America’s Health Care Debate and What it Reveals

Every nation I visited on my recent European lecture tour has a National Health System, paid for by tax dollars and run for all the people by the government itself. Contrary to the propaganda of the American political right, these health services are well run and enormously popular in both conservative and liberal circles. The citizens in these democracies assume that health care is a right, guaranteed by the state to all. It is not a perk of the workplace, available only to those who are employed. It is an asset of citizenship. So Europe’s leaders and its citizens across the political spectrum viewed the recent American episode in political brinkmanship, which attempted to defund the Affordable Care Act, as the act of an adolescent America, demonstrating yet again that its leaders are not mature enough to govern the world’s most powerful nation. Sometimes it is salutary to see our nation through the eyes of others. To them America’s Tea Party leaders were refusing to address the social problems that plagued Europe in the 19th century, problems made quite vivid by the novels of Charles Dickens!

The idea that a few of the Congressional majority would actually force America into default and bankruptcy, bringing on, the Europeans feared, a world wide depression in order to stop people from getting health care, left them disillusioned with America’s political leadership.

I share that anger and view with alarm not only the behavior of the Tea Party leaders, but also that of the moderate wing of the Republican Party for not standing up to the bullying, almost neo-Nazi like tactics, of these right wing extremists. Have we as a nation really come to the place where one of our two major political parties is willing to let the poor, who have no insurance, die because they can’t afford treatment? Are we now so individualistic as a nation that we will refuse to act out any sense of corporate responsibility toward the less fortunate of this land? Are we willing to say that people who have pre-existing medical conditions cannot buy health insurance? Have we come to the place where we act as if medical care is only the privilege of the wealthy? The stated propaganda, recycled through every right wing politician, that the United States has the best health care in the world is challenged by the facts. It also reveals how little privileged politicians know about the real world of America’s poor. There is not one single category in which U.S. health care is statistically the best in the world when the entire population is averaged in! What we do have is the most expensive health care in the world, but America’s patients get less bang for their buck than in any other developed nation.

Too many people feed at the trough of the American practice of medicine. The drug companies sell drugs to every other country of the world at a lower rate than they sell them in America. Trial lawyers, who live off suing doctors and hospitals, also add to the costs of our system of health care. Medical equipment builders and suppliers want independent hospitals to compete for their state of the art devices, even though they reach a saturation point in urban areas and once they are purchased, the doctors are encouraged to use them whether competent care calls for that test or not. The medical profession itself has become for many doctors not a vocation in which they serve, but a position that can and does make them quite wealthy. Is an income of over a million dollars a year necessary for some doctors to provide good health care? I am not anti-doctor. I know quite well the high cost of a medical education and the years of very low salaries as an intern or a resident, but should there be no limit on how much profit anyone can make on the sicknesses of our fellow citizens? Should paying dividends to shareholders or massive salaries to executives of Health Care Companies be a necessary or even a moral component in delivering health care to the masses of our citizens?

The same Congress that tried to defund the Affordable Care Act has also refused to consider increasing taxes on those whose ordinary income exceeds a million dollars a year; they have refused to cap insurance settlements awarded by juries in malpractice cases; they have balked at closing loopholes, which make it possible for the secretaries of doctors to pay a higher percentage of their incomes in taxes than do the doctors, and they have made no effort to rein in the excessive profits of the health care corporations or the medical device businesses. There is something ethically wrong when the political passion is to provide tax cover for wealthy people while at the same time trying to gut the health care of ordinary Americans. It is scary as well.

I listened in vain to the Tea Party congressmen, to Senator Ted Cruz of Texas and to those who supported their efforts to hear what alternative they had to offer, if they actually had succeeded in defunding and thus killing the Affordable Care Act. The fact is that they have no alternative to offer and when pressed on this glaring omission, they fall back on slogans like “self insurance” that have long ago failed, leaving some 40 million United States citizens, most of them women and children, without insurance and thus without significant health care.

When we clear away the political rhetoric and propaganda, there are only three alternatives for providing health care to the citizens of this country. One is to create a National Health Care System that includes every one and is funded by tax dollars and run by the government. This is the system adopted by every developed nation in the world except the United States. Critics marshal their arguments against this system which, when examined and tested by experience, are blatantly not true. “No government can run anything competently,” they say. Yet Medicare is a government run health care program that patients and doctors alike applaud. “You will have no choice in how you are treated or by whom,” is another incorrect fear-mongering attack. The fact is that the insurance companies dictate to us the doctors who are in their system that we are allowed to see. “Death panels will be set up and life or death decisions will be made by bureaucrats.” That was the Sarah Palin line. It is also blatantly untrue and it is little more than fear being peddled by people with a vested interest to protect. There comes a time when life and death decisions must be made. A “Living Will” is one way to do that and the choice to do so is always in the hands of the patient. If we could get past our fears, there are many advantages to a national health care system. Its focus is on health maintenance and prevention, not on treating the disease once contracted. There is a tremendous saving in a single payer plan.

For many in the United States, however, such a plan smacks of “socialized medicine” and even though that response is both irrational and uninformed, it is nonetheless powerful. That is why in the United States alone, some method that will provide universal health care through private corporations has been cobbled together. To do it this way is enormously complicated, which then allows its critics to castigate it for the red tape and complicated decision-making by bureaucrats rather than by doctors. If medical care is to be run as a free enterprise, profit-making system, the health corporations will of necessity be forced to control costs. The free market is designed to insure profit to share holders. So you can’t have it both ways.

The Affordable Care Act passed in the first two years of the Obama administration was in fact patterned on a plan developed by the Heritage Foundation, a conservative Republican think tank. Its original purpose was to counter any attempt to build a national health care service. It was adopted first by the state of Massachusetts under the leadership of Republican Governor Mitt Romney. In order to work, it requires universal enrollment or a fine paid by those who do not enroll. Everyone, including the young and healthy, must be in the system to keep costs down. If young people can opt out of the system it will simply collapse financially. The trade off is that people pay when they are young to be able to afford health care when they are old. To mitigate against the price shock to the young, a provision was added to the law to enable young people to stay on their parent’s heath care plan until age 26, if they were still living at home either unemployed or working on a graduate degree. It also requires that exotic health care practices be regulated. An enormous percentage of every health care dollar is spent in the last year of a person’s life. Decisions will have to be made as to when we are prolonging life and when we are simply postponing death. That fact of life, faced everyday in every hospital in this land, is what politicians use to spread fear of death panels and “allowing Grandma to die.” A mature society must be willing to define the moment when meaningful life comes to an end.

If there is no universal national health care system then this privately run, for profit, health care bill is the only alternative. The Affordable Care Act represents this alternative. The Tea Party wing of the Republican Party would not tolerate a national health program and now apparently they are not willing to tolerate a privately run health care program either. They want to defund this “disaster” before it can get established. Fair enough, we say, then what is your alternative? They have none! They propose none! So what does that mean? It means that they desire that health care be available only to those who can afford it! That is the inevitable result if this part of the Republican Party has its way. Health care thus becomes an asset that only the well-to-do can enjoy. The rest will depend on charity, the good will of a few doctors or the beneficence of a patron. Those who want to defund the Affordable Care Act surely must know that this is their only alternative.

Can the Affordable Health Care Act be improved? Of course, but that will have to be accomplished through the legislative process. The bulldozer tactics of the Tea Party will never accomplish reform. So this nation’s choice is either to make the Affordable Care Act work or to embrace the only cruel alternative that remains. I am sick of ideologically-driven politicians who do not know or admit the consequences of their own outrageous rhetoric.

~John Shelby Spong

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