Health Care

I recently finished an article for a class about health care. I've decided to post an edited version.

Part of being an American is being raised in a culture of fear. My parents raised me well: I fear being alone at night, not being a student, credit card debt, traffic accidents, large bites of steak. Chances are, if there's any risk involved, I've probably sat rationalizing it. Recently, I added hospitals to my list of scary things after learning the hard way that if you go to a hospital, you will pay. And pay. And pay some more. My first taste of American debt has not come from student loans or credit card statements, but from a hefty hospital bill I thought would be covered by my parents’ insurance company. While I struggle to afford my monthly payments, Ronald A. Williams, the CEO of insurance company Aetna made $23,045,834, almost $500,000 per week, in 2007. This is the same year that 62% of Americans went bankrupt because of their medical expenses (Ricciardelli, 2009). This isn't me - yet.

In a recent speech, President Barack Obama described our health care system as “an unsustainable burden” on the American people. For the first time in the last sixty-five years of limited health care discussion, our country’s lawmakers are having a serious debate in Congress about our current system. A public option has been proposed, and if it is passed into law, America's health care system will face some of its biggest changes since the beginning of the twentieth century. The health care system in the United States is like an old and decaying tree, with roots of rot that stretch back to pre-WWII years and reach deep beneath the surface of its apparent shortfalls.


A public health care option was first a countrywide debate in 1948 when President Harry Truman proposed a national health insurance plan in response to increasing health costs. Today, Americans generally assume that they should be provided some form of health insurance through their employers, but most Americans don’t know that before WWII, this luxury was not offered. During the Second World War, the government placed wage and price controls on the economy to fight inflation, and in an attempt to lure in scarce workers, companies began to offer “free” health insurance as a fringe benefit. But everyone knows that nothing is really free - fringe benefits are great for employees, but very costly to companies. (Drake, 1994).

In 1947 the Supreme Court ruled that health insurance could be debated through collective bargaining. With enrollment in labor unions rapidly on the rise, it didn’t take long for 72% of the population to have health insurance by the end of the 1950s (Drake, 1994). What President Truman recognized in 1948 was that not all Americans would be covered by their employers; these Americans would be left to fend for themselves. Truman’s nationalized plan, that would have covered every citizen, was defeated by the American Medical Association, who was terrified of competition, and decried a Communist plot by a House subcommittee (PBS). Sound familiar? These methods are oddly reminiscent of today's right wing, "those socialists are going to kill your grandma," scare tactics.

Today, the nation that spends 17% of its Gross Domestic Product every year on health care (more than any other nation) revisits this issue (Commonwealth Fund, 2009). I talked to Sacramento's Capital Public Radio health reporter, Kelley Weiss, and she explained to me that the public option was a complicated economic issue, but that “it’s all about competition and cost control. A nationalized program would bring together a large pool of beneficiaries that would be powerful enough to demand a good rate for services. This kind of competition would drive down the cost of health care across the board.” The “large pool” that Kelley spoke of includes a wide variety of people. They may be unemployed or recently laid off workers, but many of this group are employed and don’t receive benefits. A public option would be particularly helpful for small business owners who can’t afford to provide benefits for their workers, themselves or their families.

A Gallup poll, released in September 2009, states that 87% of American people rate their private health insurance quality as either good or excellent. The problem with this kind of statistic is that it doesn’t take into account the opinions of those Americans who don’t have any health coverage. David Hilzenrath of The Washington Post compiled data from a 2008 Kaiser Family Foundation poll and found that the people who like their health plans most are those who use them the least. If they do need to go to the doctor, their employer covers the majority of the cost, and they never have to see the entire bill. The unfortunate truth about these fringe benefits is that they can disappear in a heartbeat when they start to cost a company more than it can afford. In 2006, Cigna, one of the country’s largest insurance companies, cut its own employees benefits, leaving them only with the option of high-deductible coverage. Many of them declined and joined the millions of other Americans with no coverage at all.

The year after Cigna cut its employees benefits, New York Magazine told the story of Jake Hollner, a twenty-four year old Home Depot employee and artist who, like all of us, gets little aches and pains. He represents an entire generation of uninsured people hoping to live through their twenties without any health problems. Jake Hollner wasn’t that lucky. Plagued with reoccurring stomach ulcers, Jake first went to a public clinic where he spent his week’s paycheck on the visit, only to travel home by bus with a $73 dollar prescription for Nexium. Just a few hours later he experienced excruciating pain and took a cab to the closest hospital where he faced a long emergency room wait and, later, his bill. According to a Huffington Post report based on another Gallup poll, over the last year 4.8 million adults have lost their health insurance, joining the ranks of Jake Hollner. They bide their time, hoping that those little aches and pains don’t turn into something more.

While a public option would be helpful to the ranks of uninsured, some economists don’t think that this is a cost-effective solution to our country’s financial and health problems. According to the Cato Institute, a Washington DC non-profit public policy group, government programs are less effective than private ones, and if we had a public option, the government would use its ability to subsidize programs while not turning a profit against private companies who don’t have the same power. The Cato Institute also predicts that health care reform and a public option will cost more than projected because people will change their behavior and seek more medical attention than they do now. The Commonwealth Fund, an organization that promotes improving health care, wrote a report entitled “How Will Comprehensive Reform Improve Health Care for Americans?” in which they argue that reforming health care is actually America’s best chance at improving its entire economy, preventing us from spending a projected 21% of our GDP on health care by 2020. They state that over the next ten years, if reform occurs, businesses can save $231 billion and households can save over $2,000 a piece. It may not sound like much, but by 2020 there will be over 340 million people in this country and that creates a lot of households.

In addition to being taught to fear as I grew up, I was taught that I lived in the best county in the world. If I worked hard, saved my money, and went to school, I would lead a successful and happy life. Today, I’ve found at least one fatal flaw in that plan, and it started with my first hospital bill. Before the task grew too incomprehensible, the World Health Organization released a list in 2000 that ranked the US as 37th in a study of the world’s best health systems. That’s right between Costa Rica and Slovenia. Why is the best country in the world number thirty-seven? Shouldn’t we be number one?

We are only about seventy years down the road from when this system was born, but we are sixty years overdue in supporting proposed legislation to reform it. There are economic arguments from analysts who oppose “big-government,” that support keeping the system as it is and promote giving private corporations more power, rather than less. But we saw what happened in the fall of 2008 when big corporations have too much power. They collapse, taking the rest of the economy with them. As we recover from recession, there is no better time to reform our health system and the ways we think about our government. A healthier society will not simply help those without health insurance, it will help everyone exist in a more equal society and improve everyone’s quality of life (Wilkinson, 2009). While the Congressional debate may boil down to economics, isn’t it about time we stop putting a price on the value of someone’s life?