health care and confidence

The question of whether or not to nationalize health care is often framed within a discussion of poverty.  This is a little off target.  First of all, for the poorest Americans, there are already free health care options provided by the state – under the umbrella of Medicaid.  Programs vary from state to state, but they’re available, and many Americans make use of them.  You really do have to be at or beneath the poverty line for these to kick in, but if you are indeed among the poorest Americans, you’re covered.

Also, since this is health we’re talking about – and a flourishing society must also be a healthy one – cost is not really the most important factor here either.  Obviously in discussing the mechanism and implementation of some form of nationalized health care, cost becomes a necessary challenge to overcome.  It can be done, as many other industrialized nations have shown (with varying outcomes) but it should not be a determinative issue.

What really is important in this discussion, aside from the moral imperative of providing for the sick,  is how health care coverage effects consumer and worker behavior and confidence.  For instance, if I happen to be over the poverty line – which I am – but under the wealthy-enough-to-buy-my-own health care line, then I am left totally dependent on employer health benefits. That’s not really a predicament that makes me feel very confident.

So, especially during a recession, this leads a lot of people to suddenly lose their health care, because they suddenly lose their jobs.  Beyond this, though, if you switch jobs, or just want mobility, you are forced to go without health care for a while.  A lot of employers don’t provide any benefits while a new employee is in their “probationary” period – for maybe three months, maybe a year.  It only takes one event to lead an uninsured new employee into bankruptcy.

There are also those of us who think perhaps further education is in the cards.  People get one degree, work for a few years, and then go back for an advanced degree.  But what if you have kids?  College is already hard to afford, but purchasing insurance for the whole family while you attend grad school is really, really hard.  This effects our potential high-skilled labor pool.

Another important thing to consider during a recession is that it places workers in a much less competitive place than during boom times.  Employers can start scaling back wages, benefits, and so forth and they get away with it precisely because the confidence of their employees is shot.

These are very real obstacles for the economy and for the middle class.  People who might otherwise look for better jobs or go back to school, don’t because they lack the proper confidence that health insurance provides.  This only gets worse in a recession/depression, the one time where confidence really matters.

One concern often voiced is that confidence in the health care system itself might fall if we were to go public, but I’d argue three things: first of all, it’s been tried elsewhere and people are generally happy with it – in Sweden, the UK, Japan, Germany (all of which have their own unique programs, of course).  Second, there is a more fundamental issue at stake than our feelings about having to wait longer to see a doctor.  People are being bankrupted by their lack of access to medical care – not just quality medical care, but any medical care at all.  In this day and age, nobody should have to face bankruptcy because they get sick.

And finally, there is no reason why competitive practices can’t remain a fundamental part of the system that is eventually created to keep innovation high and costs low.  It is an illusion entirely that non-profit models will do away entirely with competition, innovation, etc.  There is that risk, of course, but other countries have done some amazing things in this regard, such as Germany.  Even in the UK, where health care is entirely free, competition remains an important element of the system.

Yes, a single-payer system and its incumbent cost-controls could be bad for doctors and hospitals – but it might be really good for businesses and employees.  And it might be really good for families and communities, something for social conservatives to take into consideration.  And yes, we may need some serious innovations to make the transition as smooth as possible, but I don’t see any other real options going forward.  The system as it stands simply isn’t working.

This is the whole point of society, to gather individuals together and to work to protect them and look out for their welfare in a larger community.  Within this system there is generally a market, the accrual of wealth, the advent of arts and leisure.  But at its core, society is built to provide strength in numbers.  If we fail to do this, we are missing the whole point of society to begin with.  If we fail to properly educate our children, or provide for the health of our neighbors, or to build up a strong middle class, we’ll find ourselves a nation lacking confidence and solidarity, replacing it instead with materialism and the false confidence of debt.  A system which profits off of the sick, sometimes at the expense of their very livelihood, does not seem too morally sound.  I understand the benefits of the market, but perhaps this is another area where those benefits are outweighed by the larger social costs.