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Health care reform: an extension of the American dream

For a country that relies on the bootstrap myth, the U.S.A. certainly has a health care system that punishes people who attempt to live that way. The self-employed, the small business owner, and most especially the scraping-by creative types—artists, designers, freelance journalists—have no easy way to get health insurance. We are stuck buying our own care on the “free” market, where a single person has very little bargaining power.

On Tuesday, September 1st, I became one of America’s 46 million uninsured. I have a graduate degree, a decent amount of published writing, and multiple regular freelance clients. There is a better-than-average possibility that I could pay my bills with my writing, except for that one problem. A survey by AHIP, the national organization of health insurance providers, reports that I can assume to pay an average premium of $4734 in New York state, where I reside.

Paul Krugman explains that employer-based health insurance is regulated by the government. Corporations can get tax advantages for providing health care for employees; benefits are not considered taxable income, so companies pay less in wages and make it up in health care. Krugman notes, “[T]o get that tax advantage employers have to follow a number of rules; roughly speaking, they can’t discriminate based on pre-existing medical conditions or restrict benefits to highly paid employees.”

Campus Progress reports that only 60% of the population is covered by employer-provided health care. 26 million small business owners or their employees remain uninsured despite having a steady source of income—because it simply costs too much.

AHIP reports that the nationwide average premium for a family buying private insurance is $5799, but this presumes a lack of “preexisting conditions,” for which one’s premiums can be raised, or coverage denied. Without the bargaining power of a large corporation behind you, you’re stuck paying what you can to whomever will accept you. My self-employed parents, in their early 60s, were paying $3300 a month for health insurance. That’s $39,600 a year.

They recently switched companies, taking a cut in the benefits that would be paid out, gambling on their own health at exactly the time that they need health insurance the most. They’re betting that they won’t have to shell out more than they already were in insurance premiums for health care before Medicare—a single-payer government-run system—kicks in when they turn 65. And they’re lucky. They make enough money to be able to afford those premiums. The average American family, meanwhile, makes just $50,740.

It’s here that the public option would come in; at least, if we end up with a version of the current House bill. Subsidized for people who make up to 400% of the federal poverty level—that would be on a sliding scale up to $43,320 for individuals and $88,200 for a family of four—the plan would provide care for those who are willing to live on less money to be their own boss or to work for a small business that can’t afford a large health insurance plan. It would allow people greater choice and freedom in the job market, in addition to providing competition for the health insurance companies that are often bloated and wasteful, spending sometimes only 60 cents of each premium dollar on actual health care.

So why is there such widespread resistance to the idea of health care reform that could make it easier for Americans to actually live the so-called American dream? Could it be that the idea of real equality makes a lot of people nervous?

Access to health care, after all, depends on more than just money. According to Adam Serwer, “Nonwhites are 52 percent of the uninsured population, the largest proportion of which is Hispanic, at 30 percent — but those numbers don’t tell the whole story about access. Even when people of color are covered, their access to quality care is diminished heavily by ongoing segregation and poverty; in nonwhite neighborhoods, it’s simply harder to find a primary provider than it is in white neighborhoods.”

As it is now, if you are white and well off, even if your health insurance costs you a bundle, you can get it—and it seems that some people would prefer to keep paying too much for their own care than pay a few dollars toward someone else’s, particularly if that someone else is not like them.

Amanda Marcotte wrote:

“They don’t want racial minorities and people without means sharing spaces with them, and especially not when they’re sick and being reminded that they’re the same flesh and blood as everyone else. The idea that a 14-year-old immigrant might get service first because she needs it more, and that there’s no way to pull rank? That’s the sort of thing that keeps the nutters up at night. When we say that the protesters are fundamentally racist, this is what we mean. They want health care access to be a privilege, a marker of class status. . . . They’re focused solely on their own potential to lose some status if others have the right to be treated like human beings, and they just can’t get past that.”

When the anti-health care reform crowd shouts about “rationing” and “waiting in line,” then, this is what they mean: they can’t use their pull to leap ahead of someone who doesn’t have the same advantages. For the same reason that large companies enjoy being able to attract better employees by being able to offer benefits the small businesses can’t match, rich people enjoy being able to push past those whose complaints might be much more serious simply because they have money.

The people protesting at health care town halls, though, aren’t all rich. Instead, many of them are barely hanging on themselves, yet seem terrified that “immigrants” or people of color might be granted the same quality of care they have. As if granting better care to someone else would take it away from them.

