by TIMOTHY EGAN
Health Care’s Historic Moment
Politics is so often a salon sport, with its up-and-down arrows, weekly winners and losers, and reliable hypocrisies providing sustainable entertainment for the permanent class in Washington. But every now and then elected officials do something that has deep and lasting consequences — a generational life-changer.
This happened 44 years ago, with the creation of Medicare, the socialized health care plan for the elderly. At the time, the poorest Americans were more often the oldest Americans. And half of all seniors had no health care coverage.
Today, this country is full of people who may hate everything about government but would take up arms if you tried to get rid of Medicare. They came to this conviction out of personal experience: seeing a spouse or parent live another 10 years because of treatment they otherwise could never have afforded.
Now we have arrived at an even bigger national moment. Within a few weeks, we will know whether health care plans designed to eliminate a problem that has vexed every president since Franklin Roosevelt will make it to this president’s desk.
Both the House and a committee in the Senate have just shown their cards in the political poker game of the decade. The price of near-universal health, the House plan indicates, will be about $1 trillion, paid for with a surtax on couples who earn more than $350,000 a year, and a promise of savings in federal programs and the considerable waste stream of the private system.
The measures would require everyone to get health care, with subsidies for the poor. Employers, except for smaller businesses, would have to provide insurance or pay a fee to the government. And there would be a public option — a plan that would, in theory, keep insurance companies honest by acting as a legitimate competitor.
The final bill will likely be the kind of sausage that is never pretty in the making. Speaking in Michigan on Tuesday, President Obama tried to move the urgency meter.
“We have no choice but to change the health care system,” he said, “because right now it’s broken for too many Americans.”
But is it really broken for enough Americans? That’s the overarching question behind the what’s-in-it-for-me check list. As with the debate over care for the elderly, a system first proposed by President Harry Truman, people will apply their own tests.
On that first question, Obama will probably win. Polling consistently shows that majorities of Americans like the quality of their health care ( their doctors and therapists), but don’t like the coverage (their insurance companies and H.M.O.’s).
Thus, even as the United States spends more per capita on health care than any major country, the overall system is not well-loved, placing the U.S. near the bottom of countries that have confidence in their medical safety net, according to Gallup polling.
Will that dissatisfaction trump warnings about the perils of socialized medicine, waiting lists and the crush on business? Big money is counting that it won’t.
Consider the campaign underway by a group called Patients United Now, which calls itself “people just like you.” But unless you’re worth somewhere north of $10 billion — the reported wealth of the one of the men behind this phony grassroots group, the oilman and right-wing activist David H. Koch — those people aren’t anything like you.
This time around, Harry and Louise, no matter how they are scripted in the public relations battle ahead, may not overcome the anecdotal arguments for change.
About 48 million Americans have no health care, which means most people are at least one degree of separation from someone with no coverage. Texas — with nearly one-in-four lacking coverage — leads the misery parade.
At the other end are people who have terrific health care, even gold-plated, and will likely find nothing in the legislative overhaul for them. But dissatisfaction runs high even among those with good benefits.
We all know somebody who is sticking with a lousy job because of the health care. Economists call this “job lock,” and it stifles entrepreneurship and mobility, among other things.
We may also know someone who has remained married to the wrong person for the same reason. Call this “marriage lock.”
Stories are legion of people who went overseas for a medical procedure because it was cheaper, or had an injury in Europe and were pleasantly surprised that they never had to fill out a lengthy insurance form in the emergency room.
Over the last decade, the courts have processed millions of former members of the middle class who lost it all on one catastrophic illness — the leading cause of most personal bankruptcies.
And plenty of people have had vital procedures rejected by their insurance company. That’s one reason why only 4 percent of Americans in a USA Today poll this week said they trust insurance companies to change health care. Congressional Republicans, at 10 percent, were not far behind.
Employees with otherwise adequate coverage complain that they can never get ahead because salary raises are wiped out by hikes in premiums and co-pays. Over the last 10 years, the average family saw its premiums more than double, the Kaiser Family Foundation found. This at a time of stagnant wages.
And it hurts small businesses just as hard, because they carry so much of the nation’s health care burden.
To change this system is an enormous gamble, arguably on the magnitude of creating Social Security. The costs are scary, and coupled with trillon-dollar deficits, are prompting many independents to doubt the road that Obama has chosen.
All of this will make for a fast-round of shouting among all the interests groups, and a stimulus package for lobbyists. But this time it may not matter: the future of American health care could be decided by the politics of personal experience.
Source: New York Times