Thursday, November 05, 2009

Why Not a Health Care Revolution?

If the Scottish journalist Charles Mackay were alive today, he would undoubtedly devote a chapter of his landmark book, Extraordinary Popular Delusions and the Madness of Crowds, to the current health care debate in the United States. Between the failure of the news media to report honestly and the deliberate manipulation of politicians and corporate interests, it seems that many—perhaps most—Americans have succumbed to cultivated ignorance about how their health care system compares with others around the world, while they seem paralyzed by fear at the thought of meaningful health care reform, which is demonized as socialism by those who would rather suffer than change. I don’t know which delusion is worse, many Americans’ allergy to government or their fetish for private corporations, but taken together they border on madness when it comes to health care.

Beyond Representative Dennis Kucinich and Senator Bernie Sanders, I wonder if there are enough American politicians committed to universal health care to fill a minivan. Both Kucinich and Sanders have expressed a preference for a single-payer system and both have been working to preserve the ability of individual states to implement single-payer systems, even though federal legislators lack the courage to go there. At first I was amused by many people’s reaction to a single-payer system but, after several months of freely-expressed ignorance, I’m troubled by the proliferation of misinformation and fear-mongering.

Living in Canada, with a single-payer system, I’ve always been able to choose my own doctors and no medical procedure has ever been denied me in a timely manner. No government official has ever interfered with my medical treatment. Those who naively believe that Americans are somehow freer to choose their doctors, or that insurance companies aren’t more like George Orwell’s “Big Brother” than governments, are living in a fantasy world. American health care is the most bureaucratically-driven health care system anywhere in the industrialized world. The negative aspects of bureaucracy have never been the sole preserve of government and the private insurance industry has been far less accountable to the public than any government agency.

Canada’s health care system isn’t perfect, but it’s decent. I don’t mean decent in the sense of merely acceptable or average—I mean decent in the sense that people are treated decently when seeking medical care. Our medical practitioners are able to treat us as individual patients without worrying about whether or not they’ll be paid for their efforts. Yes, we Canadians have our complaints about health care in our own country. But if you listen to us closely, our complaints are, more often than not, those of people whose basic care has already been well provided for, but whose sense of personal entitlement exceeds real and reasonable needs. We Canadians don’t choose between keeping our homes, or our jobs, and caring for a sick family member.

One significant measure of Canadians’ satisfaction with our public health care system can be seen in the fact that even most Canadian conservatives support its basic principles and practices. Most of its critics support refinement and amendment, not fundamental change—even though a few of us may sometimes invoke the words “fundamental change” as a grandiose gesture! Public health insurance is as “natural” as public roads, public libraries, and public schools.

Is there room for private insurance? Yes, but not when it comes to the provision of basic medical care! Private insurance is valuable precisely in those areas where an individual’s sense of entitlement or privilege exceeds reasonable standards for public health care. My wife and I carry supplementary insurance so that we can enjoy the privilege of being in a semi-private room in the event of being hospitalized. This coverage also reimburses us for the deductible amount on prescription drugs and covers certain cosmetic procedures. And since I travel extensively, both for work and pleasure, our supplementary insurance covers any medical charges I incur which might exceed the normal rates here in Manitoba. After all, why should Canadian taxpayers pay extra for my privileged travel habits? So even under a so-called single-payer system, there can be room for private insurers—just not at the expense of providing everyone with basic medical care.

I worry that the opportunity for meaningful health care reform in the United States has already passed. It’s unfortunate that health care reform wasn’t pursued under the banner, “Medicare for everyone,” since the competing proposals for reform have become a race to the bottom, as even a watered-down version of the public option is in jeopardy. That’s often the way it is with reforms: they favor tinkering with worn-out parts over creating new mechanisms, or utilizing established mechanisms for new purposes. It’s got me thinking that maybe what’s really needed isn’t health care reform at all—perhaps it’s time for a health care revolution!

In the Declaration of Independence, the Founding Fathers of the United States correctly observed that, “mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.” The health insurance industry is counting on the truth of this observation, aided by timid elected officials masquerading as leaders. But too many have suffered too much and for too long! Since Theodore Roosevelt first proposed a national health insurance plan in 1912, vested interests have succeeded in defeating virtually every initiative to move in the direction of universal health care. Instead of tinkering with incremental reform, perhaps the time has come for Americans to let their most progressive leaders in Congress take charge of the agenda, “abolish the forms to which they are accustomed,” and embrace Medicare for everyone. Now that would be a revolutionary and transformative change for the better!

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