Columns » John Brummett

A real health care story



Political opinions seldom get formed or changed by mere preaching or substantive policy debate. They're formed or changed by emotional human connections forged through compelling human stories.

What happened in August was that all the gripping stories, while false or dishonest or uninformed or overwrought or irrational, were on the side of opposition to health reform.

Members of Congress were confronted by citizens telling them stories about grandma, about the drugs she needs or the cancer she has, and about how they fear and deplore a government that would dare to ration her care or force her to have her plug pulled.

The stories were so powerful that they couldn't be countered by the plain fact that they weren't based on reality.

So I listened with interest last week as U.S. Rep. Mike Ross of Prescott related a different kind of story on health care.

There is a woman who owns and operates a diner in Ross' little hometown in southwestern Arkansas where the Rosses like to go for Sunday dinner after church sometimes.

The restaurant business is hard. That's especially so in a struggling little town during a recession when people tend to eat at home more frequently.

The woman has only a few employees and, like most tiny businesses, she provides no health insurance, either for those employees or herself. Her margins are much too small for that.

So she has this heart valve problem that needs surgical attention. But she can't possibly afford it. So her plan is to keep working hard to keep the restaurant going and hold out three more years until she goes on Medicare.

Ross sold the story a bit short. He cited it to make only two points.

One was to illustrate one reason he and other Blue Dog Democrats held up the health care bill. It was to raise the payroll threshold for an employer mandate to provide insurance or pay a penalty. Initial versions of the bill applied the mandate to businesses so small they couldn't survive it — businesses like this restaurant.

The other was that the uninsured aren't necessarily slothful or irresponsible. Many are simply in a jam.

Good points. But there are others.

The obvious one is that there's something tragically amiss when a hard-working proprietor and employer has to ration her own care.

Another is that, because of the woman's waiting for Medicare, her care will escape the responsibility of the current private profit-based system and get deferred to the taxpayers who are drowning in unsustainable deficits and debt already. We can't long go on that way.

Another is that we don't make any sense when we decry government medical care when so many of our people rely on it.

Another is that any uninsured employee of this restaurant winding up in a hospital emergency room would present another drain on taxpayers. And it's one that could have been avoided, absorbed in the private sector, if we mandated and provided the subsidies where needed for universal health insurance by which everyone, one way or another, had to get it.

The rest of us get tapped either way, whether through the portion of our own health insurance payments that go to defray the costs of care for the uninsured (about $1,100 off the top every year, Ross says) or through tax money that would subsidize low-income persons in their securing of health insurance.

It makes more economic sense to help low-income people get insured, to augment whatever payments they could afford and were required to contribute to that insurance, than to roll the dice and wait for them to run up massive medical bills.

Ross says — and this is important — that the point of universal health care isn't a new government entitlement program. It's to spread and thus help control unsustainably skyrocketing costs. It's a matter of shared public and personal responsibility.

The rationed care, the perilous waiting — that's not the ominous threat of a new health care system. It's the immoral and tragic reality of the existing one.

P. S. — Tuesday (after this column went to press) Ross was to officially announce his opposition to a public option among health insurers. His counterpoint: It is that we can have worthy health insurance reform (and help his diner friend and her employees) without a public option. He argues we can do that if we mandate that everyone get health insurance, steer the uninsured into new health care exchanges and provide the uninsured with subsidies up to 400 percent of the federal poverty level.


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