Wednesday, September 09, 2009

What I Hope Obama Says Tonight

I don't aspire to write political speeches, nor predict what will be included in them, and the one time I tried, the results were hardly impressive (much less accurate). Still, as I watch and listen to Obama's big speech before Congress on health care tonight (of course I'll be tuning in; won't you?), there are at least a few things I hope get said:

So let us confront some hard truths here. Why do health care costs spiral ever-higher in the United States, forcing your premiums to become more expensive, forcing private insurers to place more exclusions and limitations on who they are willing to insure and for how much, forcing more unemployed or underemployed individuals to desperately rely upon hospital emergency rooms for the last-minute care they need? There are many causes, of course, and I would not pretend that the House Democrat's health care reform plan, or the Senate's, or anybody's, could ever address all of them. But there are some things we can address. We can address the multiplicity of overlapping payers amongst our nation's health care systems: insurance companies which, because of our disorganized and often incoherent patchwork of plans and providers, have come too often to act like minor fiefdoms, on the one hand exercising monopolistic control over those citizens who, through their jobs, are all to happy to pay through the nose in order to maintain the protected (yet invariably arbitrary and limited) lifelines of coverage which those companies provide them with, while on the other hand abruptly and inconsistently refusing to cover this condition or another, sending many patients scurrying to find some way to pay for something which some of their fellow citizens are lucky enough to be able to take for granted.

Private doctors and insurance plans makes sense--they make good sense. There are many ways of effectively providing for health care in line with basic principles of mercy, compassion, and fairness, and arguably the way we do it in America is not the best of all those ways. We could look to those nations who have a single national medical establishment, which essentially employs every single local nurse or doctor or midwife, everywhere throughout the country. We could consider having the federal government simply assume all medical costs, and pass the burden on to tax-payers, thus making health care into a right which is collectively provided by us all. And, in truth, we already do have elements of both of those approaches. If you or a parent or a friend have served in the military, and you make use of the Veteran's Administration, you've seen the first, national-establishment approach in action. If you or a parent or a friend is of retirement age, and you make use of Medicare, then you've seen the second, collective-provision approach in action. For better or worse, however, it is my feeling, and it is the feeling of the majority of the hard-working legislators who are sweating day and night to both listen to their constituents and use their own best judgment in responding to this crisis, that the fundamentals of the American system need not change. We will still have private doctors and various insurance plans. But we must find some way to make the exchange of information, the movement from one plan to the next, the provision of coverage, smoother, less repetitive, less exclusionary, less costly, and more just. I believe we have found--or at least are very near to finding--a way to do that, and the results will mean more security, better health care, and less personal cost, for the American citizen.

The mass media has been filled with tales of outraged mobs, crying protesters, and angry citizens--and those things deserve to be discussed, just as every expression by every American citizen deserves, at the very least, to be heard. But that doesn't mean we should allow misinformation and vituperation to crowd out the productive, intelligent work and debate and information-sharing and compromises that are taking place in legislative halls and church basements and school cafeterias all across this country. The people ask: will a public option be included in the final plan? I say: I would like one, because I am doubtful that even the best regulations will be able to address all the inconsistencies in how we Americans pay for the health care coverage of diverse parts of the population unless there is a subsidized, government-led insurance plan to provide competition with private insurance monopolies. But would I veto a bill that didn't have one? Assuming it showed some other way of accomplishing the same goal, or at least something near to that same goal, I would not. The crisis of health care costs is too dire to insist on what I think is best at the expense of what many, many others more informed than me might agree on at least being pretty good.

The people ask: how much more socialism will you force us to embrace? I say: if by "socialism" you mean some crazy plan centralize the ownership of property and dictate economic decisions to manufacturers and consumers, then not one bit...or at least, not one bit more than which we have already, as a nation, long since embraced, whether the rabid haters are willing to admit to it or not: national parks, environmental regulations, public schools, city libraries, neighborhood playgrounds, Social Security and all the rest. I suspect those things are hardly the stuff of most people's nightmares of communism (assuming most people even have any such nightmares), but, if you're so inclined, they can just as accurately branded with the socialist label as any kind of Marxist plot from a century ago. Perhaps, if more of us could accept this fact, then more of us would be able to resist the media-enabled story that some radical complainers prefer, in which the fight over health care is some revolutionary struggle, as opposed to what it really us: a serious, patient attempt to democratically resolve issues which have plagued this nation for decades, which are very close--unless we act now--to being unresolvable. Of course, it may be that by "socialism" you mean any or every kind of government involvement, on any level, in any kind of private transaction whatsoever. In which case, I say that in a choice between the poor and the sick and the young and the unlucky not having what they need to save an arm or stave off crippling pain or prevent an early death, and the poor and the sick and the young and the unlucky being able to find a way to pay for just enough medical care to ensure them of at least some of those things, I will choose socialism every time. I would hope every Christian, and every American, would choose the same.

Please note that this is not the speech that I wish Obama would be in a position to give; I'm a single-payer fan, all the way. Moreover, I am perfectly aware that it would probably be political suicide, and seriously counter-productive to the cause of health care reform, if he gave this speech. So I suppose it's a good thing I'm not him, isn't it? Yep, I thought so too.