21.1 - The goal is universal health care

The goal is universal health care

I'm not going to spend any time telling you just how bad is the so-called American Health Care Act, the ACHA, recently passed by the misobiosers - which is a word I think I just made up - the haters of life in the House of Representatives.

That's because if you are the kind of person who is interested in watching this show, who has seen this show, you have heard plenty about how bad it is, how it would increase the number of people without health insurance, undermine Medicaid, "protect" people with pre-existing conditions by allowing the insurance companies to price them out of the market, and, well, a whole lot more.

And you have heard about how the leadership in the Senate is figuring they will pretty much just ignore what the House has done take up their own bill with the promise that it will only stink, not reek, which is supposed to make us happy somehow.

So I'm not going to spend any time on that. Nor am I going to spend my time going "Save the Affordable Care Act!" Remember, the GOPpers' plan, it was said, would result in 24 million more uninsured. What is rarely noted is that the actual number of uninsured would be 52 million because those 24 million were in addition to, on top of, the 28 million projected to be uninsured under Obamacare, a figure that hardly seems worth cheering about or spending all our energy trying to preserve.

What I'm going to do instead is to say that this is an opportunity, there is a political opening, to raise the banner of what should be the goal: a national health care system. And note well that I say national health care, not national health insurance, not even single-payer insurance. Bernie Sanders' repeated call for "Medicare for All" is good as far as it goes in that it's easy to understand and is light-years better than what we have - and you should know that there is a Medicare for All bill in the House, introduced by John Conyers, and Sanders intends to introduce a companion bill in the Senate.

But at the same time that ease of understanding is it's biggest flaw and failing: "Medicare for All," exactly like Medicare itself, only goes so far and sometimes, that's not nearly far enough, as anyone who has dealt with Medicare, especially in cases involving long-term care or lengthy illness, can tell you. In short, it's good, it's certainly better than what we have - but it's not good enough.

The goal is universal health care. Health insurance is supposed to be a means to health care. But what we have done is made insurance the goal, not the means, and that is a failure. Any program built around insurance, even universal insurance, is not good enough and will inevitably fall short of the goal of everyone, regardless of means or condition, having access to adequate, affordable, health care. And I'm not going to play the GOPpers' verbal game about "sure you have access to health care (footnote in small type: if you can afford it)." The fact is, I do not have access to a door if it is locked and I do not have access to health care (or anything else) if I can't afford the cost.

But in fact, the heck with it. The heck with all the talk about "affordable." I don't want "affordable" health care, which only leads to plunging into the dark labyrinth of what constitutes "affordable" and does any level of expense short of what would produce penury or bankruptcy make it "affordable." I wanted taxpayer-financed, government-funded health care. I want people to be able to go into a clinic, into an emergency room, into a hospital, into a skilled care facility, and not have to worry about the size of the bill because there won't be one. I want people to be able to get the care they need without having to think about the cost because there won't be any. I want no more hospitals designed and laid out so that you have to go past the cashier's window in order to leave the building.

What I want, that is, is a national health care system, a layered system running from neighborhood-level clinics through community hospitals and regional health centers up to a small number of national district hospitals for special, rare, or unusually complex treatments. The workers in all those facilities are federal employees. Ethical and financial oversight is exercised by committees of the public and health care workers at each level. The system is primarily financed through taxes and if - if - there is any payment for elective services it is on a sliding scale based strictly on ability to pay.

And know that, as radical as that sounds, we would not be the first nation to have a system similar to that.

If alongside that public system a private system persists for those who can afford and want to pay for some extra luxury or who will indulge in various nips and tucks and facelifts and the rest of the vanities, fine. In fact, good, because those people will still be paying their full share of taxes to support the system - no tax deductions for private insurance - while reducing the demands on it.

My wife is a retired registered nurse who often lamented the fact that the health care industry is becoming ever-more "industry" and ever-less "health care." She continues to cling to the ideal that the needs of the patient, not the needs of accountants or investors or executives of health insurance corporations, should be the focus of health care workers.

Ultimately, a not-for-profit national health care system is the only way to get there. And we as progressives should take this opening to call for it. And don't give me any of that "It's all  fantasy, it'll never pass this Congress." Of course it will not pass this year; don't take me for a fool. But it never will pass unless at some point you stake out the ground and say this is where we want to be, this where we should be, this is where we have to go.

So let's do it.