Health Care/Joan Retsinas

Why Not National Health Insurance?

For decades progressives have pleaded for national health insurance, but those pleas haven’t nudged Congress. We can recite a century of pleas, starting with the equity-and-compassion one, where we plead on behalf of the unfortunate ones — Isabel Wilkerson called them our very own American caste — who lead dismal lives. Substandard health care is only one of the barometers.

The contagion argument — that the unhealthy can infect the healty — should have worked during this time-of-COVID, when we have been trying to test and vaccinate everybody, regardless of race, ethnicity, immigration status. But still, the argument for national health insurance hasn’t moved the Congressional needle. We cling to the status quo, shifting it marginally, but clinging to a disturbingly hybrid model where some us get comprehensive insurance, some of us get mediocre coverage, and some of us get nothing. A Baby Bear approach to the porridge.

Optimists might opine that we are getting there, but the pace has been glacial. Sixty years ago with Medicare we leaped along the path, as we did with Medicaid. “Government” now covers a swathe of Americans, via the Department of Defense, the Veterans Administration, and state and federal employers. Under President Clinton, we insured a broader range of women and children (Supplemental Health Insurance); and under President Obama, we created exchanges and subsidies (to individuals and states) to insure more people. Yet this has been a truncated path. Recently, President President Biden moved us further along this rocky road, enhancing the Affordable Care Act; but that advance is so bureaucratic, so expensive, so cumbersome that only a policy-wonk can embrace it.

How about shelving all those “why we should” pleas? They haven’t worked. “Progress” has been piecemeal, fractured, reliant on states’ largesse and initiative.

Let’s embrace a new argument: Why not national health insurance?

As we commit to spending a trillion plus dollars to pump up a post-COVID economy, in a racially divided, polarized country, we are embracing the politically neutral rationale of “infrastructure,” which, in 2021, includes not just roads and bridges, but broadband, housing, education. We are pumping money to fashion a richer, fairer, country. Why not add national health insurance to the packet?

The “why not?” argument shifts the focus from the painful pleading of progessives who have grown hoarse with their equity-and-compassion pleas, and from the urgent pleading of public health officials with their fear-of-contagion pleas. Let’s leave those aside.

Let’s ask instead, “Why not?”

Let opponents explain why not.

Have they so embraced the Horatio Alger myth that they trace individual misery -- and illness -- not to circumstances of birth, but to aptitude and zeal. Do they think that if people worked harder, they would either be so healthy as not to need health care, or so wealthy as not to need insurance?

Do they honestly trust private-sector benevolence for a genuine medical safety net? No evidence to date to warrant that trust.

Do they think that every employer, from the local diner to Walmart (which now lets some employees qualify for state health care assisstance) gives every employee health insurance?

Do they think that they, the well-insured, can sequester themselves from unhealthy people (think pneumonia, the flu, measles….) who serve them coffee? Clean their homes? Service their cars?

Do they fear that the profits of private insurers (who contract with Medicare and government programs) will plummet? Do they care?

Let them face the legions of people without insurance and explain to them: Why not?

Finally, ask those conservative voices cautioning pragmatic baby steps the centuries-old question from Rabbi Hillel: “If not now, when?”

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

From The Progressive Populist, May 15, 2021

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