Disease, injury, and chronic pain are great levelers, after all: no matter how much money you have, cancer can strike or you can slip and fall. It’s arbitrary. You can’t buy your way around it. Yet our health care system purports to treat people as though you could; as if the people who get sick simply deserve it.

Countries that provide health care to all, by contrast, treat people on the basis of their illness, not their income, class, or skin tone. British journalist and comic book writer Kieron Gillen notes, “It’s one of the few things about my country I feel genuinely proud of. That we decided our country should have such a thing. . . it’s right. In a tedious, old fashioned way, it’s how the world should be.”

Providing basic health care to all citizens would be the furthest thing from un-American, from denying people’s freedom of choice. It would allow people the choice to leave jobs they hate without fear of losing benefits. It would allow people to strike out on their own without being punished with higher premiums and less coverage.

A public health care system would be an extension of the social contract that says what most Americans believe to be true already: that this country is stronger and better for the entrepreneurs, the creatives, the dreamers, the people who are willing to take a risk and fail. Those people deserve to have their basic needs taken care of. The only rights that will be stifled by a public health care system is the right of the rich to have a monopoly on innovation and risk-taking.

The current state of our economy can testify to how well that’s worked out for us.


Sarah Jaffe

Sarah Jaffe is former deputy editor of GlobalComment. She's interested in politics and pop culture, and has a special place in her heart for comics.

13 thoughts on “Health care reform: an extension of the American dream

  1. I love the States but boy am I glad I live in the UK. The NHS isn’t perfect by any means but I wouldn’t trade it for the world. I hope America sees sense, after all if you’ve got the money you can still go private if you want-so what’s the problem?

  2. No problem at all Mark, if you don’t live in this puzzling country. I lived in the UK and Canada but now my family lives outside Chicago and I have endless discussions with friends and neighbors about health-care misconceptions. The problem is our dysfunctional Congress,or more particularly the Senate. Democratic mandates are practically meaningless. Look at the century it took to grant voting rights to blacks in the south after an epochal war.

  3. Journalism like this is why I keep coming back to this site, over and over again. Great job, Ms. Jaffe!

  4. This is a straw man argument. The resistance to health care reform is not race and class.

    “When the anti-health care reform crowd shouts about “rationing” and “waiting in line,” then, this is what they mean: they can’t use their pull to leap ahead of someone who doesn’t have the same advantages. For the same reason that large companies enjoy being able to attract better employees by being able to offer benefits the small businesses can’t match, rich people enjoy being able to push past those whose complaints might be much more serious simply because they have money.”

    This is the worst of what you wrote. It’s disgusting that you would characterize people this way, but it’s a typical socialist’s point of view. The only possible reason that people could be opposed to this is that they’re heartless bigots, yeah, sure whatever.

    The real reason socialized health care is not a good idea is that the government, which already pays about 50% of health care bills via Medicare (when I was making $40K with a family of 4 to support, I still had to pay for fucking Medicare even though I couldn’t afford any insurance for my fam.) has no hope of managing this well. The government is pretty much shit at managing anything efficiently.

    The second thing is tyranny of the majority. Someone will be forced by threat of violence or loss of property (that’s what happens when you choose not to pay taxes, no matter if you think they are unjust) to pay for something someone else wants. Apparently the world thinks that it’s ok to steal from whom we can in order to pay for health care – some kind of right I suppose. I wasn’t aware that people have a God-given basic right to good health. Apparently God has been pretty lax on that count, considering history…

    I am by no means a rich person, but I can see that “democracy” is going to ruin this country. No matter how advanced technology-wise we become, there’s still no cure for good-ol’ envy.

  5. @ Ben C

    Your “tyranny of the majority” argument could be applied to any and all public services – including building roads, providing schools, paying police, buying tanks for the army, building jails or libraries – etc.

    “Life, liberty and the pursuit of happiness” can easily be defined as including basic health care.

    Also from a purely self-interested and patriotic point of view a strong, stable and economically successful country depends on having a strong, healthy and well-educated population. If America wants to remain relevant in the face of countries that are rapidly developing (eg China) it needs to take good care of its key assets (ie its people) and stop wasting so much money on inefficient health care.

  6. Sorry Ben,
    If you think the taxes are unjust you can leave.

    Apparently some people think that they have the right to generate wealth from a society without contributing to the things that allow that society to function.

    Guess what, if society has decided that one of the things that that it needs to function adequately is for you to have a smaller mansion so that people who aren’t as well off aren’t needlessly sick, if you don’t like it, the door is just over there.

