For the better part of the past year, Gov. Arnold Schwarzenegger has been in intense negotiations with the Democrats who are in power in Sacramento over how California will ensure that all Californians have access to at least a minimal level of health care.
Without a doubt, this is a huge, terribly important public-policy undertaking that will impact numerous special interests, most of them quite powerful. It's such a shame that talks have to be drawn out so long and produce something so complicated. Because to us, the solution seems so simple.
If you start from scratch, you have an elementary quandary: Provide universal access to preventative and emergency healthcare, as well as long-term treatment of serious, chronic illness—and find a way to pay for it. The answer, it seems, would be to gather up the smartest healthcare economists and have them estimate the annual cost of such a massive program, divide that figure by the number of American taxpayers and then determine each taxpayer's burden by applying a progressive taxation scheme. Why would we ever add elements such as private insurance and profit to that system? Why would we ever dream of giving insurance professionals the power to make healthcare decisions? Why would we ever devise a system that allows stock prices to affect the way medicine and treatment are delivered to patients? Why would we make employers shoulder the burden of making sure their employees are healthy?
Wouldn't we build a system that emphasizes relatively cheap preventative care—you know, regular checkups and early diagnosis and all that? Instead, we have the opposite. We make it impossible for millions of citizens, most of whom work hard for a living, to get basic medical care, and then we incur the cost at the other end, where costly emergency and catastrophic care—much of which is preventable—is delivered. Meanwhile, we pay private insurance companies to market to us as they compete with each other for our business, only to be told, too often, that the care we ultimately need isn't covered by our plans, even though our premiums, co-pays and deductibles keep rising. It just seems so counterproductive and unnecessarily complicated. It just seems so dumb.
It's especially maddening when you learn that private, employer-based health insurance was somewhat of an accident. Though President Franklin Roosevelt moved in the 1930s toward institutionalizing fringe-benefit programs created by some employers, the system was cemented when businesses saw it as a way to offset the cost of mandatory contributions to the World War II effort and pacify workers caught in a wartime wage freeze, and when the unions counter-intuitively bought into the deal after the war.
The rest—including the rise of the ever-more-powerful insurance and drug industries and their increasing influence over elected officials through campaign contributions—is history.
As a result, we now have healthcare-policy inertia at the federal level, where reform is needed most, and a well-intentioned yet complex mess of a plan at the state level. Because lawmakers have to reconcile the true need—getting 6.5 million uninsured Californians access to healthcare—with the wishes of the employers, unions, doctors, hospitals, insurers and drug companies that all have a stake in the system, the plan is a jumble of requirements, exceptions, taxes, fees and other ideas for funding (such as a cigarette tax, which bums out Big Tobacco, and lottery revenue, which upsets Big Education).
Our dream of starting over is pie in the sky, of course. It would be naïve to think otherwise. Until the U.S. Supreme Court allows us to take private money out of election campaigns, we'll never see such bold, sensible policy proposals. The promise of financial backing from insurance and drug companies come election time allows politicians, who might otherwise be brave, demonize single-payer healthcare as “socialized medicine” and a taxpayer-funded boondoggle.But why aren't those same folks railing against public education, which could be defined as “socialized education.” Though there are wide disparities between the educational experiences in wealthy communities and poor communities, with public schools, we've, theoretically at least, figured out how much it costs to educate ourselves and tax ourselves for it—largely without involving the private sector, although anti-government forces are busily trying to change that.
What is it with this pervasive loathing of government? True, government doesn't always do the job well, and sometimes it's corrupt. But corporations can be corrupt, too. Either way, public or private, it's not a monolithic entity that makes decisions—it's people. In a public system, as long as you have genuine representative democracy untainted by money, you at least have the power to be part of the decision-making. Sure, in a private system, you can vote in the marketplace, but be honest: Do you feel like you have much control over your health plan?
Sadly, what we'll have before us is two choices: Bad reform or status quo.