Yesterday, I read this post from a mother of a boy with a mental illness--a boy she loves, a boy who frightens her, a boy who might one day do the kind of thing that causes a nation to weep. For now it is the mother who weeps. If you haven't read it yet, do so. Now. Don't even finish this post. It will change how you think.
I said in an earlier post that we need a serious national conversation about easy access to guns in this country. We also need a serious conversation about how to improve access to and quality of mental health care for those who suffer.
The gun lobby has this slogan: "Guns don't kill people. People kill people." The obvious response is that people kill people with guns. And guns make it so much easier to kill. The more powerful the gun and the more ammunition it holds, the easier it is.
The person with suicidal thoughts is so much more likely to act on those thoughts if there's a gun in easy reach. A person in a jealous rage is so much more likely to kill if there is a gun right there.
If a tornado rips through a school, children's lives are at risk. But there are people with tornados in their heads. Whether they become as dangerous as actual tornados depends on what weapons they have available.
But there is something right about the gun lobby's slogan. A gun, without a human at the trigger, is inert. When death happens it is because something human has been added to the mix: negligence or malevolence, hate or jealousy, fear or desperation. Or madness. In a perfect world, a wold purged of all sickness and sin--that is, in a world that we will never see this side of death--guns would pose no danger to anyone.
Because a perfect world is impossible, we need to talk about sensible ways to make it harder for guns to fall into the hands of those who would use them to harm the innocent. But because we can do better even if we can't purge all the forces that drive people to murder, we need to talk seriously about doing what we can to reduce impulses to violence--not only to nurture a more nonviolent spirit among those of us who are of sound mind, but to extend desperately needed help to those of us who are not.
This is a dimension of health care reform that must be explored seriously by everyone. The invocation of mental illness and mental health care reform cannot and must not be reduced to a diversion tactic by opponents of greater gun regulations--a way of turning attention away from one of the issues we need to wrestle with. It must be something that all of us regard as a high priority. And those of us who favor greater gun regulations cannot ignore the cry of the mother who finds herself struggling to help a beloved child who terrifies her. We cannot think that all has been solved by making sure her child can't get hold of an assault weapon. We cannot leave that mother out to dry.
In a world where the mental health care of children depends on the benefits package that the parents might or might not receive through their employer, our world will have more people growing up with tornados in their heads than there have to be. We can do better. We must do better for the sake of children like those slain at Sandy Hook, for the sake of those mothers who find themselves responsible for children who seem like ticking time bombs. For the sake of those children who don't know what to do with the tornado in their heads, and who sometimes imagine it will all be better if they just let it loose in the world.
Showing posts with label health care reform. Show all posts
Showing posts with label health care reform. Show all posts
Monday, December 17, 2012
Tuesday, July 17, 2012
Giving the Affordable Care Act ("Obamacare") a Human Face
My friend Tracy (a wonderful actress and church secretary) has an infectious laugh, a somewhat racy sense of humor, and a daughter with juvenile arthritis. Shortly after the Supreme Court upheld the constitutionality of the Affordable Care Act, Tracy's family posted the following image of their daughter (along with the accompanying text) on Facebook:
The image went kind of viral. Earlier today, Addicting Info posted an article about Cassie, "The Face of Obamacare." The details of Cassie's story appear there.
I haven't said much about health care reform on this blog, in part because it is a complex topic about which I have little in the way of what might be called expertise. But here are a few things that seem pretty clear to me:
1. The most controversial aspect of the ACA is the so-called "mandate"--that is, the requirement that all Americans have a health insurance policy or pay a fine. This is the part of the ACA that Justice Roberts declared a tax. I think this is a fine way to look at it, even if Obama resisted calling it a tax for political reasons.
2. The mandate is an essential trade-off for the part of the ACA that most directly affects Cassie and her family--namely, the clause that precludes insurers from denying coverage based on pre-existing conditions. Were there no pre-existing conditions clause and no mandate, there'd be nothing keeping healthy individuals from just going without insurance until they get sick. So, we need one or the other: either there has to be some requirement that everyone have insurance if they can afford it (parts of the ACA are directed towards addressing those who can't afford it), or insurers will deny coverage for pre-existing conditions. Either the liberty of individuals to risk themselves in order to save some money has to be truncated, or the opportunity of people to get the coverage they need will inevitably be denied them. To have it both ways--unrestricted individual liberty to take risks and opportunity for the neediest to have their needs met--just isn't a realistic option. We have to choose. The question is whether we choose the liberty of all to risk going without health insurance or the liberty of all to get the health insurance they need.
