Medicare for All

Congress went on vacation, with all three committees in the House approving a healthcare reform bill, and one of two in the Senate. While headlines emphasize that support for the Obama proposals was weakening, there is also substantial strength of support, and the distinct possibility that the worst is almost over, and the momentum could swing back to a more robust bill with a strong public option.

Congressional Republicans are clearly making it their priority to defeat any plan President Obama would approve. They have allied their political interests with the economic interests of insurance conglomerates and Big Pharma, as have some conservative Democrats. So now there are two sides (at least) and throughout August they will battle for popular support.

So far GOPers have apparently caused public anxiety about healthcare reform mostly through telling shameless lies, especially by saying that Obama wants to kill seniors. So far, Obama and the Democrats have been less than adroit in responding. While Obama's low-key reasoning drives the media crazy, it generally has been effective with the voting public. On this issue however a little righteous indignation might be called for--if not from Barack, then from Michelle. Because that's what the right is saying: if you're old, Obama wants to kill you.

I support the President on health care, and urge others to do so. But I am resigned to reform that will do much less than it should. It is likely to be complex and unwieldy, and morally as well as operationally compromised. It's clear from the experience of other nations, and from the experience of this nation with Medicare, that the method that works is basically a not-for-profit health care system with all medical insurance administered by the national government.

This is known these days as the "single-payer" system, a term so guarded and abstract that it could mean anything. Today I heard another description: Medicare for all. That's a phrase that people would immediately understand, and given that a higher percentage of Medicare recipients are pleased with it than any other kind of medical insurance, it could gain widespread approval.

Medicare is so popular, that people don't even think of it as a government program. I have to admit that I'm surprised that after the past decade and a half of corporate shamelessness and multi-billion dollar bureaucracies devoted to denying care, the spectre of government involvement in healthcare is still an effective scare tactic. Despite the fact, that as Paul Krugman shows, health care in America only works at all because the government is involved.

Medicare looks like it has its frustrations and complexities, too (if I get through the next few years I'll let you know how it works.) But it has very low administrative costs, and already pays for preventive care that most insurance doesn't. But Medicare for all comes closest to, say, that dreaded Canadian system, where (as a recent article about Vancouver puts it) polls suggest Canadians love their health system -- they spend about 55 percent of what Americans spend on comparable health care, and they have longer life expectancy and lower infant mortality rates." GOPers love the urban myth about Canadians coming to the U.S. for medical care--right, all of about 20 of them. Versus more than a million Californians who go to Mexico for treatment they can't afford in the U.S.

Medicare for all is also morally and ethically clear: you don't make money off of the sick and dying, not when you can afford not to. (And again, profit is what corporations get after doctors, nurses, administrators, etc. are paid, as well as the equipment, research, etc. All profit pays for is mansions for CEOs, buying other companies and paying for marketing and lobbying so the profits keep coming.) In other words (you know I'm going to say it), La salute non si paga: health is not for sale!

So why do I support President Obama, the principles he stands for, and the plan that he is likely to support? In the depths of the Great Depression, President Franklin D. Roosevelt had to figure out how to rebuild a shattered economy and society. He and his advisors came up with policies and programs that focused on structural and long-term solutions. They were necessary. But he was reminded of the suffering of the moment by his two closest advisors, his wife Eleanor Roosevelt, and advisor Harry Hopkins who said this: "People don't eat in the long term. They eat every day."

I think of that quote often. To me it means your responsibility includes dealing with the needs and suffering of the moment. Such a philosophy led to most of the New Deal programs we remember, including those that have turned out to have lasting benefits. (Some of the state parks that California may be closing were built by the CCCs during the Depression.)

President Obama seems very mindful of these two responsibilities--to the long term and to the needs of now. His Recovery Act shows this. I also believe that balancing these two responsibilities is of foremost importance to him, over considerations of re-election.

But in any case this is my belief. Applied to health care, it means to me that it's important to fight for the principle of health is not for sale, and for every government program and law that furthers that principle. I would like to see Medicare for all become a clarion call. But if the public gets queasy about the kinds of changes Washington is contemplating, it looks like a long time coming before Medicare for all is politically possible.

The danger is that the kind of mixed private-public system in current Congressional bills (especially one with a very weak or illusory public component) won't succeed in helping people, but Washington will consider the job done and not focus again on health care. Well, it will just as likely be a long time before Washington focuses on it again if no bill is passed at all. And we know the current system is terrible, and is going to get worse, for individuals and the national economy.

The bills before Congress probably will make some important long term and structural changes for the better. But it also becomes about eating every day--or getting the medical attention and care you need today. So if a health insurance reform bill passes Congress that means that more people get the medical care they need--people with "pre-existing conditions" or who change jobs or who can't afford insurance now or who won't even seek care because it will bankrupt their families--then that bill is worth signing into law. Even if I'm not one of those people.