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Sunday, June 08, 2008

Universal Health Care: Do We Care Enough?

Is our failure to provide adequate medical care for some segments of the population due to the fact that we don't care enough about them?:

"Want Universal Health Care? The Operative Word Is 'Care'," by Michael L. Millenson, Commentary, Washington Post: ...Here's a cold truth: Despite much media hand-wringing on the subject, most of us give about as much thought to those who lack health coverage as we do to soybean subsidies. The major obstacle to change? Those of us with insurance simply don't care very much about those without it. It's only when health care costs spike sharply, the economy totters or private employers begin to cut back on benefits that the lack of universal health care comes into focus. Noticing the steadily growing ranks of the uninsured, the broad American public -- "us" -- begins to worry that we'll soon be joining the ranks of "them." ...

Two-thirds of those without health insurance are poor or near poor... And there are clear disparities in how different racial and ethnic groups are affected. Only 13 percent of non-Hispanic white Americans is uninsured, compared with 36 percent of Hispanics, 33 percent of Native Americans, 22 percent of blacks and 17 percent of Asians/Pacific Islanders.

Politicians understand what this means in practical terms. If a lack of health insurance were truly a white middle-class crisis, then conservatives and liberals would long ago have joined together, carved out a compromise and done something. Instead, we're served a constantly recycled set of excuses for legislative stalemate. ...

When the general public talks about a health care crisis, what they're generally talking about is rising costs, a constant complaint since the Hoover administration (though Richard M. Nixon was the first president to officially declare a health care "crisis"). In response to this public clamor for cost control, those who advocate for the uninsured have decided to talk not only about the 22,000 of "them" who die annually because of a lack of access to care, but also to emphasize the money that providing coverage to "them" could actually save the rest of "us."

The Commonwealth Fund recently tallied the ways in which universal health care would save hundreds of millions of dollars, most of which were related to lowering the societal costs exacted by the greater burden of illness among the uninsured. The list was an exhaustive and exhausting one that nonetheless had the whiff of desperation, as if civil rights activists had appealed for support against segregation because it was reducing the pool of qualified candidates for the Selma, Ala., police department.

There are glimmers of hope. A growing number of insured families are struggling with higher co-payments and deductibles and skimpier coverage. These uneasy "underinsured" may yet join forces with the uninsured to demand [change]...

A survey last year ... found that more than two thirds of Americans were willing to pay 1 percent more in federal income taxes to make sure that everyone had health insurance. This counts as progress, as does the bipartisan Healthy Americans Act, a significant step toward universal coverage proposed by Sens. Ron Wyden (D-Ore.) and Bob Bennett (R-Utah).

Over the years, our society has gradually provided a medical safety net for the elderly and disabled (Medicare), the poor (Medicaid) and veterans. At one time, these commitments were controversial, and there's no doubt that they're expensive. Yet Americans from all walks of life understand that the true value of these programs must be weighed on a moral scale as well as a financial one. ...

It has been nearly a century since Theodore Roosevelt, a Republican running unsuccessfully on the Bull Moose Party ticket, boldly became the first presidential candidate to promise universal health coverage. That was in 1912. Nearly a century later, we're still waiting for a leader with the courage and skill to break through our fears and successfully lead the charge up that particular hill.

Assuming that people don't care enough currently, we can hope that people suddenly begin to care more about the disadvantaged than they do about soybean subsidies and, because it's the right thing to do, agree to provide universal health care. Maybe that can happen, the author says it is happening to some degree, but even so, I don't see anything wrong with explaining why it's in society's best economic interest to adopt a universal care system and framing the argument along those lines. That seems easier than telling people they don't care enough (or making emotional appeals), though I suppose you could try that too.

However, I'm not so sure that people are indifferent to the health care needs of the disadvantaged. But even if people do care about providing adequate health care for the disadvantaged, and I want to believe they do, even if they do recognize the moral obligation in their evaluation of the benefits of providing universal coverage, that doesn't mean that they will voluntarily step forward to help. For example, there could be a standard free rider problem. It's optimal for me if everyone else except me pays the cost of providing health care for those who cannot afford it. In that case, the poor are helped just as much since my missing contribution makes no practical difference in a large pool of people, and the help costs me nothing (and I get the benefit of being less likely to contract a contagious disease, etc.). So, the mere fact that we do not have universal coverage does not necessarily mean we don't care about the poor (though it might). It could be that we do care, there is net social value in providing coverage, but we haven't yet found a way to fully articulate the net societal benefits of universal care in a way that allows us to overcome the political obstacles that stand in the way of solving the market failure problem(s).

As for the likelihood of change, it's certainly true that the motivation to do something about the problem is greater as the costs begin to fall on the politically powerful parts of the population, and that is driving some of the current movement toward health care reform. And moving forward, as the problem becomes more widespread and the benefits of reform begin to become more evident to middle class (voting) families, the chances for reform should steadily increase. But I hesitate to follow the article's lead and use the term "glimmer of hope" to describe this since it involves things like a "growing number of insured families ... struggling with higher co-payments and deductibles and skimpier coverage" and it's hard to hope for that.

    Posted by on Sunday, June 8, 2008 at 02:07 AM in Economics, Health Care, Market Failure | Permalink  TrackBack (0)  Comments (71)

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