aTypical Joe: a gay New Yorker living in the rural South

Saturday, October 22, 2005

Universal health

The husband of a colleague had a liver transplant. I learned recently that he is roughly my age. His health care, same plan as mine, has maxed out. No more coverage. Tens, possibly hundreds, of thousands of dollars in costs left to come.

Then there’s the co-pays and deductibles and “exclusions” they still owe. The plan also has “Stop Loss” and “pre-certification requirements” and “balanced billing” and despite all that is the best in the area. There but for the grace of God go I. Or you.

So what’s the current thinking on health care?

Ezra Klein, in a post commenting on a recent Boston Globe article by Joshua Kendall:

Kendall keeps track of two threads crucial to understanding the basic arguments [in the current health care debate]. The first is that employer-based health coverage is an accident of history, an unsustainable system that blossomed out of a WWII-era tax quirk. But unlike in the 1990s, when Bill Clinton, the Republicans, and everyone else thought it a basically sound structure merely in need of tweaking, participants on the left and the right are beginning to decide it must be dumped. That’s largely because business itself desperately wants it dumped. For more on that, yesterday’s agreement between GM and the United Auto Workers to slash the union’s hard-won health care coverage explains the issue. In an age of outsourcing and global competition, corporations cannot keep assuming medical responsibility for their workers while remaining competitive.

But while the media has spent some time outlining the old system’s slow-motion destruction, the drawing of the battle lines for the fight to replace it have been vastly underreported. It’s here that Kendall’s article shines. Conservatives have settled on an individualized concept of health care, most often expressed in their advocacy for so-called consumer-driven health plans (Health Savings Accounts, Health Reimbursement Accounts, and so forth). In the future they envision, health care would be an individual responsibility; if you screwed up and lost big, or just had a run of bad luck, well, that’s life. Liberals, conversely, want to make health care a community burden, be it through massive expansion of currently existing federal pools (think Medicaid, Medicare, SCHIP, and FEHBP) or the creation of a wholly new, state-run insurance program. This way, your personal decisions and circumstances would have little to no effect on your coverage; the healthy would pay for the sick and the young would subsidize the old.

I believe in shared responsibility. And the fairest share is when all of us participate.