3. If we favor the former, there are people who are going to suffer--people like Cassie. And her parents. And her siblings and all the others who love her. I don't like that result. I think about the fact that Cassie could easily have been one of my children. I think about the fact that Cassie is, in fact, the child of people I care about.
4. Also, if we favor the former our ERs will be filled to the gills with the uninsured who go there for all their medical needs when they become urgent enough (and hence are, more often than not, costlier than they might otherwise have been). This leads to increased medical costs for the rest of us--since the costs of treating the uninsured have to be recovered somehow. Viewed in this light, the health care mandate can be seen as a way to guarantee that everyone who can afford it does their share to pay for health care, rather than there being "free riders" that the rest of us end up paying for.
5. Favoring the former is routinely represented by ACA opponents as government tyranny because it is making demands on people, requiring that they buy something. The implication seems to be that favoring the latter respects liberty in a way that favoring the former does not. But as Cassie's story makes clear, her family faced serious truncations of liberty--imposed not by the government but by private insurance companies; companies who, out of an interest in maximizing profits, uniformly exercised their freedom to deny coverage such that Cassie's parents were denied the freedom to buy for their daughter what she so urgently needed.
6. What we have here is a choice about whose liberty is more important: the liberty of the healthy 30-something to risk going without insurance, to gamble that he won't get sick (a gamble that the rest of us pay for when he shows up at the ER with an infection that has gotten out of a control and takes expensive life-saving measures to cure); or the liberty of people like Cassie's parents to provide for their children the things that those children need in a way that doesn't bankrupt them.
7. What we have here is a choice between who is going to impose constraints on our freedom: the government, which is made up of elected representatives who are ultimately answerable to the public and are voted into office with a mandate to pursue the public good; or private companies, which exist to make profit and are answerable primarily to those for whom they are making that profit (e.g., stockholders).
I'm sure there are lots of problems with the ACA. It is a clunky and complicated piece of legislation aimed at trying to achieve what, it seems to me, could be far more elegantly achieved by moving to a system in which Medicare is extended to provide universal basic coverage paid for through taxation, and supplemental coverage is available through private insurers. Yes, there are surely problems with the ACA. But favoring a health insurance mandate for those who can afford it over a system in which people like Cassie find themselves unable to get insurance because of pre-existing conditions? That doesn't strike me as a problem with the ACA. That strikes me as one of its virtues.
The image went kind of viral. Earlier today, Addicting Info posted an article about Cassie, "The Face of Obamacare." The details of Cassie's story appear there.
I haven't said much about health care reform on this blog, in part because it is a complex topic about which I have little in the way of what might be called expertise. But here are a few things that seem pretty clear to me:
1. The most controversial aspect of the ACA is the so-called "mandate"--that is, the requirement that all Americans have a health insurance policy or pay a fine. This is the part of the ACA that Justice Roberts declared a tax. I think this is a fine way to look at it, even if Obama resisted calling it a tax for political reasons.
2. The mandate is an essential trade-off for the part of the ACA that most directly affects Cassie and her family--namely, the clause that precludes insurers from denying coverage based on pre-existing conditions. Were there no pre-existing conditions clause and no mandate, there'd be nothing keeping healthy individuals from just going without insurance until they get sick. So, we need one or the other: either there has to be some requirement that everyone have insurance if they can afford it (parts of the ACA are directed towards addressing those who can't afford it), or insurers will deny coverage for pre-existing conditions. Either the liberty of individuals to risk themselves in order to save some money has to be truncated, or the opportunity of people to get the coverage they need will inevitably be denied them. To have it both ways--unrestricted individual liberty to take risks and opportunity for the neediest to have their needs met--just isn't a realistic option. We have to choose. The question is whether we choose the liberty of all to risk going without health insurance or the liberty of all to get the health insurance they need.
3. If we favor the former, there are people who are going to suffer--people like Cassie. And her parents. And her siblings and all the others who love her. I don't like that result. I think about the fact that Cassie could easily have been one of my children. I think about the fact that Cassie is, in fact, the child of people I care about.
