Friends, I hope you've had a good fortnight. I'll try to post a blog entry soon about my Virginia vacation once I've had a chance to upload some photographs. In the meantime, however, I've been watching the acrimonious debate over proposed health care reforms.
As the Clintons learned more than a decade ago, President Barack Obama has found that guaranteeing affordable health insurance coverage for all Americans is easier said than done. Not only are there complicated connections among employers, insurers, regulators, and health care providers, but the political process has also been contaminated by money and demagoguery over the public interest.
The basic responsibility of government is to protect the citizenry, whether from hostile nations, corporate (and its own) corruption, or natural disaster. The New Deal of the 1930s and the Great Society of the 1960s tried to add safety nets for the poor, elderly, and ill before they were derailed by wars, bureaucratic bloat, and laissez-faire backlash.
Since then, both Democratic and Republican administrations have expanded middle class and business entitlements through tax credits, spending earmarked for key states, and a resulting growth in federal spending. A growing reliance on private contractors and the largest military budget in the world have also contributed to the U.S.'s fiscal problems.
The current economic recession has further highlighted workers' vulnerability to mass layoffs, climbing insurance premiums, and increasing costs of living that are partly the result of dependence on fossil fuels. In past generations, angry mobs might have protested in the streets or joined unions (themselves potential agents of progress and corruption), but public outrage has been hard to find until recently.
Conservatives have been looking for so-called wedge issues to divide and conquer the popular support for Obama. Gay marriage, stimulus spending, and even the wars in Iraq and Afghanistan served them no better than they had during the presidential campaign. However, by exaggerating the threat to middle-class entitlements such as Medicare, labeling Obama's proposals "socialistic," and focusing on tried-and-true controversies such as abortion and euthanasia, they finally got traction.
Even if the U.S. wanted to follow the example of socialized medicine in Europe and elsewhere, problems with providers' existing infrastructure and practices, cultural differences, and the sheer scale of the problem make such an idea impractical at best.
Despite gains in public opinion and at the polls, liberals are still seen (and arguably still see themselves) as disunited underdogs and have also expressed disappointment with elements of Obama's plan. As a recent victim of a layoff, I myself would prefer employee portability of insurance plans — not to mention 401(k) retirement accounts — and I wonder how we'll pay for increased health coverage.
On the other hand, the amount of paperwork, marked-up fees, and disparities between care for the richest (the "best in the world," we're continually told) and for the more numerous poorest all need to be addressed as soon as possible. If my father, a college professor, and my mother, a retired nurse, have difficulty understanding their coverage without aid from a daughter-in-law who works in human resources, what chance does the average person have?
Health costs are already putting a drag on the U.S. economy, and as with education and transportation, a public utility has been turned into a profit center beholden to stockholders rather than patients. An aging population, numerous stories of fraud at every level, and proliferating demands for worthy research (not to be confused with the latest pharmaceutical commercials) make the need for reform all the more urgent.
I believe that only by spreading the expenses among the largest possible amount of people, thus requiring federal organization, can we afford to improve health care. I also believe that a society should be judged more by how it cares for its neediest and nurtures its resources than for the conspicuous consumption of a competitive minority.
I would like to see a bipartisan consensus on health care reform, but vested interests such as insurers have spent millions of dollars lobbying in Congress, and Republicans are understandably (if not altruistically) making the most of public uncertainty. I support any plan that serves more people equitably, controls costs, and avoids the dangers of bureaucratic, individual, or corporate fraud.