A NOTE FROM DR. J.
(Reprinted from Emergence - The Institute for Ethics and Emerging Technologies (IEET) Newsletter (subscribe)
-----
Surprisingly I had not watched Michael Moore's Sicko, a documentary about the failures of the American healthcare system, until tonight. My thirteen year-old son and I watched it while working out on our elliptical machines. I was interested in his reaction, his growing sense of youthful disbelief and outrage, while jaded I was simply sad and bemused. I confess I did cry. But my overall reaction was simply shame that I have not done more to fight for universal healthcare coverage in the last decade.
My father was a Blue Cross Vice President, an actuary, and my mother was a lobbyist for public mental health services. Our family was deep into healthcare politics from about 1965 on, when the first attempts at public coverage were enacted in the United States, Medicare for the elderly and Medicaid for the poor. From then on my parents grew increasingly disgusted with the failures of American health insurance, and both strongly supported a public, universal health insurance program like Canada's.
My experience of public universal coverage was during my year in Japan. My now wife, then girlfriend, had contracted amoebic dysentery while briefly visiting me in Sri Lanka. She was treated for months after in Japanese hospitals for free, as was I for more minor ailments when I joined her later. It wasn't till I returned to the U.S. and began to study health policy at the University of Chicago that I began to understand what a radical failure the American disordered "system" is in comparison to rest of the industrial world.
During the 1994 Clinton health care reform push bioethicists I worked with or knew were part of the "committee of 500" that drafted the Clinton plan. Although I supported single payer universality for its political and administrative simplicity, I was won over to the virtues of a Clinton-style system universal voucher based choice, one which could ensure relatively equitable healthcare for all while allowing a greater diversity of healthcare options than a single payer system. One of the things I read at the time that influenced my views was Ezekiel Emanuel's The Ends of Life, which also argued for universal vouchers with a choice of multiple plans, as Emanuel did again most recently in his book with the highly respected Victor Fuchs in Healthcare, Guaranteed: A Simple, Secure Solution for America. (You may recognize Emanuel as the head bioethicist at the NIH, chief healthcare advisor to Obama administration, and brother to White House chief of staff Rahm Emanuel.)
Frankly I would have been happy with either single payer or a universal voucher system like the Clintons' and Emanuel's, but on the margin I was intrigued with the idea that with a universal voucher we might have a Catholic health plan without birth control or abortion, an alternative medicine health plan with homeopathy, and a transhumanist health insurance plan that could spend a lot on experimental gene therapies and life extension drugs, but shave costs by sticking you in a vat of liquid nitrogen if you had a bad prognosis.
The Republicans and the health insurance industry demagogued the Clinton plan to death in 1994, calling it "socialism," like every other attempt at health insurance reform since 1914. And they are doing the same thing today, aided now by their Faustian alliance with the frothing, right-wing conspiracy-mongers, gun nuts, racists and anti-government activists collectively known as "teabaggers." The difference is that this time the reforms on the table offer far less in terms of regulation of health insurance than in 1994.
The big difference this time is that the proposed reforms will ensure that the 50 million Americans without health insurance will have a public insurance option to choose in addition to the private health insurance options. In the 1994 proposal every Health Insurance Purchasing Cooperative would have had to ensure that there was at least one fee-for-service, one PPO, and one HMO to choose from, all non-governmental. This time, at least in the more progressive House version of health reform, we would be guaranteed a choice of a for-profit health care or a public health insurance plan.
This is not socialism, and not a government take-over of health care, although I confess that I wouldn't lose any sleep if the public option grew and eventually drove out private health insurance.
Now the craven sold-out right wing of the Democratic Party in the Senate, pockets bulging with health care lobby money, wants to remove the public option in their mind-numbingly futile effort at seeking "bipartisan consensus" on healthcare.
How can we have bipartisan consensus with people practicing the Big Lie straight out of the Goebbels playbook? People inventing their own Protocols of the Elders of Zeke, screaming that "Obama is a Communist Nazi" and that the Democrats want to kill old people?
The opportunity for healthcare reform comes once every twenty years in the United States. By 2029 we will have gene therapies, anti-aging therapies, organ and tissue engineering, and nanomedicine. Today being uninsured will take a couple years off your life expectancy. In 2029 even fewer people will have health insurance, and being without will take decades off your life expectancy. Today our exploding healthcare costs from wasteful, for-profit administrative costs and overtreatment are already crippling the American economy. The health cost cancer will be unimaginably worse without reform in twenty years.
Don't get me wrong: I would still support reform legislation with a public option, if only to ban insurance companies from screening for pre-existing conditions, one of the most obscene practices of American health care. And the reforms will still attempt to mandate a kind of universality, by requiring everyone to purchase healthcare, with subsidies if necessary. (The Clinton reforms would have ensured universality by issuing every citizen a voucher.) But we can and should do far better.
This is an essential technoprogressive value: every person should be ensured access to life enabling benefits of safe, effective biotechnology. In every other industrialized country the debate over enabling technologies is whether they are safe and effective enough to be included in the universal health plan. I fervently hope that, after more than one hundred years of American health reform agitation, we can finally create a system mature enough to allow that debate here.