Health care debate lacks productive talk

June 19, 2009


At the Barbara Jordan Conference Center in Washington last week, researchers unveiled a new study showing that women from racial and ethnic minority groups lack health insurance, receive late or no prenatal care, and put off medical care because they can’t afford it.

On Capitol Hill this week, Democrats were backtracking on ambitious draft legislation estimated to cost more than $1 trillion over 10 years, while Republicans were dissing “elites” and warning of a tax-happy “government takeover” of the health insurance system that so many Americans know and supposedly love.

They all were talking about health-care reform, but I wonder whether they all were part of the same conversation.

Momentum behind the Obama administration’s efforts to improve the nation’s fundamentally unsustainable health insurance system seems to be running into the us-versus-them politics that so often leaves good intentions in the rubble of failed legislation.

I’d like to believe that Republicans and Democrats, as well as the many stakeholders and interest groups involved, are on the same side in wanting to bring down health care costs, improve the quality of medical care and expand access to affordable services.

But are they willing to do what’s necessary to achieve those goals?

When 46 million people in this country lack health insurance, that means far too many aren’t being served well and everyone ends up paying because of it.

Lots of Americans supposedly like their current coverage, but I wonder whether they’re more afraid of the devil they don’t know than of the devil they do. And what about those who have nothing to like?

Years ago, when the plan my employer provided didn’t cover annual well-woman physicals, I hated it, but better to have a flawed plan than none.

Same thing now, when my 80-20 plan carries a sizable monthly premium, a hefty deductible and that 80 percent ends up being 80 percent of what the insurer wants to pay, not of what the doctors actually charge.

Part of the difficulty of overhauling health care is devising something that will work for the have-nots as well as the haves and the just-barely-holding-ons. It’s not nearly as straightforward as deciding which income level qualifies for government aid to buy insurance ($66,000? $88,000?).

The current system perpetuates many unfairnesses, not the least of which is less access to care for those who tend to have higher rates of illness.

For instance, a study from the Kaiser Family Foundation found that “Women of color fare worse than white women across a broad range of measures in almost every state, and in some states these disparities were quite stark.” In Texas, 27 percent of black women and 45 percent of Hispanic women are uninsured, compared with 16 percent of white women, the foundation reported. And more than twice as many minority women as white women in Texas live in poverty and lack a personal doctor.

The day-to-day realities of getting sick and staying well in America will remain to be addressed even if Congress is able to work out some of the most divisive issues: whether to have a government plan compete with private ones, whether to tax health benefits, whether to penalize companies that don’t offer their workers coverage.

What doesn’t help is to keep polluting the debate with scare-tactics bogeymen of “socialized medicine” and “rationed care” and, heaven forbid, “higher taxes.”

Government already has a significant hand in health insurance — providing for members of Congress, veterans, and federal and state workers.

The federal government also partners with states to cover low-income children through the Children’s Health Insurance Program, wherein providers, not bureaucrats, administer the plans. That doesn’t mean a government-run plan will solve all ills. But it isn’t the end of America as we know it.

Much as we like to imagine that job-based insurance offers freedom of choice, reality is that in most workplaces the employers pick the plans. If they switch, the doctor you’ve seen for years might no longer be in your coverage network.

As for taxes, nobody likes them. But right now the costs of uninsured patients get shifted into higher premiums and hospital bills, and a chunk of tax money goes to reimbursements for uncompensated care.

Maybe the plan laid out last week by four former Senate leaders through the Bipartisan Policy Center can help get the conversation back to productive discussion — before everyone’s just talking past each other.

— Linda P. Campbell is a columnist and editorial writer for the Fort Worth Star-Telegram. Her e-mail address is lcampbell@star-telegram.com.


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