Some ins and outs of the American health debate
By Ira Sharkansky
JERUSALEM–A month with family and friends across the United States found health a lively a topic of conversation. Almost all are sufficiently correct politically to concede that it is time to improve service delivery, but virtually none are happy with the work of the White House and Congress.
No surprise that in two thousand pages there is much to oppose. People fear losing some of what they currently enjoy. Many blanch at the overall expense, and argue against one or another detail for financing the proposals or controlling costs.
My contacts as well as media commentators are also quarreling with the lack of clarity. There have been deals to win a key member, or any member of the House and Senate. And where is the transparency that the president so foolishly promised?
The last point gets again to the naivete of Barack Obama. It should remind a history buff of another president who blundered at a crucial moment. Woodrow Wilson insisted on open agreements openly arrived at when he went to Versailles to end World War I. His weaker but more experienced European and adversaries cringed at the thought. The disasters that began there, in part due to him, contributed to the more destructive war two decades later.
Signs are that Obama is more flexible than Wilson, and quicker to learn that politicians cannot surrender prized aspirations in public, but will do so for the sake of a decent bargain in private.
It is tempting to conclude that much of the detailed opposition is a cover for the conventional American unwillingness to join the democratic consensus that basic health care is a right that ought to be available to all citizens, and maybe even to those who slip into a country illegally.
The concept of rights is flexible, and expands. Massachusetts was an outlier in 1647 when its colonial legislature required compulsory education. The federal government provided for the public support of education in the Northwest Ordinance of 1787, concerned with what became the states of Ohio to Wisconsin. The family now in the White House would not have been permitted to sit on park benches or drink at public water fountains in much of the United States as late as the 1960s. More recently, American authorities have recognized the rights of people to be free of secondary smoke, and the rights of the handicapped to access public facilities. American advocates who view health as a right have more trouble persuading fellow citizens to do what the other democracies have been doing for years.
Patriotism and denial are also prominent. Opponents of socialized medicine have their stories of the indigent and the illegal receiving care in emergency rooms and perpetual dialysis. One of my contacts emphasized 600 pound American behemoths to demonstrate that poor health is the choice of the ignorant. Government and private organizations have analyzed statistics to counter the findings that America’s indicators are worse than those of all other western societies. None of the calculations indicate that America’s delivery of medicine is among the world leaders. Some show that its record is not quite as bad as shown by a simple reading of the data.
Rights to health care are nowhere total. Scientists create medicines, machines, and technologies more expensive than governments are willing to support. Public programs do not cover everything. The best avoid the Canadian experiment of denying patients opportunities to buy privately, or with private insurance, services or medications not covered by public programs.
All struggle with what to cover and how to pay for it, usually in the context of campaigns by drug companies and other providers to include their products and services. They arrange demonstrations demanding the inclusion of what sufferers say will “save their lives,” when the most to be hoped is prolonged life at great expense.
Coverage of tourists from overseas, as well as illegal migrants, payments for cosmetic surgery , fertility treatments, sex changes, mental health, and abortion are other issues with no obvious solution.
The political problems associated with the campaigns of those who suffer, those who aspire to profit, and those who ascribe to one ideology or another are not essentially different than deciding what to do about local education or public universities.
Some of the deals seen to date are not fair, or even conscionable, but they are the way a complex and contentious society does its politics. Only those living in paradise ought to complain. If enough legislators and the president will hold their noses while smiling and voting or signing, the United States will move closer to the civilized norm.
Sharkansky is professor emeritus of political science at Hebrew University