I have not said anything about the SCOTUS decision validating Obamacare the other day, principally because I don’t understand healthcare policy well enough to have an informed opinion about it. A couple of days ago I heard a self-identified Tea Party member interviewed on NPR about the decision, and she was on the brink of tears, saying that freedom in America is over and done with. I suppose I can perfectly well understand the belief that this is a bad ruling — I know people who really do understand health care policy who say this — but some of the reaction from the Right to the decision has been completely hysterical. All the major European democracies have some advanced form of socialized health care. I do not think they are behind the Iron Hospital Gown.
At some point during my late sister’s fight with cancer, she told me what her cancer drugs cost, and I nearly fell out of my chair. “Thank God I have good insurance,” she said. Indeed. There is no way under heaven she, a public schoolteacher, and her husband, a professional firefighter, could have afforded any of it without insurance. Of course she could have been treated at a public hospital, but I don’t know what level of care she would have received. Be that as it may, the whole thing made me think about how health insurance had become so huge in my mind as a feature of employment. Many years ago, in my twenties, I started a new job and carelessly overlooked a deadline in my paperwork. Result: I spent three years without health insurance, and nothing my employer said to the insurer convinced them to add me to their rolls. Because I was young and stupid (which is how I got into this mess), I didn’t think to buy any kind of health coverage on my own. I went three years without seeing a doctor, except for the urgent care doc-in-a-box I saw when I had a serious case of the flu once. Thank God I never got sick enough to be hospitalized; I was in my twenties, and was lucky. The only reason I got health insurance at all was I changed jobs. That’s not why I changed, but I would have had to have done something, because I had just gotten married, and my new wife, who had just graduated from college, didn’t yet have a job, so we were both uninsured.
Anyway, it seems to me, and has for a long time, that the way we handle health care in our country is pretty irrational. I haven’t thought much about it because I’m not the sort of person who has a mind for policy, and, to be honest, I have always had good private insurance through my employer, and haven’t really needed to use it for anything very costly. If I lost my job tomorrow and suddenly didn’t have insurance for my family, and couldn’t afford COBRA (which doesn’t last forever, anyway), I would be consumed by anxiety over the vulnerability my wife and kids would be facing. Again, I suppose they could be treated at the charity hospital if it got that bad, but that is a far from ideal solution.
Besides, what kind of system pays for the poor and uninsured to receive some level of care, but does so partially by indirectly passing on the costs to those with private insurance (via things like the $25 aspirin)? Even though I’m not a policy guy, this doesn’t make sense to me. And, as a practicing Christian, I find it hard to justify a society as well-off as ours tolerating a situation in which so many people lack affordable, decent health care. Back when Congress was debating Obamacare, I was prepared to believe that Obama’s proposal was unacceptable, but it bothered me a lot that the Republicans had nothing to offer in its place. It seemed to me that they were implicitly denying that affordable health care was a problem.
My sister had it pretty good with her cancer policy, but there was a time when she had to fight with her insurer over some issue. Ruthie was the kind of person who hated conflict, and in fact failed to get a second opinion about her persistent cough for months because she didn’t want to hurt her doctor’s feelings (the second opinion revealed cancer). But she had to fight with the insurance company because her own life was on the line. She prevailed, but I remember thinking it monstrous that she was put in that position. Fortunately for her, she was well educated and persistent; many people in this country are not as fortunate in that regard.
My parents are aging. My father, who is 77, has medical problems standard for men his age, but they are multiplying. They have insurance, and Medicare, but he still worries that what he’s managed to save from a lifetime could be wiped out in a catastrophic medical event. It seems wrong to me that he has to spend his old age with the realistic fear that he could lose everything if fate dealt him a particular medical blow.
But there is this kind of thing too. A couple of weeks ago I was visiting with an elderly woman I know, who brought out a pair of expensive hearing aids to show off. She told me they cost $1,000 each, and that she didn’t need them, but a nurse who cares for her told her she might as well get them, because Medicare would pay for them. So she did, and so it did. I was shocked by this. How many people are there like this old lady, driving up costs to the taxpayer not out of need, but out of reckless want, aided and abetted by doctors milking the system?
And: what looks suspiciously like death panels in Great Britain.
I say all this to help explain why I have mixed feelings about the healthcare debate, and resist coming to a conclusion. It seems to me that everyone who voices an opinion in the public square is so thoroughly convinced of the unassailability of their own opinion that there is no room for doubt, and certainly not doubt expressed by someone like me, who knows very little about the policy details, and who is therefore too intimidated by his own ignorance to offer a meaningful opinion.
All that is throat-clearing to set up the thoughts of Father Dwight Longenecker, a conservative Roman Catholic priest who offers what many on the right may consider to be heretical thoughts about socialized medicine. He lived in England for many years, and believes that socialized medicine, while not without serious problems, is better than what we have in the US. Excerpts:
All of us already pay taxes and receive certain services for the whole community which we take advantage of when we need them. Nobody bleats about socialism when they pay taxes to pay for the police, the national guard, the armed forces, the judicial system, the prisons, and fire fighters. Nobody complains too much that we pay taxes and receive education for our children, libraries, museums and city, state and national parks to enjoy. I don’t hear people complaining when they get their social security check in old age or their elderly parents get medicaid and medicare. I don’t see people campaigning to close the food welfare banks or calling for all welfare payments to cease.
The fact of the matter is that we already live in a mixed economy in the US. Our system is part socialistic and part capitalistic. In my opinion this is actually a healthy and civilized solution. Complete and consistent capitalism does not have adequate systems to put in place and maintain proper public services. Complete and consistent socialism quashes enterprise, hard work, initiative and proper reward.
He admits that the National Health Service in Britain can be massively corrupt and inefficient, for the reason that socialism usually is: lack of competition. But:
Furthermore, in my limited personal experience of health care in the USA–for all the bragging we do about how excellent it is, I have found it to be hugely expensive, health insurance to be expensive and getting worse, and the actual care provided to often be poor and at times scandalously poor. My fellow Americans may not like to hear me say it, but on balance I think the National Health Service has the edge.
Read the whole thing. Is Father Longenecker correct? I don’t know. But his sentiments resonate with me. I still don’t know what I think about Obamacare, or what kind of improvements we should have to our healthcare system. Still, I am not prepared to believe conservatives who say the status quo is acceptable — which is how the Republican Party has behaved. Writes Ross Douthat today:
This “just say no” approach made a certain amount of political sense, for many of the same reasons the White House’s “all in” approach turned out to be so politically risky. But it left the Republicans with no leverage on policy: they had nothing to offer wavering Congressional Democrats (from Ben Nelson to Bart Stupak) who had problems with the legislation but wanted to vote for some kind of reform, and they had nothing substantial to put forward when Scott Brown’s victory seemed as if it might force the White House back to the negotiating table.
As a result, now that the bill has been passed and the Supreme Court has declined to do their work for them, the Republicans are left to thread a very narrow needle. First they need to take the Senate as well as the White House, and then they need to find a way to pass a party-line repeal bill while lacking any clear consensus on a replacement. Otherwise they will have combined a political victory with a once-in-a-generation policy defeat.