Conservatives woke up to a harrowing sound on Capitol Hill on Wednesday: a serious discussion about single payer health care. The House hearing won’t necessarily lead to a viable policy proposal–and there’s plenty to debate even within the progressive circle–but advocates didn’t have trouble making the case for providing equitable universal health care. Yet, centrist Democrats have cautiously rolled out proposals that gesture toward a “public plan option,” but ultimately assure medical industry lobbyists and other opponents that Big Brother would not encroach on the turf of private insurers. One stated goal in the Democrats’ proposed legislation is to deal with racial disparities in health—stressing the need for more comprehensive community-based care and “new data collection efforts to better identify and address racial, ethnic and other health disparities." Yet health data that has been piling up for years has already pointed one key conclusion: the gaps plaguing communities of color can be alleviated efficiently through universal public health care. A new report from the Office of Minority Health spells it out plain: mind-boggling disparities in cancer deaths between Blacks and whites, disproportionate rates of diabetes among people of color, a stark color line in new HIV infections, and here’s the kicker: "More than one in three Hispanics and American Indians – and just under one in five African Americans – are uninsured. In comparison, only about one in eight Whites lacks health insurance." Another new study links household bankruptcy and medical bills, clearly tying healthcare disparities to economic distress that disproportionately affects people of color. So the crisis is obvious. But what does this tell us about single payer? It’s hard to project the effectiveness of untested models, after all. Thankfully, we can refer to massive case studies already in existence for clues about what universal public health care would do. According to a recent study on the impact of Medicare on health disparities, "Medicare coverage greatly ameliorated racial, ethnic, and socioeconomic disparities, suggesting that covering more of the under-65 population would improve health outcomes overall." Nonetheless, lawmakers remain locked in a waltz of apprehension—some say self-defeatism—arguing that no reform can move forward without reserving a dominant role for the private sector. While some Black, Asian American and Latino lawmakers have called for more sweeping reforms, others are still pursuing that “genuine philosophical truce” with the foes of socialized medicine. But Timothy Noah at Slate explains that employer-based health insurance is becoming increasingly difficult to defend on both ethical and policy grounds. And in her statement before the House, Dr. Marcia Angell of Harvard Medical School talked about matching the goal of healthcare for all with the institutional structure that best facilitates it:
I don’t underestimate the special interests that would be arrayed against establishing such a system – they would be formidable, and it would take concerted pressure from the public and the medical profession to defeat them – but the fact remains that a national system is the only way to provide universal, comprehensive care, while providing a mechanism to contain costs. What is truly unrealistic is anything else…. We live in a country that tolerates enormous and growing disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities. We need to acknowledge the same thing for health care. Providing these essential services to all Americans, regardless of who they are, marks a decent and cohesive society.
With inequality embedded, and politically accepted, in virtually every facet of American society, Congress may not be ready to treat health care any differently than it does other social resources. That might have to wait until enough people outside the Beltway get sick enough of the conventional wisdom. Image: Air America