Our 'Kindness Deficit' of Care
Newsweek, November 8
Jane Bryant Quinn
Our ‘Kindness Deficit’ of Care
After the third presidential debate, the plight of those without health insurance vanished from political sight. No surprise there. Lack of medical care represents a moral lapse that voters love to tut-tut about but aren’t moved to fix. Fixing it might cost money, at which point the moralists usually change the subject to the weather. Besides, the uninsured tend to be powerless people whom America’s comfortable middle can ignore.
A cynical judgment? Sure, but true. If we cared, public policy would have changed long ago. When the elderly scream about the cost of prescription drugs, ears prick up. But 80 percent of the 45 million uninsured are what Princeton health-care analyst Uwe Reinhardt calls “low-income, hardworking stiffs “waitresses, taxi drivers, clerks, nursing-home aides, gas-station attendants. They swing no weight among policymakers; no lobby represents them; their pockets aren’t deep enough to buy congressional attention. Working stiffs have to depend on the kindness of strangers and we’re running a kindness deficit.
What’s more, failing to cover 45 million people is, indisputably, a bargain.
The uninsured received $48 billion in free or government-paid care last year (less than they needed, but so what?). Insuring them could cost about $96 billion more. Ooooh, that would raise taxes, so we look away.But does it have to raise taxes? Imagine, for a blessed moment, that we ditched our costly, inefficient, bureaucratic, paper-pushing, interfering private health insurers in favor of a single government-run system for example, Medicare for everyone. The savings in administrative costs alone could reach $325 billion, says Dr. David Himmelstein of the Harvard Medical School. Taxpayers already cover 61 percent of American health-care spending (counting both subsidies and direct payments). If that money didn’t have to be funneled through private insurers, who take 20 percent or more off the top, we could have universal care at no increase in cost.
Any rant against our carelessness toward the uninsured requires statistics, so here they are: among all working people, 61 percent receive employer coverage, down from 65 percent in 2001 (Kaiser Family Foundation). One out of three people under 65that’s 85.2 millionwent uninsured at some point during 2002-03 (Families USA). The proportion of doctors giving charity care dropped to 71.5 percent in 2001, from 76.3 percent in 1997 (Center for Studying Health System Change). Among people 51 to 61, the uninsured are 63 percent more likely to suffer declining health, over a four-year period, than the insured (Center on an Aging Society). All of us “comfortables” stay insured only because we keep our jobs or can afford to pay private-insurance premiums, whose cost has been soaring at three times the rate of earnings over the past four years.
Nevertheless, Big Medicine holds enough power to beat down true reform. You
can still be spooked by phrases like “government-run health care,” even though that defines Medicare, which you want more of. You’re also hearing a fierce assault on Canada’s universal coverageclaims that patients get poor care, wait months for treatment and flee to the United States for surgery. In truth, only a fraction of 1 percent of Canadians seek care in the United States, says health expert Steven Lewis of Access Consulting in Saskatoon, Saskatchewan. Canada does have waiting lines of eight to 12 weeks for surgery not considered urgent, owing to ceilings on what the government will spend. Maybe more patients would come south if they could afford it. But for most, the wait seems a reasonable trade-off for coverage that’s broad, universal and secure. Anyway, the United States doesn’t have to go that route. We spend nearly twice what Canada does per person. If that same money were applied to a universal program here, no one would wait. Canada outscores the United States in such basic health measures as longevity and infant mortality (not to mention cheap drugs and flu shots). “If the purpose of a health-care system is to improve health,” Lewis says, “Canada wins hands down.”
All health systems have pluses and minuses; all ration health care in some way. We ration it, harshly, by income and price. People with money and access command topnotch care. Those without scramble for what they can get. Big businesses negotiate good group-health insurance. Small businesses are pushed against the wall. The healthy find private policies, the sick get kicked out. That’s the American Way.The next Congress may give a nod to the uninsured, says Karen Davis, head of the Commonwealth Fund, which studies health policy. Maybe tax credits for people who lose their jobs, to help them buy interim, COBRA coverage, or eliminating the two-year waiting period that keeps the disabled from Medicare.
But will we make a fundamental fix? Nah. Too many rich, corporate players have a stake in the status quo. Princeton’s Reinhardt distills our chosen policy this way: the suffering of a few million Americans, while regrettable, is a price well worth paying for fine coverage for the rest of us. What’s really regrettable is that that sounds, to most Americans, OK.