by Chris Powell, managing editor of the Journal Inquirer in Manchester.
Published in the Record Journal, Monday March 22, 2010.
On his provocative talk show on WTICAM1080 in Hartford the other day, Jim Vicevich and his callers complained that the national medical insurance legislation advocated by President Obama and the Democratic majority in Congress is a scheme to tax young people, who are less likely to need medical care, for the benefit of old people, who tend to spend their declining years shuttling among doctors, hospitals, pharmacies, and nursing homes. The insurance legislation, it was said, is socialism.
Vicevich and his callers were right. But they still did not have much of an argument against the legislation. For as faulty and bureaucratic as the legislation may be, the country long ago settled the two principles underlying it.
The first principle is: The generations take care of each other in turn.
Older people whose children are grown or who never had children pay taxes for schools, even if some old folks vote against school appropriations for selfish reasons. Forty-five years ago the country decided to guarantee basic medical care to the elderly, and in fits and starts since then the country has decided to do the same for the non-elderly poor. For some reason the country has not yet decided to guarantee basic medical care to the non-elderly non-poor. But the non-elderly non-poor, including the young people the talk show host portrayed as victims of the legislation pending in Congress, sometimes do suffer catastrophic illness and need care they can’t pay for, and thus they could benefit from the pending legislation too. And the country already does guarantee some medical care to everyone, having settled the second principle: We’re not going to let people die in the street.
The law requires public hospitals to treat everyone who shows up with an emergency condition, without regard to ability to pay. Expenses incurred by hospitals on behalf of those who can’t or won’t pay are passed along to patients who do pay, directly or through insurance.
Creaky as all this can be, it is a social insurance system, and it is socialism only in the sense that any service to the public by government — from national defense to road maintenance to police protection— is socialism. It is not socialism in the sense of government ownership of the means of production, in which the federal government has engaged lately, as with General Motors and AIG. To the contrary, this social insurance system is based on a sound idea and sound morality — the idea of insurance itself, the sharing of financial risk, which was practically invented in Connecticut, and the morality of personal and social responsibility. That is, people should carry insurance for their own good and society’s, and government, the great teacher, should push them in that direction.
And the main element of the established social insurance system — Social Security — provides not just modest pensions for retirees but also crucial income for widows, orphans, and people who cannot support themselves because of physical or mental disability. If the government did not require universal participation in this system, many people would not insure themselves at all, would meet great misfortune, and would be left to the street. Would even the most ardent social Darwinist want that?
There are various ways of achieving a system in which all are insured medically, but in essence either the government becomes the big single insurer or medical insurance companies are so regulated as to be turned into public utilities. Each system has advantages and disadvantages, sensitivity and indifference, and efficiencies and sodden bloat. Gradual and incremental change into universality almost certainly would be best, less disruptive and less controversial.
It’s too bad that Republicans in Congress won’t help save the country from the Democratic majority’s megalomaniacal impulses by supporting any compromise legislation that would get everyone covered.
The Republicans say the country can’t afford universality and that the new system will grow and never save any money on balance. They’re right. The performance of any medical insurance system will depend largely on how much money is put into it. More always will be wanted.
But maybe the unnoticed virtue of enacting a new system now is that its vast expense, pushing the country deeper into insolvency, may force reconsideration of the socialism the country really cannot afford— like stupid imperial wars, corporate bailouts, and excessive public employee salaries and pensions, grotesqueries that already have cost far more than a universal medical insurance system would.