WHY WE NEED NATIONAL HEALTH INSURANCE FOR ALL WORKING FAMILIES IN THE USA

Virtually all industrialized nations use a national health insurance system.  In the United States we followed (decades later) most European countries in adopting Social Security for our elderly population so they could have an income in their remaining years.  All working Americans pay for Social Security, which is a separate tax from income tax or sales taxes.  I am grateful I have both Social Security and Medicare.  The cost of health services not covered by Medicare can be substantial—try getting implants instead of false teeth (upper or lower plates) and four or five implants can run up to $20,000 (as it did for me because I do not have a dental insurance plan covering them). If we each had to pay for our major medical expenses the death rate would go up because poor people would die.  Physicians and other health providers would have to cut back on their standard of living to serve the poor and most people who could afford it rarely make charity meet the needs of all those who are needy.  I am a biologist, so here are a few facts to consider.  We live longer than we did in the 1900s. Most people born in the early 21^st century (2001 on) will live to be in their mid 80s.  If they retire at 65 they will likely require Social Security for 20 years and Medicare for their health needs. The bulk of cancers, strokes, heart failures, diabetes, senility, and arthritic conditions occur in people who are 50 or over.  Younger people feel resentful that they are paying for older people.  I can understand that, and some want to gamble that at age 20 they will have another 65 years of life without a stay at a hospital for sickness, without a major accident, without mental or physical impairments that limit their work or change their life activities.  But the odds are overwhelming that most of those young people, when they are old, will have cancer, strokes, heart attacks, diabetes, arthritis, or other illnesses that cost a lot.  The odds are also overwhelming that most people will not have 100,000 dollars or more set aside for medical emergencies in their old age.  The odds are overwhelming too, that a young person who is 20 or 30 years old who has an illness or accident will lack the money to pay for medical expenses.  We have a government and a civilization because we believe that collective responsibility makes all citizens better off than having a world where there are a few healthy winners and a massive majority of humanity dying prematurely or suffering pain and limited activities because they cannot afford the sky-high costs of their health needs.

              I much prefer extending Medicare to all working people so all can pay into a national health insurance that is non-profit.  Private health insurance is by definition set up to make a profit.  A significant portion of those premiums paid each month go to corporate stock holders or the families that own and manage these private health companies. They will try (as they did before being regulated) to purge from health insurance those with preexisting conditions, those who are in risky categories (let us say based on race or socio-economic status), and offer their insurance to the healthiest payers. President Roosevelt and President Johnson both tried to get a national health insurance for all working adults to pay into.  President Obama had to compromise and choose Governor Romney’s Massachusetts plan for his Affordable Health Care Plan. They failed because of the tactic that opponents used describing national health insurance as “socialized medicine.”  So is a standing army where our government owns everything down to the shoelaces of the persons wearing a uniform.  I don’t see red flags flying over Scandinavia, Great Britain, and other industrialized capitalist countries that have nationalized health insurance for all their citizens.  I have yet to hear a workable plan from opponents of national health insurance that covers the health needs of those who are poor, lower middle class, or middle class with competing needs of education for their children, a mortgage to pay, and companies doing their best to freeze their wages and dump their coverage for health insurance and retirement. 

Blog March 19 2011 Is there a social contract for our health?

We believe that a government is a social contract between those who are governed and those who govern us with our consent. It is the basis of our own American government which is part democracy and part republic with lots of checks and balances and a Constitution to prevent tyranny. It is an imperfect system but it works reasonably well and we voters have the power to throw out administrations that fail us and we can shift to a new direction. We reject anarchy or extreme libertarianism (a sort of “devil get the hindmost” social Darwinian system) in which the government plays such a minimal role that each person is at the mercy of the good will of the rest of humanity. Herbert Spencer preached that extreme libertarianism some 150 years ago in his book Social Statics and he believed that everything should be privatized, except for the military. We should pay for our police protection, fire protection, health, testing of safety, and education. He opposed public schools because they preached loyalty to the state and he felt the individual should always be an enemy of the state, criticizing it for its encroachments on individual freedom. He also opposed colonialism, the institution of a Royal family, and discrimination against women. He felt all education should be autodidactic with the library (private , of course) as the source of knowledge instead of the classroom.
Unfortunately people are complex and do not work as ideal components of utopian dreams. Those utopian schemes often end up in totalitarian thinking, with conformity rather than cantankerous diversity as the favored state of society. If we are to live in a “real world” we have to recognize the following. Humans are mortal. They are genetically diverse. They are raised in diverse households with diverse idiosyncratic parenting. They are grossly varied in opportunities and the circumstances of their birth. Some will have birth defects (about 3 to 5 percent). Some will have infectious diseases and they vary in their immune systems. Some will have physical impairments of their senses and require eyeglasses or hearing aids. Some will have organ failures. Some will have autoimmune diseases. Some will get cancers. It may not be possible to tell who will be at risk for such disorders. To address our health problems we either have to be lucky and our families have the wealth to pay for needed surgery or medication or we have to have an affordable health insurance that provides most of our basic health needs. If we are born poor then the costs of such health care are beyond what our incomes can provide. If we have a government universal health insurance then the costs are spread across all citizens just as we pay for our military through taxation.
I have yet to hear a proposal from critics of Medicare and Medicaid of a private health insurance program that can exist for the poor. I can only assume that premature death and illness of the less fortunate are tolerable for those who are fortunate enough to buy their own very effective private health insurance plans. That is not just selfish it is morally disturbing. What it tells me is that it all right to ignore the needs of others as long as you yourself are OK. Is this what our religions have taught us? Is this the message of the “good Samaritan?” Is this compatible with the “ Golden rule?”

What surprises me is how we respond with haste to new epidemics but ignore chronic and “familiar” diseases that saturate a good portion of humanity. Here is the reality for the coming decades. We will have more old people who will have lots of chronic illnesses. We have shifted away from employer provided health insurance to individual provided health insurance but for most Americans they cannot afford the costs of private insurance. Private insurance, like fee for service medicine, is wildly expensive and has far outpaced inflation. Most individuals have no factual basis for making informed decisions on what type of health care to buy or what to do if they are not covered. We need to rethink how to provide care with numerous “triage type” health centers instead of hospital emergency rooms so less expensive physician assistants and RNs can assess minor health emergencies (e.g., colds, upset stomachs, sprains, minor cuts) and distinguish those from patients with profound or more complex medical needs. We also have to think about what type of health care should be available to the very old, especially those requiring assisted living. For those who can trade in the equity of their homes for such care this is usually not a problem. For the working class who live in apartments or homes which have more modest equity, this is a very serious problem. For legislators I have a prediction for them to consider. In a few years the very old will be such a significant portion of the population that they will have the votes to favor their own interests.