Health Care

Weeks of self-quarantine/social distancing present an opportunity to think about things . Our health care system seems a particularly appropriate subject for thought during this pandemic. We routinely hear from politicians, especially Republicans, that ours is the best health care system in the world. It's a feel-good statement that flies under the radar without much scrutiny. But if we were to think about it, we would realize that it depends on how the quality of health care is defined. Our health care system can provide good care to those with good insurance, high income and/or personal wealth. In fact, it is probably the best system for wealthy people anywhere in the world if they can access it. I use the word "access" not by accident. If, instead of defining health care as the availability of cutting edge technology and pharmacology for a price, we were to think about it as the ability to provide basic health care to the public at large, our system starts to lose its sheen. If you look at indicators like maternal, perinatal and infant mortality, or the prevalence of hypertension, diabetes and obesity, the US is firmly in the middle of the pack of developed nations. The price tag for this segregated system is far greater than any other nation's. This price is paid by all of us, whether by way of medical bills, insurance premiums and/or taxes. The price is especially heavy for those with limited access. I do not mean just the jobless, destitute or homeless. Many insurance policies have deductibles which force the holder to carefully consider seeking care. Pre-existing conditions clauses deny coverage to others. A glimmer of hope is provided by the Affordable Care Act. With all its limitations, it is still a "something is better than nothing" proposition. It has so far survived in the face of sustained repeal efforts but has been whittled down almost to the point of irrelevance. I would be remiss if I did not acknowledge the dramatic midnight vote by the late Arizona senator John McCain which kept the ACA on the books. What is the reason for Republican opposition to the ACA? Fiscal conservatives point to the cost but have no qualms about adding a trillion dollars to the deficit to pay for a tax cut for the rich. In my opinion the return on the investment in the ACA is far greater than the benefit of the tax cut. The real opposition is to "socialism". Again, Republicans have no problem with corporate welfare. The same old arguments about benefits to the people at the top trickling down to the masses are trotted out. Experience shows that by the time stock buy-backs and golden parachutes are payed for there is little left to trickle down. Regardless, at election time there are enough people falling for the siren song of lower taxes, gun rights and the right to life. I think the COVID-19 crisis should make people think about the value of a good health care system as opposed to its cost. Is the current economic downturn with its accompanying job losses and resulting loss of health care coverage for large numbers of people preferable to whatever is the cost of decent coverage for everyone? This pandemic is often compared to the Spanish flu a century ago, the implication being that this is a once-in-a-century calamity. I would suggest that between climate change and the growing world population we can expect similar events on a global scale at far more frequent intervals. The question we should be asking is, are we ready?