    The real reason US healthcare is in such a poor state is that it has let the various healthcare companies dictate the legislation/policy. Every other country in the Western world somehow manages to provide a more socialist health system to it’s people, and not fuck it up as badly as the US.

  7. Brilliant article.

    The world is faced with the swine flu epademic which means that 46 million people in the U.S will be denied health care should the swine flu start spreading rapidly and 46 million people will be denied the vaccine when it becomes availabe. Therefore 46 million U.S citizens are definitely exposed to death should or more likely when the H1N1 virus fires up. What kind of a nation will the U.S be if it accepts to lose 46 million people? what American will accept to lose 46 million of his/her fellow citizens.

    The notion that anyone one would wish harm to his or her fellow citizen regardless of his/her background or color is morally unacceptable and denying the basic right of health care to a fellow citizen regardless of his/her background or color is morally unacceptable. A healthy nation makes a nation strong and a heathy nation makes a nation prosper. Repbulican and Democrats together hold the moral responsbility to protect all Americans equally and unfortuantely this is not happening because politics in Washington takes over principles, moral values and ethics.

    The republican party and their leadership are to be blamed for the failure to provide basic health care to America. The republicans; they like to preach about the principles and moral values but they are the least to implement. They like to preach about freedom but yet they encourage invasion of countries without any pretext. They like to preach about human rights but they encourage erecting detention and torture camps in Guantanamo Bay and else where in the world. This is the type of party that does not want to see a universal health care system enjoyed equally by all American because they have no morals but greed.Unfortunately they use democracy to hamper progress and spread greed and fear among Americans.

    In less than two years there will be congressional elections in the U.S and America needs to show that these bastards must not continue to oppress America and stand in the way of democracy and prospertity.

  8. The only issue I take with this writing is it embeds somewhat of a defeatist attitude.

    One of the first things in life I believe one must come to realize, ESPECIALLY IF THEY ARE AN ARTIST, is that, THE WORLD AND EVERYONE IN IT OWES YOU NOTHING.

    That statement isn’t a matter of moral “right” and “wrong”, it is simply a statement of FACTUAL REALITY.

    That is to say, no matter how many favors I may do for someone, no matter how many times I go out of my way for someone, there is absolutely no guarantee that they will return in kind.
    Therefore, not only should I be thankful and appreciative for ANY TIME anyone does anything for me (including something as basic as my parents feeding me when I was 3 years old), but I need to be prepared to “gun it alone” as often and as readily as possible.

    Oddly, this is half of the key to any socialized system being able to truly function well.
    It is based on assumption that the individuals of the community for INDEPENDENT functional ability at all times.

    It is not until this is locked in place that a socialized anything can begin to function in any kind of meaningful way.

    Again, as an artist, this frustrates me.
    With my label for example, there are two heads. Myself, which along with running the label, handling my own artist affairs, studio maintenance cost, etc. I have to make sure that (unlike many of our artist) I can do my part to keep us backed. An end deal where to make it all happen, what I’m called on to do extends way beyond my mere arts in multiple ways. (It’s also how I end up being able to afford decent medical, dental, vision, etc.)
    The other label head is in a similar case; to his end, I can be a bit more specific, and voice that he owns two restaurants.

    I will note, the very first thing we had to do was ensure we could function INDEPENDENTLY. (both of us deal with work hours that easily extend to around 70 hrs. a week)

    Next comes the socializing aspect. We strive to keep cost for any events we throw (look for us to be hitting Pacha up in NY soon Sarah), no kid should have to pay more then $20 to get top of the line anything far as we’re concerned.
    If our artists need something, that isn’t covered under the scope of our dealings with them, we try our best to accomodate. This is literally to the extent of doing things like me offering to open up my own home recently for an indefinite period of time, telling the person not to worry about rent, letting it be known I’d cover food cost, and then further looking into helping them get a job to help supplement their artist income.

    This is simply how we work.
    It’s very very communal.

    However, when a certain one of us laid claim to not being able to work for daily for what amounted to about a 6 month a time, we eventually dropped the person.
    The fact of the matter was, WE ARE NOT HERE TO CARRY YOU.
    All of us have to seriously strive for independent functionality otherwise our (my labels) system collapses. So long as we all work to the serious best of our ability, which does not always mean we can sit comfortably (there’s nothing comfortable about 70 hr work weeks, notably when there’s times where so much of that end result is being spread out that you’re left eating PB and J for weeks)….so long as WE ALL do that, when some circumstances come up that would hold one of us back or cause one to fall they can know that there’s a complete backing behind them to prevent this from happening.

