HEALTH CARE/Joan Retsinas

Awaiting the Right Time

Astrologists chart the planets, searching for the optimum alignment. If we act at that propitious moment, we succeed. If not, we fail. Even people who profess to scorn astrology often scan their daily horoscope for a green light.

Policy-makers sometimes sound like astrologers, explaining that “the time is not right” for action.

At first glance, the times don’t seem propitious for Uncle Sam to institute national health insurance.

On the economic front, the question is no longer: Are we in a recession. The question is: How deep the recession? Gas, food, utilities—the costs have soared. Unemployment is up. Many Americans have lost their homes. Still others are drowning in debt. Pollyanna would be hard-pressed to find a glad tiding.

At the same time, even while Uncle Sam spends billions overseas, revenue is down. The national debt has reached its highest point ever. And state governments—the minions of Uncle Sam—also face the unhappy confluence of two graphs: rising costs (governments pay for gas, food, and utilities, just like taxpayers), balanced by decreasing tax revenue.

But, unlike Uncle Sam, many states cannot go into debt. States have two choices. States can raise taxes—an unpopular course when citizens are struggling to pay their rising bills. Or states can cut services—another unpopular course in a recession, when more people need public services.

Pollyanna wouldn’t even fake optimism.

So a new administration and a new Congress can—indeed, might—decide to delay discussion of national health insurance, to put it on a policy back burner, awaiting an economic upswing, as well as an end to our crippling (financial and personal) entanglements abroad.

Don’t buy that argument.

The time for national health insurance is now—regardless of the glum indicators.

Here are reasons.

First, more people need health insurance. During near-full employment, 44 million Americans had no insurance; as layoffs mount, the census of the uninsured is mounting. Soon we will have more people relying on a porous, fragmented safety net of public clinics and hospitals. (A decade of governmental neglect has dismantled much of that system.) People who need care won’t get it. Consider the consequences: more unvaccinated children; more people suffering complications of untreated asthma, diabetes, heart disease; higher mortality rates. Without an infusion of money, states will not be able to pick up the slack. Indeed, states are struggling to hold the line.

Second, private insurers—the backbone of our system—are making the cuts that render insurance illusive. The word “rescission” has entered the lexicon: insurers decide after the fact that an enrollee lied about a pre-existing condition on application, or didn’t fill out an application properly. So the insurer cancels coverage, leaving the patient with bills. (In California, under state pressure, 2 large insurers recently reinstated coverage and paid a $10 million fine. [By Lisa Girion, Los Angeles Times, July 18]). Or insurers market high-deductible policies, with lengthy exclusions and small-print caveats, leaving policy-holders impoverished. A Harvard study (Health Affairs 2005) traced half of all personal bankruptcies to medical bills, hence the term “medical bankruptcy.”

Third, and crucially, government exists to help citizens. No developed nation relies totally on “voluntary” employer-sponsored private insurers. In 1965 President Johnson and Congress recognized that retirees and people with disabilities were ill-served by that system. So our government launched Medicare. That year, the country was entangled in another costly war – hardly a propitious time for a major domestic investment. But our leaders acted anyway.

We should expect the same visionary fervor from new leaders. Ironically, it is precisely because of the glum indicators that the nation needs health insurance.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, Sept. 1, 2008

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