Healthcare Legislation: Blowing Off 15 Million Americans

Wednesday, December 16, 2009

“In the beginning…” Sounds biblical, doesn’t it? In the beginning, going way back to January 20 of this year, the day Barack Obama took office, there were two reasons for healthcare reform legislation. They were, in no particular order: (1) Because the costs of healthcare are spiraling out of control; and (2) Because there are an estimated 46 million Americans who have no medical insurance at all and who, because they can’t afford it, are not receiving adequate healthcare. This piece is about the second of these reasons, the need for universal healthcare, for a system, a program that would ensure that all Americans would have access to the quality healthcare they need.

To his credit, President Obama wasted no time telling Congress to get its collective ass in gear to devise and pass healthcare reform legislation of, once again, biblical proportions. Easier said than done.

For one thing, Congress doesn’t work for the President, which is a good thing. He can encourage them, but he can’t order them, not really, to do anything.

For another, rather than offering Congress the details of a program he would like them to pass and then shepherding that program through, President Obama left it up to the House and Senate to pretty much come up with their own plans – which turns out to have been a huge mistake.

Third, he’s a good guy, but inexperienced and naïve. His best intentions notwithstanding, President Obama seriously underestimated the difficulty of what he was asking. Rather than relaxing the pace and working with Congress to perfect this essential legislation, he’s continued to push Congress to wrap it up by this and that imaginary deadline. His message, which his Democrats have dutifully repeated among themselves, is that “passing something is better than nothing” – to which I respond, with profound eloquence and intelligence, “What?!”

Fourth, the President and Congress have been hell bent on making history since the beginning and have been fixated on passing a single, comprehensive piece of legislation that no one, not even themselves, fully understands. They could have, and still can, write separate laws for different objectives – no pre-existing conditions, for example, letting insurance companies do business across state lines, allowing the duty free import of pharmaceuticals from Canada, etc. – many of which are free things to do. But no. (I, personally, have long believed that the more pages there are in any legislation, the less likely it is to succeed. It’s sort of a Newton’s Law of Legislative Uselessness: That the effectiveness of any legislation is inversely proportional to the square of the product of the number of pages, times… that’s right, times 1 over the size of the font. Nobel Prize Committee, get ready. I’m leaving for Oslo now.)

Unfortunately, there is a fifth problem.

On September 8 of this year, the day before his speech on healthcare reform to a joint session of Congress, President Obama met with 40 students, freshmen at Wakefield High School in Arlington, Virginia, just across the Potomac. One student asked the President this question:

“…currently 36 countries have universal health coverage, including Iraq and Afghanistan, which have it paid for by the United States. Why can’t the United States have universal health coverage?”

To which President Obama responded by saying:

“Well, I think that’s the question I’ve been asking Congress, because I think we need it,” Obama said. “I think we can do it. And I’m going to be making a speech tomorrow night, talking about my plan to make sure that everybody has access to affordable health care.”

Unfortunately, when the President said “everybody,” he was only kidding. The following day when he made his speech before Congress, the concept of universal healthcare was never mentioned.

The President and Congress may tell you that the recession, budget deficits and the national debt have, regrettably made the objective of truly universal healthcare temporarily unattainable. It is an excuse which presumes that there is no less expensive way to provide expanded healthcare coverage than what Congress has been able to devise so far, and that that there are no other items in the federal budget which are of lower priority and might be cut to make room for universal coverage. (By the way, according the estimates by the Centers for Disease Control, outlawing smoking would probably make truly universal coverage affordable by virtue of the savings in medical services related to smoking-related illness.)

The legislation which the Senate is currently debating insures an estimated 31 million of the 46 million or so Americans who are currently without coverage. As to the other 15 million, that’s roughly a million people more than the total 2008 estimated populations of our 14 smallest states, including – sorry, I have to do this to make my point – in ascending order: Wyoming, District of Columbia, Vermont, North Dakota, Alaska, South Dakota, Delaware, Montana, Rhode Island, Hawaii, New Hampshire, Maine, Idaho and Nebraska. That’s right, to the equivalent of population of all those states, and then some, we’re effectively saying, “Tough. Good luck. You’re on your own. Maybe next time.”


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