4. Also, if we favor the former our ERs will be filled to the gills with the uninsured who go there for all their medical needs when they become urgent enough (and hence are, more often than not, costlier than they might otherwise have been). This leads to increased medical costs for the rest of us--since the costs of treating the uninsured have to be recovered somehow. Viewed in this light, the health care mandate can be seen as a way to guarantee that everyone who can afford it does their share to pay for health care, rather than there being "free riders" that the rest of us end up paying for.
5. Favoring the former is routinely represented by ACA opponents as government tyranny because it is making demands on people, requiring that they buy something. The implication seems to be that favoring the latter respects liberty in a way that favoring the former does not. But as Cassie's story makes clear, her family faced serious truncations of liberty--imposed not by the government but by private insurance companies; companies who, out of an interest in maximizing profits, uniformly exercised their freedom to deny coverage such that Cassie's parents were denied the freedom to buy for their daughter what she so urgently needed.
6. What we have here is a choice about whose liberty is more important: the liberty of the healthy 30-something to risk going without insurance, to gamble that he won't get sick (a gamble that the rest of us pay for when he shows up at the ER with an infection that has gotten out of a control and takes expensive life-saving measures to cure); or the liberty of people like Cassie's parents to provide for their children the things that those children need in a way that doesn't bankrupt them.
7. What we have here is a choice between who is going to impose constraints on our freedom: the government, which is made up of elected representatives who are ultimately answerable to the public and are voted into office with a mandate to pursue the public good; or private companies, which exist to make profit and are answerable primarily to those for whom they are making that profit (e.g., stockholders).
I'm sure there are lots of problems with the ACA. It is a clunky and complicated piece of legislation aimed at trying to achieve what, it seems to me, could be far more elegantly achieved by moving to a system in which Medicare is extended to provide universal basic coverage paid for through taxation, and supplemental coverage is available through private insurers. Yes, there are surely problems with the ACA. But favoring a health insurance mandate for those who can afford it over a system in which people like Cassie find themselves unable to get insurance because of pre-existing conditions? That doesn't strike me as a problem with the ACA. That strikes me as one of its virtues.
Wednesday, March 24, 2010
A Prayer for Our Times
Introductory Remark: There is, of course, much that can be said for and against the details of the recently passed health care legislation. My own view, for what it’s worth, is that by trying to “patch up” the current system rather than overhaul it more thoroughly, and by making key concessions to the beneficiaries of the existing system, the real gains in coverage are weighed down by inefficient bureaucratic complexities and pointless “appendixes” which can only serve as a source of infection. I remain hopeful that despite this Rube-Goldberg-like clunkiness, it will offer more benefits than costs in terms of social justice…but I don’t know. Only time will tell.
But, of course, my concerns are trivial, since the real problem—as we all know thanks to FOX News—lies with the fact that the new legislation is socialist, that socialism is by definition un-American, and that this health care legislation will therefore ruin the American way of life.
And so, for all my friends who have digested the teachings of FOX News, I offer the following prayer.
Heavenly Father,
In this time of unprecedented national crisis, when the Democrats in Congress have brought the nation to the very brink of national catastrophe—nay, Armageddon itself—by passing socialist health care reform legislation, remind me of those things about our nation for which I can still be grateful.
Thank you, Heavenly Father, for the fact that the Socialists who are running this country haven’t messed with our nation’s system for building and maintaining its infrastructure. Thank you that it is still entirely in the hands of for-profit private enterprise, without government regulations restricting private industries from doing what they please with the bridges over which I drive. Thank you that none of my tax dollars are being spent to maintain roads I don’t personally…Oh wait. Scratch that one. Back up. Try again.
Thank you, gracious God, that our nation’s defense isn’t controlled by big government bureaucracies (which would likely be housed in some large hexagonal or octagonal structure) or paid for with my tax dollars, since that would be Godless socialism, and therefore evil and un-American. Thank you that we have seen fit to entrust our national security to privately-run for-profit mercenary firms…Oh wait. No, no, no. I didn’t mean to call our U.S. military un-American just because it happens to be entirely run by the government and therefore qualifies as socialism under the loose definition I’ve inherited from FOX News. All socialism is evil except the military. Alright. Deep breath. Let’s try again.
Thank you, Lord, that the reach of un-American socialist ideology hasn’t infected the way in which we educate our children. Thank you that no one has had the gall to propose a “public option” in education, since that would be evil commie stuff and…Oh wait. Crud. Um…Lord, thank you that at least the post-secondary education system remains outside the intrusive reach of state-run…Oh, crap. I teach at a state university. Forgot about that.