    My point here is simple, it is my duty to realize not only my own end objectives, but where I’d like to see the world in general.
    I then further becomes my duty to first and foremost make sure I’m capable of pushing my agendas without falling (to my end that means I need to know I have an adequate income, that I can take care of myself without going broke if serious health issues arise, etc.); but the end deal doesn’t stop with me, and even now, at having just turned 30, AM I ENSURING I’M SECURE FOR WHEN I’M 60?
    After all this, I expand out, “I’m o.k., now how do I effect the system at large”.

    Any time artist begin making qualms with me about what they lack it annoys me. Similarly when cases come up and one of our artist is having some minor gripe because we can’t fly them in for an event (to hang out) while in the meantime I’m back to Ramen because all personal free spending cash (as opposed to investments and what not) has been gobbled up by literally helping push the same complaining artist and else.

    In this vein, the studio aquirements, marketing costs, etc.
    They are not something that occurred out of some sort of weird form of inherited wealth. Nor do I feel any sympathy or mercy for those not doing the best they can.
    These things may sound extremely “right”, but that’s because that’s half the formula.
    It’s only half the formula though.
    Just as real as it is that THE WORLD OWES YOU NOTHING, it is also true that YOU ARE NOT ALONE IN THE UNIVERSE.

    So you have to act on both premise.

    You’re initial premise in this writing took me a bit aback, because it stemmed from a world I know INTIMATELY.
    And the premise was simply false on it’s assumed stances of because I’m a “writer, musician, painter, etc. the concept behind insurance cost is often out of the question”.
    That entire premise allows for the first half of the equation to be destroyed and relies entirely on the second….which in and of itself falls apart without the first.

  9. Why is it that anyone who opposes the public option or gov’t run healthcare or anything like that is assumed to be racist? Am I not allowed oppose gov’t healthcare on its merits alone?

    Obama claims he won’t sign anything unless it’s budget neutral. We assume that to mean it must be budget neutral immediately and stay budget neutral. 1 big problem: they’re working with estimates. Gov’t programs never come in under budget, and cost estimates are always way too low compared with reality. Medicare was over budget by 20% in its first year. In 1969, the gov’t estimated Medicare would cost $12B by 1990. The actual cost was $110B.

    The 2 major entitlement programs in this country are broke! According to the CBO, Medicare has $37 TRILLION in unfunded liabilities. Social Security will be insolvent by the end of the next decade.

    With that track record, why should we trust that the gov’t can all of a sudden change how it operates?

    I’m all for healthcare reform. We need to change how healthcare is delivered and how insurance is sold. But there are better ways than turning it all over to the gov’t. Obama may tout the public option as just that, but long-term it will be the only “option”.

  10. I would like to make a comment to those who think that social health-care would cost us all too much: Wake up people!

    Those who have insurance (or the money to pay their health care bills privately) are already paying for those who do not have health-care. It is ALREADY passed on to you by the hospitals and doctors who have raised their existing prices to accommodate those who do not have health care. In turn, your insurance company has raised your rates and lowered your coverage. How can you think for a moment that you are not already paying for the fact that the care of the human race is disproportionate?? Would you actually rather the hospitals just let those without die in their waiting rooms? If so, please raise your hands high. I personally would like to see the faces of those who think so.

  11. I am an artist too. Thank you for those thoughts. It is not easy to do it yourself, and as real artists are so important to the health of a culture, we ought not be dying by the wayside or having our teeth go bad in our head, and in fact nobody should. Tooth pain will right your mind in a minute as to who “deserves” to be helped when they are sick.

    And to the selfish ranting self-described artist in the comments above…nobody owes you a living buying your work either. But you sure expect they will, don’t you? You sure expect to have a very satisfying life doing what you love on the dollars of those around you. And why the hell are you up there justifying your individual lifestyle when we are discussing systemic problems?

    Anyway, Mr “Artist,” we need to frame things less in this amoral greedy sense of doing only what the hell you MUST and damn the rest. What kind of junk is that? Lowlifes think like this.

  12. I live in the UK where healthcare is free to all, however illegal immigration has put such a strain on the system that government spending has nearly doubled and our taxes just keep going up as a result. Drug makers can charge what they want because it is an open ended commitment and we have no choice but to pay. There are no caps, but people die waiting for treatment

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