Thursday, October 8, 2009

Let Congress Go Without Insurance

From the New York Times:

Let Congress Go Without Insurance

Let me offer a modest proposal: If Congress fails to pass
comprehensive health reform this year, its members should surrender
health insurance in proportion with the American population that is

Nicholas D. Kristof

It may be that the lulling effect of having very fine health insurance
leaves members of Congress insensitive to the dysfunction of our
existing insurance system. So what better way to attune our leaders to
the needs of their constituents than to put them in the same position?

About 15 percent of Americans have no health insurance, according to
the Census Bureau. Another 8 percent are underinsured, according to
the Commonwealth Fund, a health policy research group. So I propose
that if health reform fails this year, 15 percent of members of
Congress, along with their families, randomly lose all health
insurance and another 8 percent receive inadequate coverage.

Congressional critics of President Obama’s efforts to achieve health
reform worry that universal coverage will be expensive, while their
priority is to curb social spending. So here’s their chance to save
government dollars in keeping with their own priorities.

Those same critics sometimes argue that universal coverage needn’t be
a top priority because anybody can get coverage at the emergency room.
Let them try that with their kids.

Some members also worry that a public option (an effective way to
bring competition to the insurance market) would compete unfairly with
private companies and amount to a step toward socialism. If they
object so passionately to “socialized health,” why don’t they block
their 911 service to socialized police and fire services, disconnect
themselves from socialized sewers and avoid socialized interstate

I wouldn’t wish the trauma of losing health insurance on anyone, but
our politicians’ failure to assure health care for all citizens is
such a longstanding and grievous breach of their responsibility that
they deserve it. In January 1917, Progressive Magazine wrote: “At
present the United States has the unenviable distinction of being the
only great industrial nation without universal health insurance." More
than 90 years later, we still have that distinction.

Theodore Roosevelt campaigned for national health insurance in 1912.
Richard Nixon tried for universal coverage in 1974. Yet, even now,
nearly half of Congress is vigorously opposed to such a plan.

Health care has often been debated as a technical or economic issue.
That has been a mistake, I believe. At root, universal health care is
not an economic or technical question but a moral one.

We accept that life is unfair, that some people will live in cramped
apartments and others in sprawling mansions. But our existing
insurance system is not simply inequitable but also lethal: a very
recent, peer-reviewed article in the American Journal of Public Health
finds that nearly 45,000 uninsured people die annually as a
consequence of not having insurance. That’s one needless death every
12 minutes.

When nearly 3,000 people were killed on 9/11, we began wars and were
willing to devote more than $1 trillion in additional expenses. Yet
about the same number of Americans die from our failed insurance
system every three weeks.

The obstacle isn’t so much money as priorities. America made it a
priority to provide tax breaks, largely to the wealthy, in the Bush
years, at a 10-year cost including interest of $2.4 trillion.
Allocating less than half that much to assure equal access to health
care isn’t deemed an equal priority.

The plan emerging in the Senate is no panacea. America needs to
promote exercise and discourage sugary drinks to hold down the rise in
obesity, diabetes and medical bills. We need more competition among
insurance companies. And conservatives are right to call for tort
reform to reduce the costs of malpractice insurance and defensive

But those steps are not a substitute for guaranteed health coverage
for all Americans. And if health reform fails this year, then hopes
for universal coverage will recede again. There was a lag of 19 years
after the Nixon plan before another serious try, and a 16-year lag
after the Clinton effort of 1993. Another 16-year delay would be
accompanied by more than 700,000 unnecessary deaths. That’s more
Americans than died in World War I, World War II, Korea, Vietnam and
Iraq combined.

The collapse of health reform would be a political and policy failure,
but it would also be a profound moral failure. Periodically, there are
political questions that are fundamentally moral, including slavery in
the 19th century and civil rights battles in the 1950s and ’60s. In
the same way, allowing tens of thousands of Americans to die each year
because they are uninsured is not simply unwise and unfortunate. It is
also wrong — a moral blot on a great nation.

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