losing jobs and with them, their health insurance. For a lot of
us who haven't worried about it before, it's getting personal.
I'll use myself as an example. I've always been very fortunate to have
employer-sponsored insurance. Sure, I contribute to the cost, but the lion's
share was paid for. I worry a little about the increasing bite it takes each
year, but still feel lucky. So why do I worry? Besides my abstract, "it's the
right thing to do for all of our citizens" leaning, it has become personal. One
of my brothers has lost a job in this economic downturn. He's got to worry about
getting insurance. When my kids leave college, they don't have insurance unless
and until they find a job that carries a health insurance benefit.
I worry about them. I'll pay more taxes if it means they're covered. I think
most of us feel that way.
Kevin McDonald lives in Bennington.