Okay, try again. Thank you, Heavenly Father, that at the very least our domestic safety is preserved by private security firms rather than some shamefully socialist public police force paid for through tax dollars, since we all know the government cannot be trusted with something as important as…Oh wait. No, no, no. Police are our friends. Love the police. Technically socialist, yes, but police are an exception like the military. Okay. Good. Try again.
Thank you, Lord of Life, that we’ve seen fit to ensure that fire safety in this country is overseen by unregulated, privately-run, for-profit fire protection businesses that charge clients a fee and only respond to fire emergencies affecting their paying clients. After all, public fire departments paid for through taxes would amount to socialism and therefore would destroy the American way of life. Thank you that our Founding Fathers, people like Ben Franklin, had the wisdom to set up safeguards against such…Oh wait. Dang.
Thank you, God, that the financial industry remains blessedly unregulated by the government, since innovation and greatness is achieved not through regulating American entrepreneurs but by giving them full freedom to pursue wealth in a competitive marketplace. Unregulated free enterprise, without the meddling of heavy-handed government bureaucracies, has made and continues to make the financial industry an ongoing engine of economic prosperity. Nothing can go wrong so long as the government stays out of…Oh, crud.
Never mind.
But, of course, my concerns are trivial, since the real problem—as we all know thanks to FOX News—lies with the fact that the new legislation is socialist, that socialism is by definition un-American, and that this health care legislation will therefore ruin the American way of life.
And so, for all my friends who have digested the teachings of FOX News, I offer the following prayer.
Heavenly Father,
In this time of unprecedented national crisis, when the Democrats in Congress have brought the nation to the very brink of national catastrophe—nay, Armageddon itself—by passing socialist health care reform legislation, remind me of those things about our nation for which I can still be grateful.
Thank you, Heavenly Father, for the fact that the Socialists who are running this country haven’t messed with our nation’s system for building and maintaining its infrastructure. Thank you that it is still entirely in the hands of for-profit private enterprise, without government regulations restricting private industries from doing what they please with the bridges over which I drive. Thank you that none of my tax dollars are being spent to maintain roads I don’t personally…Oh wait. Scratch that one. Back up. Try again.
Thank you, gracious God, that our nation’s defense isn’t controlled by big government bureaucracies (which would likely be housed in some large hexagonal or octagonal structure) or paid for with my tax dollars, since that would be Godless socialism, and therefore evil and un-American. Thank you that we have seen fit to entrust our national security to privately-run for-profit mercenary firms…Oh wait. No, no, no. I didn’t mean to call our U.S. military un-American just because it happens to be entirely run by the government and therefore qualifies as socialism under the loose definition I’ve inherited from FOX News. All socialism is evil except the military. Alright. Deep breath. Let’s try again.
Thank you, Lord, that the reach of un-American socialist ideology hasn’t infected the way in which we educate our children. Thank you that no one has had the gall to propose a “public option” in education, since that would be evil commie stuff and…Oh wait. Crud. Um…Lord, thank you that at least the post-secondary education system remains outside the intrusive reach of state-run…Oh, crap. I teach at a state university. Forgot about that.
Okay, try again. Thank you, Heavenly Father, that at the very least our domestic safety is preserved by private security firms rather than some shamefully socialist public police force paid for through tax dollars, since we all know the government cannot be trusted with something as important as…Oh wait. No, no, no. Police are our friends. Love the police. Technically socialist, yes, but police are an exception like the military. Okay. Good. Try again.
Thank you, Lord of Life, that we’ve seen fit to ensure that fire safety in this country is overseen by unregulated, privately-run, for-profit fire protection businesses that charge clients a fee and only respond to fire emergencies affecting their paying clients. After all, public fire departments paid for through taxes would amount to socialism and therefore would destroy the American way of life. Thank you that our Founding Fathers, people like Ben Franklin, had the wisdom to set up safeguards against such…Oh wait. Dang.
Thank you, God, that the financial industry remains blessedly unregulated by the government, since innovation and greatness is achieved not through regulating American entrepreneurs but by giving them full freedom to pursue wealth in a competitive marketplace. Unregulated free enterprise, without the meddling of heavy-handed government bureaucracies, has made and continues to make the financial industry an ongoing engine of economic prosperity. Nothing can go wrong so long as the government stays out of…Oh, crud.
Never mind.
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