The Baucus Bill: Simply Not Good Enough

An examination of the health care issue here is long overdue (okay, everything here is long overdue), and I confess that I began a post on the subject at least two months ago—a point in time when it appeared that disingenuous Republican outrage—“socialism,” “death panels,” “rationing,” and the like—threatened to derail passage of major reform legislation altogether. In the meantime, much of the negative momentum generated by that overheated rhetoric and undercooked reasoning has been halted by the feverish efforts (imperfect as they may be) of the Max Baucus-led Senate Finance Committee to craft a compromise bill, as well as Obama’s own willingness to stand up and be counted on the matter (in his characteristically pragmatic, noncommittal way). Now it appears probable that legislation will pass at some point in the months ahead, but absent a new government insurance plan paralleling Medicare and Medicaid (the so-called public option) or any measure that will significantly alter the manner in which insurance companies, hospitals, and doctors do business. At what point does compromise legislation become compromised?

The Senate bill, which is much closer to the bill that, given prevailing currents, will actually come before Obama for signature, is, according to the Congressional Budget Office (CBO), expected to expand coverage to nearly 30 million people primarily through direct government financial assistance to qualified individuals and families—those who aren’t eligible for an expanded Medicaid program but whose household income falls short of a predetermined threshold. Thirty million is nothing to sniff at—it represents a significant expansion of coverage, by most measures. And yet the shortfall is galling: the CBO estimates that under the Senate plan, 25 million would still be without health insurance in 2019, one third of whom would be unauthorized immigrants. Ultimately, 6% of Americans would be without coverage in ten years time, compared to 17% today—a vast improvement—and yet it simply isn’t good enough.

Health care, it seems evident, should be recognized as a human right (and if you disagree with me on this, best not to read further—we’ve got no grounds on which to debate). Every human being—including prisoners, terrorists, torturers, and Yankee fans—has the right to see a doctor and to be treated for illness, accident, and injury. Thus, every human being should have access to essential health care (including primary care) regardless of his or her ability to pay for it. But who guarantees that access? Who guarantees human rights? Certainly not markets, or the private sector. Clearly, it is governments who do this; it is an essential part of the social contract between states and their citizens. However, the way in which governments choose to guarantee those rights is more of an open question—in the case of health care, on the continuum between universal government-financed care and a system in which the private sector insures every citizen (a dream more fanciful than any Dan Brown novel), the possible proportional ratios of public to private coverage, and plans to achieve universal coverage, are virtually infinite.

The current American system, in which most Americans are covered by private insurers through employer-provided health plans and the government picks up significant slack for seniors (Medicare) and the indigent (Medicaid), is both anomaly and quirk. I am more interested in the former than the latter—unraveling how our system came to take the shape that it has would be instructive, but it is a diversion from my purpose. Forthwith the anomaly, oft repeated, but with good reason: The U.S. is the only “Western,” developed nation in which more than a negligible proportion of its citizens is without health insurance. Forty-five million Americans —45 million!—more than the combined populations of Portugal, Senegal, Bolivia, Sweden, and Mongolia—are a single untimely accident or illness from financial ruin. Among a surfeit of national shames—the death penalty, Guantanamo Bay, inner-city public education, Wall Street cupidity, Transformers: Revenge of the Fallen—a health care system that fails so many must rank near the top. The manifest dysfunction of the system is neatly encapsulated by a single fraction—one-sixth—the proportion of Americans without insurance, and the proportion of the nation’s economy given over to health care. Cost is the other head of this health care hydra. Without reducing costs, the effort to insure all Americans—a moral imperative—becomes hopeless.