Sometimes politics can get in the way of a good thing. Just look what is transpiring on Capitol Hill over health care reform. Every conceivable interest group acknowledges the crisis in health care in our country but somehow the need to be right overwhelms the importance of doing right. While I am not one to suggest that it is the most important issue, I put jobs at the top of the list; health care is without question a matter of urgent need in this country. After the debacle that occurred during the Clinton administration when health care reform was beat to a bloody pulp, the stakes are high to get it right this time because if the Obama administration does not succeed we will likely not have another opportunity for some time.
From the start, it was clear that health care reform would be the biggest nut for the President to crack. No matter where he turns, there is some interest group to anger: doctors, trial lawyers, small business owners, large employers, unions, retirees and “progressive” advocates. It is one of the reasons I had hoped he would not take this issue up until the second year of his first term, given the volatile nature of the debate, and the political minefield he has to cross. However, life and death has a way of overrunning political considerations and it has become clear that the nation’s health care system is on life support. Too many Americans are uninsured and too many people face financial ruin trying to afford to stay well or keep a loved one in good health. The sad truth is that the cost of care is making it too expensive to stay healthy or at the extreme, sustain life. Making matters worse is a recession in which millions of Americans have lost their jobs and the health care plan that went with it.
The debate over universal health care is particularly significant for Black Americans. On many health indices, Blacks are at the bottom or habitually rank among the worst. We have been devastated by HIV/AIDS and certain forms of cancer, along with diabetes, plagued by asthma and still haunted by high infant mortality rates. Travel through any heavily concentrated Black neighborhood and the impact of illness is evident. What is also apparent is that many of us are not tending to our health needs with obesity being one of the clearest examples of that. Young and old in our community are overweight and risk heart failure from lack of exercise and poor diet. No doubt, poverty is a major factor but even among the Black middle class, these issues persist. Add to the mix gun violence that has resulted in a wave of people, mostly young Black men, who have been disabled and it is easy to see why health care is one of our priority concerns. Far too many Blacks lack a primary care physician and have to opt for an emergency room, one of the most expensive forms of care, to be treated for conditions that by their time of their arrival are sometimes life threatening. Access to care continues to be one of the greatest obstacles in the path to wellness.
While it is generally agreed by all parties that we must broaden our health care system, the devil is truly in the details. Over the last two weeks, the main sticking point has been on the total cost of the Obama package. Conservative “Blue Dog” Democrats have aligned with Republicans to forestall consideration of the bill until after Congress returns from its August recess. The President had initially aimed to have the package ready for consideration this month. The pushback he got also affected his standing with the public on this issue as recent polls have indicated he is losing support. This is turning out to be one of the pivotal moments of Mr. Obama’s presidency so he has little choice but to cede to some of the concerns on Capitol Hill if he is going to achieve his goal.
Ultimately, if this gets done, we will likely have a hybrid public-private system, with some level of mandate and some requirement that we contribute to the cost of the plan. The notion of a single-payer, “Canadian” style system, long the fancy of liberals, is dead. Far from the “socialized” medicine conservatives claim a government plan to be, a single payer system is almost impossible to fathom given the complexity of the existing health care infrastructure. In many ways, it is like the existing copper wire telephone system; too expensive to repair and too costly to completely tear down. We have to work with what we have and what we have, with all of its problems, is still the best health care system in the world. What we need is some leveling so citizens can be assured that they will have access to primary care, options for more serious health emergencies and the security of knowing that they will not be driven to financial ruin if long-term care is necessary. Such a system will hopefully peel back costs and cut down on the number of unnecessary procedures. Perhaps there will be some way to include incentives that can mean savings for those of us who proactively pursue healthy lifestyles.
Congressional leaders have now indicated that the health care reform package will not be on the table until September, and they have already indicated they plan to shave back costs and exempt more small businesses from the requirement to provide health care. Clearly, the political process is at work and this President, like those before him, has learned that Congress, with all its complexities and contradictions, must be part of the solution if there is to be a positive policy outcome. The give and take of the process, admittedly more push and take, is an unavoidable aspect of our system of government that should produce better results for the American people. Stay tuned. We are in for a bumpy ride.
