Margarette - NYC, NY: For Reform

The health care debate has been raging all summer, and lucky me, I’ve been ignoring it. I’ve been too busy working to pay attention, but that doesn’t mean I don’t care. I very much care, as my son and I are part of the over 46 million Americans without health insurance. I haven’t been able to find full time work for the past year, so I’ve been working three part time jobs. That keeps the roof over our heads and the bare minimum bills paid. I pay the car insurance (because I can’t get out of my lease), but I can’t afford private health insurance. I make too much for Medicaid, but now that my son is over 18, he can apply for coverage. And now, thanks to my strong union, I will be eligible for health care through my employer in the fall.

But in the time I spent overseas, I lived in two countries with national health and one with mandatory health insurance. Taiwan and Sweden were the national health countries, and in Switzerland, insurance is mandatory. If one isn’t covered through an employer, there is an affordable option available through the government.

Sweden is often held up as the exemplar for national health, and while I wouldn’t go that far, I can say that in most instances, it was fine. My son is an epileptic, and as a child under 18, all of his medical care was covered. When we came to America, even with the insurance I had the first year, my co-pay was over $300 on an office visit and some blood work. And he’s supposed to see the doctor twice a year.

Of course, on the flip side of that, my taxes in Sweden ran close to 50%. Through taxes, I paid for the care there, as well, but when my husband and I were out of work, my son still got the care he needed. I checked some policies, and private health insurance for myself alone would cost about 25% of my yearly income; for the two of us, about 44% of my income. Add my taxes to 44% and I’d be paying well over 50% of my income, so cheaper in Sweden.

One major problem with the Swedish system is that it’s overtaxed. Unemployment is high—about 10%–and with an ageing population, there’s too much going out and not enough coming in. And Sweden only has a population of nine million people. Administrative costs are relatively low.

Swedes also register with the government and are assigned doctors, whether you like them or trust them or not. I was very lucky with my son’s doctor, but terribly unfortunate with the “specialist” I was assigned. To be perfectly blunt, she was inept at treating my disease and prescribed something no longer prescribed, in fact, something contraindicated. When I balked, so did she and my care went downhill from there.

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America has fine health care, but it’s just not affordable. And one thing alone is not going to fix the mess we’re in. America’s health care woes are caused by many factors: profit-driven insurance and pharmaceutical companies, foolish laws, core ideals about personal responsibility and American’s poor health habits. And frankly, labels don’t help. Am I left or right? Am I socialist or capitalist? Am I liberal or conservative? Throw out the labels and just think.

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I really don’t mind physicians getting a large salary. Most made years of sacrifice and paid through the nose for their educations, and they hold my life in their hands. I would love to be making what they are (the average US general practitioner, internist or pediatrician makes just under $150,000 a year according to the website payscale.com) since I have as much education, and I hold the future of the country in my hands, but that’s another story. Of course, that’s the average salary. That means that there are selfless physicians working for $30K in America’s rural and urban poverty centers while there are profit-driven folks raking in obscene amounts. But that’s capitalism.

Doctors today are major employers—they have nurses, LPNs, office staff and so on. Physicians have to pay salaries and often benefits, as well. All that is reflected in the price of a visit. I get that, as well.

Many states also succumb to pressure groups, making insurance companies cover all sorts of things on minimum plans. Boston Globe columnist Jeff Jacoby wrote a very enlightening piece on this “Healthcare: Do we need the Lexus?” that I highly recommend. Let me include one very eye-opening paragraph:

Forty years ago, there were only a handful of benefits that health policies were required by law to cover. Today, the Council for Affordable Health Insurance identifies an astonishing 1,961 mandated benefits and providers. While any one mandate may not add appreciably to the price of an insurance policy, in the aggregate their cost is huge. The Cato Institute, citing the Congressional Budget Office, estimates that state regulations increase the cost of health insurance by 15 percent. And since “each percentage-point rise in health insurance costs increases the number of uninsured by 300,000 people,’’ as scholars John Cogan, Glenn Hubbard, and Daniel Kessler point out, it is clear that the proliferation of insurance mandates is one reason why millions of Americans are uninsured.

