HEALTH CARE/Joan Retsinas

Health Reform Optimism, or Harry and Louise Redux

Health reform feels afoot. Cynics point to the last chapter in the saga, written 16 years ago. The myriad plans, the commissions, the lobbyists, the ultimate configuration of “alliances” that looked startlingly like a subway system, the wrangling, the recriminations—and, finally, nothing. Today more Americans (from 37 then to 45 million now, roughly) are uninsured; and states, once touted as the centerpiece of a proposed federalist system, are barely solvent.

So why the optimism?

Harry and Louise, who 16 years ago broadcast their opposition to substantive reform on incessant nightly television commercials, now view the world differently.

First, today one (or both) of them are probably unemployed—or fearing a pink slip. If their company went bankrupt, poor Harry (or Louise) doesn’t even have the option of paying premiums under COBRA to keep their Cadillac coverage. If the company downsized, then Harry and Louise must weigh mortgage payments versus COBRA premiums—a common dilemma in this recession.

Second, 16 years ago, Harry and Louise were healthy baby boomers. By now they’ve tested the insurance they touted on television commercials: they’ve traipsed through the maze of pre-existing conditions, excluded conditions, high deductibles, and caps. They may not be “uninsured,” but they are likely to consider themselves “underinsured.”

Third, Harry and Louise have watched their 401Ks, their IRAs, their nest eggs plummet. The private sector has lost its sheen. For years this sector boasted of its efficiency, its innovativeness, its ability to fuel the economy. But Lehman Brothers, Goldman Sachs, and the cascade of failing banks argue otherwise: the private sector may have made some of its executives rich, but it hasn’t done so well for many of its customers. Ironically, government’s “hands-off” approach to regulation—letting business do its thing unfettered by the shackles of an intrinsically inefficient government—propelled us into a fiscal downfall.

So private sector insurers—particularly the for-profit plans blessed under President Reagan—have also lost their sheen. “Innovativeness” has translated into stinginess; and some states have gone to court to press the claims of enrollees. Consider California, where the Attorney General moved to stop one insurer from retroactively dropping enrollees who presented with expensive claims. Or New York, whose attorney general has sought to bar insurers from charging inflated fees for visits to “out of network” physicians. As Harry and Louise inch toward retirement, they are looking forward to Medicare—the governmental insurer.

Indeed, the fact that Harry and Louise are inching toward retirement marks an optimistic note for health reform. Harry and Louise are no longer in charge. Their children are. This ascendant generation has struggled to get coverage after college, when they were starting to enter the work-force. They don’t see the status quo that their parents praised 16 years ago as marvelous or tenable.

Most crucially, this new generation has a broader sense of social connectedness than their parents. Harry and Louise were selfish: they weighed the costs of health reform against any slight diminution of their welfare, or slight increase in their taxes. And with a “me first” mentality, they marshaled enough of their cohort to defeat any reform that promised to insure more Americans. This was the Independent Couple, spurning any responsibility for anybody but themselves. They gravitated to gated communities; they sought tax cuts; they even bowled alone.

Their children and grandchildren, though, recognize the nation as a whole. Younger Americans, organizing themselves into a vast network of internet-fed groups, fueled a political revolution: we have a President who has inherited the baggage, domestic and international, of the Harry and Louise generation; but his generation promises to be one where Americans take responsibility for each other. The 2 million people crowding onto the Washington Mall to wish President Obama well were also wishing well for our entire patchwork nation.

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

From The Progressive Populist, March 1, 2009

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