Monday, September 07, 2009

Yes, Josh, There Is No Santa Claus

Yes, without a Robust Public Option we are indeed heading into a destructive death spiral in which the poor, the unemployed, the working class are forced to pay large sums they don't have to insurance companies for "junk insurance" with high deductibles. In addition, the taxpayer will be socked with the task of a) monitoring and punishing the bewildered newly mandated insurance payer, b) paying the minimal subsidies, and c) debating how much care poor people should be entitled to. This has been a simple answer to simple question. This is why "the left" has been so fussy about the Public Option. This is why we are so angry that Obama allowed the Public Discussion to fall so far from real life and real language. People need health care. They need air. And they need water. It must be accessible, or it must be provided. Failure to do so kills people.

The talking heads and the right wing still don't admit that we all pay for lousy health care in the end. We pay hugely in lost wages, in lost lives, and in absurd last minute emergency care for trivial, manageable, chronic illnesses. We pay at the end, but as always we could save money and improve lives by agreeing to pay up front and at the start. It is essentially the same debate we have about Public Education vs Imprisonment. People who get a good public education and have good job prospects seldom end up in Prison. A year of Prison costs much more than a year at Harvard. And yet we can't, as a society, bring ourselves to pay the money up front to improve lives--that would be socialism, or charity, or something. We are only willing, and that grudingly, to pay to punish people. The fact that the money is fungible and all comes from the same source, the taxpayer's pocket, seems lost on our public discourse.

We can have a universal mandate to buy health care--its called taxes! It works when you have a single payer system because everyone is in the pool of beneficiaries. You are simply paying your premiums in the form of taxes. For the wealthiest among us there would be no extra cost--we are already paying a very high price for our lousy coverage. The benefit is that a tax based premium payment is levied more or less invisibly, and fairly, on everyone when they are working and it is available to everyone when they need it. The costs are spread progressively through progressive taxation on all income brackets. And, of course, the risk is pooled by comprehensively putting all citizens and taxpayers into the same program so that one person's fees can pay for another person's emergency. You aren't allowed to "Free
ride" when you imagine yourself health, and you aren't forced out of the system when a family member becomes unemployed, or you get sick and need the treatments. Small co-pays can be used to discourage needless medical procedures. Subsidization of co-pays can be used to urge people to get necessary long term treatments.

Health Care is not a privilige, but its more than a "right"-- it is a necessity. Without adequate, daily, low level and high level health care Americans will continue to lead lives of desperation, one step away from disaster. By allowing the public debate to turn on such absurdities as whether Republicans, who hate the very idea of a "public" like or don't like a nationalized health care system Obama and the Dems have already ceded too much.


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