I don’t know if I support Obama’s health care plan simply because I don’t know what’s in it. The fact that Republicans have made so many amendments to the bill in committee and still gave it no votes seems to mean that they wish to make the bill fail completely. But let’s be optimistic. Despite my lack of a status as a policy wonk, I do have some warm feelings about a public plan in competition with private plans, if only because of the lingering libertarianism (that is near dead) in me that does not trust the democratic-republican system of government (i.e., voting in new blood) to solve problems that might creep up with a single-payer system fast enough. Private plans could (not necessarily will) be nimble enough to change policies and market those changes when patients see injustice, unfairness, or other problems in the public plan, but I’m no longer naive enough to think that private insurers will ever improve service unless they’re forced to. As things stand, with health care virtually divided into companies in non-competing regions of states, the profit motive will never, ever, ever make private insurers improve. Do they put patients’ health first? In my admittedly anecdotal experience and the second-hand experiences of friends, I must answer: Absolutely not. Do they even take the completely rational and capitalistic route of using aggressive preventative care to improve long-term profits? No. And if you’re a statistical outlier, you’re fucked. The health care industry is the victim of the same disease that rots away our financial system: Short-term profits make big bonuses for execs. Full stop.
I don’t apply this logic to every industry simply because health care is unique. From a purely selfish perspective, I would prefer that people be able to work to make society work for my benefit. And from another, I don’t think compassion and empathy are incompatible with liberty. We’ve seen the contrary now for long enough. Government without compassion for the least of us (conservatives should remember this biblical allusion to words attributed to Jesus, but don’t seem to), without a reasonable and logical view of the value of the lower and middle classes to society at large, is a government run at the expense of those same classes, run by the rich who only seek to get richer, run by the powerful who only seek more power. And that wealth and power can only come at the expense of the great masses who make society work. The GOP is successful only in lying to people—that the American dream of working from nothing to be super-rich and super-powerful is attainable by anyone. The truth is simply that money begets money, and power begets power. Only a very lucky few will accomplish anything that looks like the American dream. Hard work, intelligence, and diligence guarantee nothing, especially when disease or disorder kicks your legs out from under you.
Imagine a young man, beset by mental and other health problems. Imagine that in his twenties, when it gets bad enough to affect his ability to keep a job, he uses his public health care plan to get treated, and image he gets better—well enough even to get back to work, perhaps still needing certain ongoing medical care. Perhaps this required six month of living on public assistance. Now he would be a productive worker doing what he loves to do again. Here’s the reality. He’s in his thirties. The one thing, employment, that can get him affordable health insurance is unattainable, Medicaid is not available due to the ridiculous way some states deny coverage to those who actually need it, and it will only be because of what little family support he can find and unemployment payments that he may ever get well, be happy, and be productive again. The aforementioned imaginary guy with a public health plan has now paid back the health care costs multiple times in tax revenue, and the real guy will have small tax returns for the foreseeable future. And let’s not lie here: This is not his fault. He’s a drain on his society simply because he refuses to give up. His American dream is mere happiness doing what he loves to do, and if he could do it, it would help everyone.