House Speaker Nancy Pelosi during introduction of Democratic health care
reform legislation Tuesday, July 14, 2009 (AP Photo/Manuel Balce Ceneta)
Two polls recently released suggest the American people are sharply divided on health care reform, especially along partisan lines. McClatchy and Gallup conducted their surveys before House Democratic leaders introduced a draft of their legislation to reform the system, and the results are less than encouraging for those hoping for quick passage and a fundamental change in health care access and cost control.
According to Gallup, only 56% believe it is important to pass reform this year (if not now, then when? Ever?), and 33% oppose, but among Republicans, a whopping 71% oppose. That means millions of Americans, many of whom are uninsured, don't seem particularly concerned about the crisis. In the McClatchy poll, Americans were split down the middle as to whether access or cost was the biggest concern.
These are the two major components of the health care crisis: lack of access to care, and runaway costs. Yet in a Gallup who-do-you-trust-to-fix-it question 45% of the people chose doctors and hospitals, and only 33% selected Obama and Democrats in Congress. What do doctors and hospitals know about insurance? Only that they won't treat you without it, except in the ER facility. And how can they control runaway costs? They are part of the problem. It's as if the American people are disconnected from the issue and its ramifications. Putting trust in your doctor to manage your health is not the same as putting trust in your doctor to run the entire system. Ballplayers make lousy CEOs of baseball teams.
Both pollsters asked whether all Americans should be required to carry health insurance. Now it should be obvious that if everyone is given guaranteed access to the system, then everyone has to participate. You can't let the young and healthy game the system, and jump in only when they think they are at risk. It is the fundamental principle of insurance - everyone in the pool has to pay. But in the Gallup poll, only 56% thought participation should be mandatory. In the McClatchy poll, the figure was higher, 69%, but still showed considerable resistance to a major feature of the House bill.
We need to remember that people who don't carry insurance have access even now. We can't turn them away from emergency rooms, and it would be inhuman to even try to do so. So they drain the resources of the system, yet rarely pay for the treatment. That simply isn't fair on the one hand, and isn't sustainable on the other. You can't control costs without mandatory participation.
One question which wasn't asked is whether Americans believe health care should be a fundamental right, as it is in other advanced nations, or not. It is disappointing that such a basic philosophical question isn't posed or debated in the Congress or among the people. What kind of nation do we want to be? What kind of safety net do we want to provide for citizens? Where do we want to be half a century from now? It's hard to talk about reform when there are no explicit goals, no objectives, no premise to start with. In the end, it seems Republicans have no societal goals at all - whatever falls out from the unregulated capitalistic model of free markets, small government, and low taxes is the correct result. It is frustrating to deal with them, because every problem posed delivers the same, robotic response: cut taxes on the wealthy and deregulate the markets. We did that for thirty years. The health care crisis is worse than ever, just like the energy mess. It didn't work.
I have examined literally hundreds of blog threads and read thousands of comments on health care reform, and encountered a bewildering array of attitudes, misconceptions, complaints and demands about our system, with no clear consensus on any aspect of the crisis, other than that most Americans covered by employer plans seem to like what they themselves have and don't want to alter anything. They appear to approve of reform in the abstract, but not when it impacts them personally, through higher costs or taxes, or a change to their plans.
It will be interesting to see how Americans respond to the plan put forth by the House, which I think is a good one, all things considered. It is historic. If passed, for the first time, every American will be guaranteed access to affordable health care for his or her entire lifetime. That is worth fighting for.