Frankly, if the insurance mess was cleaned up, there would be a lot more affordable private insurance that would be available for people to purchase.

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And finally, the thing I am seeing get in the way of discussion so that we can’t even make a small change is America’s core values. As many have correctly pointed out, health care is not something to be provided for by the government. The Constitution and Bill of Rights don’t mention health care at all. Of course, in 1776, health care was a pretty rudimentary item. Catastrophic medical bills weren’t an issue.

America also likes to pride itself on being a caring country. Some people claim that we are a Christian country, and while I don’t agree, our culture, like all of Western culture, is solidly based on Judeo-Christian-Islamic values (all three are sons of Abraham, following the same basic rules given to Moses). Just about any religious value system includes caring for the sick, so that’s at odds with our capitalist values on some levels.

Of course, we say that people have the right to life, liberty and the pursuit of happiness. I guess health care falls under the life part. So it can get sticky.

When we discuss issues that involve core values, things can get heated. We see this by the knee jerk reactions on both sides of the discussion. People are no longer discussing health care—they are discussing what it means to be an American. They don’t articulate it, but that’s what it is. In America, the word “socialist” is a bad word, but we have Social Security and Medicaid and Medicare.

As you can tell by the previous 2000 words, this is a complex issue. As the New York Times notes in its helpful article “A Primer on the Details of Health Care Reform:”

“Each side hopes to win ground by boiling down one of the most complex policy discussions in history into digestible nuggets.”

Not only are the sides turning this complex discussion into sound bites, most Americans seem to be perfectly happy with looking no further than those sound bites. When I started really looking into President Obama’s health care reform, I found it confusing and amorphous. And I have 20 years of experience reading freshman compositions. I am not being facetious. Most students today have incredibly weak logic skills, yet I read their papers and ferret out meaning. Before I was a teacher I was a legislative correspondent. That’s a fancy term for being a reporter in the state capitol, reporting on legal stuff. I’ve read more bills and laws than most non-lawyers. I’m not a neophyte at this.

At the end of the day, I do wish there was a way I could afford health care for my son. I don’t mind paying premiums at all, but I can not afford to pay 44% of my salary to cover us both. As President Obama rightly points out, health care costs in this country are out of control. Something should be done. Now we have to see exactly what gets put on the table. It all seems unformed still.

One final point: Americans have to take responsibility for their health. Americans are some of the fattest people in the world, and even many who are thin have deplorable diets. I’ve written about this before, what and how Americans eat, but we need to take control of our lives. When I am a rich philanthropist, my ultimate goal in life, I want to teach nutritious cooking to young people and young mothers. And I mean real nutrition, not the government-sponsored ideas of nutrition. I’m overweight myself, and I work at getting thinner, but I do know that my diet is relatively better than the average American.

Drunk driving is also something Americans do more than most places I’ve ever lived. In Sweden, a country known for massive drinking, people simply don’t drink and drive. Not just because there are stricter laws; driving while drunk is stupid, and almost every Swede I’ve ever met at parties, where I was the designated driver, has asked why Americans are stupid enough to drink and drive. Answering that we have the freedom to do what we want just doesn’t sound right. How many millions does drunk driving cost in medical bills per year?

James - Littleton, MA: For Reform

I hear a lot about socialism, tax increases and so on, but here's the deal: we're all going to pay for it anyway. I pay big money for healthcare every month. Call it premiums, call it taxes, call it whatever, today I pay for myself, my family, and anyone without insurance that shows up at the ER unable to pay. It's not about politics...as a nation, we need to figure out how to take care of each other and how to pay for it.

...or not, because we could just tell people to go be sick at home for free, and live in a country like that.

Let's stop dragging our feet and make some tough choices, starting with the basics.