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Keven Cullen writes in his Globe article "Pre-existing conditional," of a common health care story in America. It is the story of people facing hard economic times who have to confront exorbitant health care costs. I have no issue with the article or its point. In fact I applaud it. My only problem is WHY stories like these haven't been appearing throughout the United States, in multiple media formats, all day, every day.
The question posed is a simple one. What is it that our legislators are so scared of when it comes to health care reform? What is it that they don't get about the severity of the problem?
What has paralyzed movement on this issue for decade is actually a combination of factors. The themes is a common one. The people who are the most vulnerable in our society just can't seem to get the rest of the country to acknowledge their problems.
After numerous conversations with upper middle class friends and colleagues who have had relative but consistent job security they say that they literally do not see those problems. They do not have to worry about things like pre-existing conditions, out of network Doctors, and escalating costs. Our current system works out just fine for them. Again - the common themes in modern America. If it isn't broken FOR ME - then I guess it isn't broken. That's why, in the Cullen column, the featured family gets the sense that congress thinks the system isn't broken. As always, if something does not impact the upper classes who contribute to campaigns, run for elected office, and belong to all the boards and leadership organizations, then - it just can't be a major concern for our government.
It is the "there but for the grace of god argument" so few really get. If you have no experience with the fringes of our society or have never been on the fringes of our society, you just don't get it. Right now, that is still the biggest difference between fiscal conservatives and liberals - in my opinion. If this were the only problem, however, health care reform may just have a chance.
Unfortunately, this reality combines with a number of other factors that contribute to a number of constituencies acting against their own self interest. Interestingly, the very problems that exist in the current health care system are being used to demonize possible solutions. Sit around the table with any group adversely impacted by problems in the system will speak of:
1) Losing health care when they lose their job
2) Being denied health care for pre-existing conditions
3) Not being able to go to the Doctor of your choice because he or she is "out of network."
4) Not having access to the best care
These are commonly known problems, yet people seem to forget that when they are brought up as problems with a future government plan.
Another longstanding problem is that people who are just one bad stroke of luck away from the fringes of society don't always see themselves that way. It is not because of a lack of foresight but is often, frankly, much more about politics, culture and race. Noted politicos have often commented that almost 75% of Americans consider themselves in either in the "middle or upper middle class" or see themselves realistically getting there. And because of that, policies that seem to benefit "the poor" and ask more of those with means, are often looked down upon by this very group of at risk individuals. Conservative politics prey on this reality and that is how a party that has little to do with the "common man" garners so much support from them. Ad to this trend the underlying racism and/or classism it represents, and you have a recipe for disaster. I would tend to call it the "Post Populist" moment.
Historically, the populist movement has always included some of these contradictions. But it seems these contradictions have reached their zenith in the 21st Century with the election of the country's first Black President. The town meetings we have been privy to have revealed an ignorance of and hostility to "big government" of an almost unprecedented nature, which can only be explained by a heightened sense of us versus them. The us of course, is the white American ideal of prosperous, middle class folks. The them is the immigrant, the undocumented (illegal) immigrant, the minority, the criminal, and the poor who are leeching off of hard working Americans. Of course no mention is ever made of the benefits all those same "folks" get and expect from the big, bad government. That can be seen no more clearly than in the inexplicable exhortations to the government to get their hands of people's medicare. This was both the exemplar of the problem and hopefully, the very eccentricity that can send us back in a better direction. Just as it was hard to hear (for some) Obama described as a Muslim, a "friend" of Muslims, and a "terrorist"/friend of terrorists - it has been hard to hear all these false and erroneous claims. And it is still difficult to hear the cultural and racial comments re-released for used in the health care debate. That is how we know culture, race, and class still matter. We are not in a post-racial world yet. To think otherwise is naive. But we may very well be in the post-populist age I spoke of where what it means to be against big-business is so blurred and turned on its head.
The idea that the best care in this country is available to all is a myth. And to hear conservative use the supposed "mediocre" care in other countries as a scare tactic is the height of hypocrisy. To think that what people get in other countries, as part of their social compact, paid for by their taxes, is any less than what the vast majority of people get in this country is - frankly - a crime.
It is therefore up to us - for causes including but not limited to health care - to right the ship of populism and progressivism. If you have a job, and have never had a brush with being un-insured, please take the word of all who will tell you - it is a huge problem with life destroying consequences. Yes, cost calculations don't mean much when they are just a random number next to a small co-payment or a "zero due" balance. But they are critical when you have to pay them yourself. And yes, the idea of a "public option" may have been so colored as to sound like a bad government program - but it needs to be thought of as no different then medicare or medicaid - the very program so many depend on.
And for all those people who want to know where the money would come from, I propose two items for your consideration. First, as I suggested in an earlier post, is it really about the money? Is there really anything that could be more worthy of our tax dollars? Do you also ask that same thing about war? Do you even get to? No you don't - you just pay for it and go back to your life. Why can't a public option for the uninsured be the same? Second, I propose a radical postulate. I propose a look a the US Postal Service. In its inception, the government saw some value in a populace that could communicate efficiently with each other. They saw it as an essential tool for business and a continuation of a long legacy of the sharing of knowledge and the advancement of human understanding. Is the health of children and our most vulnerable any less important or noble? And yes sometimes it IS about the children. But if you are still unconvinced, well then, why not close the postal service and use those funds for a public option for health care. I mean really, in the year 2009 is there really anything the post office does that FedEx, UPS, and the Internet can't already do for us?
For your consideration ....
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