The Health Care Debate- Coming Soon To A Congress Near You

With great crisis comes great opportunity.

This is a terrific day to be writing my first entry for True/Slant.  The House of Representatives has just voted in favor of the conference committee version to expand SCHIP- the government program that brings health care to millions of middle class children who do not have health coverage. Today’s extension, which basically puts before President Obama a bill which is almost identical to the one vetoed by President Bush,  will bring health care to an additional 4.1 million kids. That is what I call meaningful progress.

While there was some wrangling in the Senate over certain provisions of the SCHIP expansion-reminding us how difficult it will be to pass health care reform-the fact is the bill passed and is going to be signed into law by the President.

Why?

Because with great crisis comes great opportunity.

Congress knows very well that their middle class constituents are facing serious problems when it comes to obtaining adequate and affordable health care- and its only getting worse as millions lose their benefits along with their jobs. If we learned anything from our recent presidential election, it was that that things only begin to happen when the middle class becomes engaged with the issues. (Yes, we also learned that Sarah Palin can shoot the eye out of deer from five thousand feet hanging out of an airplane, but that’s another topic and far less interesting.)

Lest you have any question, the middle class is now deeply engaged in the health care issue.

The “collective perception” of the American public has always been that is was primarily the poor who struggled to achieve access to health care. While this was never actually the case, Congress is all about perception. This allowed previous administrations and past congresses to simply turn their head and cough when the subject of health care came up. Today, with a staggering number of middle class workers and families finding themselves in real trouble when it comes to accessing and paying for health care, Congress has little choice but to pay attention.

Its not just the newly unemployed. For the past decade, 7 out of 10 uninsured or under-insured people have come from families with at least one working member. These are the people who earn too much to qualify for the Medicaid safety net but not enough to splurge on a health insurance policy to protect their families. Now add in the steep decline in employer provided health benefits and the inability of employees to pay their constantly growing share of premium costs even if they are provided employer based health coverage and…well, you should be getting the point.

With both the President and Congress understanding that they might actually have to do something about our systemic health care mess, it now feels as if the moon, the stars, and the sun might be coming into alignment. Believe me when I tell you, in the almost one hundred years this country has engaged in the debate over how health care should be provided, the opportunities to actually do something about it have been few and far between.

Much of the success or failure of Obama’s efforts to improve the nation’s health care circumstances will depend on the prevailing point of view of the American people. And to have a legitimate point of view, the public requires accurate and truthful information, something that has always been in remarkably short supply when it comes to almost a century’s worth of health care debate.

So, for those willing to keep an open mind as they engage with this issue, consider the following;

-Federal health care reform is not the sole domain of liberals and democrats.

I can hear the conservatives snickering at the notion that some difference actually exists between “liberals” and “democrats”.  But it does. In fact, it was the conservative democrats of the 1960’s, particularly the powerful chairman of the House Ways and Means Committee, Wilbur Mills, who played a huge role in the first real leap forward towards a meaningful national health care program. These were conservative democrats who would, in all likelihood, be Republicans if they were sitting in Congress today.

What’s more, it was actually a Republican who first brought the issue to the national agenda. Compulsory national health care for working Americans was a key plank in the platform of Theodore Roosevelt in his attempt to recapture the White House in 1912. Roosevelt lost that election, providing us with a glimpse of what was to come in the national health care debate.

But T.R. wasn’t the only Republican to step up the plate.  The unsuccessful efforts of Republican senators Flanders and Ivers (circa. 1948 -1955), and the eventual “forced” adoption of many of their ideas by President Eisenhower (who was not much of a health care reform man), were the first presentation of the principals that would eventually become Medicaid. That’s right, Virginia… we have the Republicans to thank for the ideas that led to one of our landmark, social programs for the poor.

So, whether you identify as a conservative, a liberal or whatever, it’s okay…really…. to be supportive of programs designed to help everyone improve their health care circumstances without fear of being banished from whatever team you play for.

-It’s not about socialized medicine- it’s about socialized insurance.

If anything is to be accomplished, we have to get past this whole socialized medicine thing because it simply is not- and never was – real. Every serious effort to bring about change in national health care policy has been met by cries involving the end of American democracy as we know it…and it has almost always worked. Yet, to the best of my knowledge, nobody who matters -past or present- has ever actually proposed that the federal government directly employ the doctors or own the hospitals. That would be socialized medicine. We’ve seen discussions and enactments involving federal payment to medical providers; we’ve seen federal guidelines and mandates attached to the federal grants that are the basis for the state operated Medicaid programs; and we’ve seen volume upon volume of federally issued regulations that play a huge roll in the cost of medicine in our country. But we have yet to see government entertain the notion that the docs should be in the employ of the US government just have we yet to embark on a nationwide government hospital building program.

So, should you feel the need to resist health care reform in support of the free enterprise system, a strong belief that we would be better off without “big government” involvement or for any other reason you may have, that’s cool – but let’s frame the debate where it belongs, not in some anti-communist rhetoric from a time long since past.

-It is completely fair to consider American culture in the discussion as to what should and should not be part of a nation health care program.

Americans spend far more on health care than anyone else in the world and receive less for the money. Unpleasant as that may be, it is a fact.  And while we spend approximately 17% of GNP on health care, we appear to do better in only a few serious disease categories than other countries. In many instances we do far worse. However, this does not mean that we are required to default to adopting the national health care systems of other countries.

Every culture must come up with a plan that suits its own unique cultural imperatives.

Take the example of The Netherlands where every citizen and resident is required by law to have a basic health care insurance policy, i.e. mandated medical coverage. Even with this stringent requirement, the percentage of Dutch GNP spent on health care is considerably lower than in the US while the level of satisfaction with the Dutch medical system is amongst the highest in the world. Does this mean that America should being jumping on the Dutch medical bandwagon? Maybe…maybe not.

There are cultural reasons why the system works so well in The Netherlands, reasons that would be completely irrelevant to our own circumstances. For example, less than 10% of Dutch women have their babies in a hospital. In their culture, childbirth is a private matter that should take place in the home. No surprise then that few health care euros are spent on hospital visits and physician costs associated with having a baby – a primary health related cost in the USA.  What’s more, the Dutch consider many of the “everyday” aches, pains and illnesses of youth to be things that should be experienced rather than cured or attended to by doctors. To the Dutch, these common maladies are all a part of “growing up” and building the character required to be a functioning member of society.

Meanwhile, here in the US of A, few women with access to hospitals and physicians have their babies at home, despite small segments of society who subscribe to the concept of midwives. And for those us with health insurance, when our kids get colds, we tend to take them to the doctor.

With the Dutch far less likely to run to the doctor than we Americans, it isn’t hard to see how health care costs are far more manageable in The Netherlands.

So who’s right?

We all are. What is culturally correct for the Dutch is just that…culturally correct for the Dutch. And the same goes for us.

This is not to say that we cannot learn from the health care experiences of other nations. An understanding of what is done in the other industrialized countries sheds a great deal of light on what might work for us and what would not work for us.

As the health care debate moves to the center stage in the coming months, I suggest that everyone remain open to the facts and realities of our health care situation rather than fall back on what you might think your response should be based on your political ideology or affiliation. What’s more, there is absolutely nothing to be gained by pitting our national pride against any another country. This isn’t the Olympics.There is no “We’re number one!” when it comes to the physical and mental well-being of our families.

Its about creating a system that is accessible, affordable and available to every American.

As we search for a way out of this mess, my advice is that you check the ideology at the door and focus on pragmatic, workable solutions.

Because when you, or someone you love, is facing a critical medical condition, I can absolutely promise you that the very last thing on your mind will be the political party that turns you on.