The World Health Organization gives the U.S. health system an overall ranking of 37th in the world, far below other Western democracies. The CIA World Factbook — hardly the work of a bunch of left-leaning one-worlders — reports that life expectancy in the United States is not just lower than in other industrialized countries but also lower than in Jordan and Bosnia.Infant mortality in this country, according to the CIA, exceeds that of Slovenia and Cuba. It is possible to quibble with these figures but not to ignore them. We should be ashamed of ourselves.That paragraph is from The Supreme Court helps heal the nation, Eugene Robinson's Washington Post column in response to the ACA decision yesterday.
In an earlier paragraph, Robinson also makes a very important point:
Obama’s great achievement is not any one element of the health-care reform law — not even the now-upheld “individual mandate,” which compels individuals to have health insurance or pay a fine. The important thing is the law’s underlying assumption that every American, rich or poor, should have access to adequate health care.I said that we need ACA - it has started to move us in the right direction. The underlying assumption that I have quoted from Robinson is not, however, something agreed to by everyone: we can easily remember those during the Republican debates who seem willing to let people die or suffer or go bankrupt just so that they can keep the theological or ideological purity - except some of them who rant against certain government programs themselves draw benefits from those self-same programs.
But it is not enough. Not even close to enough. Let me try to explain why.
We are still for now leaving too many of the poor at the mercy of Governors and Legislatures that can refuse to accept the expansion of Medicaid, at the very time when increasing numbers of Americans seem to need access to that program.
We still see an unfortunate tendency that to pay for expansion of medical coverage we cap reimbursements for doctors under federal programs at a level that many doctors or dentists or other medical professionals will not take - the medical practice to which I go will not accept new Medicare patients, but will allow those of us who are already patients to remain in their practice when they switch to Medicare - they could not keep the doors open were all their patients paying them at the reimbursement rate the government is willing to pay for Medicare.
What good is medical insurance coverage if one cannot find a doctor willing to take it?
Remember, there are still millions of people here who do not have medical insurance through their employment.
If you are over 26 and either are unemployed or your employment does not not offer healthcare, you are no longer eligible for the provision allowing you to stay on parental plans.
While the President was right to announce his decision to start addressing the immigration issue of those who would have been covered by the Dream Act, they are still not eligible for medical coverage - we have something over 11 million Americans who cannot get medical insurance, and that creates something of a public health risk, especially in schools and colleges, unless the college has a group plan in which they can participate.
'I am not arguing that passing ACA was wrong, although it did not go far enough.
But like much of what we do in this country, we are not addressing the larger context of the need for social programs.
Politically it may be hard - what President or aspirant to the Oval Office wants to tell the American people that we are far from the greatest country in the world, which is why there are lots of things that need to be addressed?
What Senator or Representative or Governor is willing to be blunt with the American people, that we have choices to make that may require us to think hard
- on taxes
- on military spending
- on building more prisons
We will not fix the issue of medical care in this country in isolation.
We have to address nutrition - for a country as wealthy as in theory we are, too many are undernourished, too many do not eat healthily. These are things that contribute to our escalating costs on medical care.
We have to address what we do to the environment - if we are unwilling to require businesses to be more responsible about what they do to water, soil, air, we will pay extensively in otherwise avoidable medical costs down the road.
Nutrition and environment - the costs are not only those paid for treatment, but the loss of productive work as lives get limited or shortened, and that means loss of revenue for taxes to pay for the necessary work of government.
NECESSARY WORK OF GOVERNMENT - we need to reclaim the words of the Preamble, that one key reason for the social contract that establishes our government is to promote the general welfare - the general wellbeing of the people. Without proper health we undermine that general welfare. It is a key purpose of government to address those things necessary for that general welfare.
Ronald Reagan would have had no trouble supporting ACA. Richard Nixon would probably have argued that it did not go far enough.
It is time for those who truly care about this country to stand up and push back against those who are selfish, concerned only for themselves and their own, their wealth and their (economic, social and political) power.
Hubert Humphrey put it bluntly -
It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.Or perhaps we can for those Americans who take their lead from Scripture remind them of the words in Matthew Chapter 25, that how we treat the hungry, the thirsty, the stranger (including undocumented aliens, perhaps?), the naked (which for us could be the homeless) the sick, even the criminals (those in prison) is how we shall be judged, because "whatever you did for one of the least of these brothers and sisters of mine, you did for me."
We need ACA. John Roberts did the nation a service by voting to preserve it.
It is not enough.
It is time for all of us to do more.
Lest we fail the moral test, lest we be found wanting in our care for our fellow human beings, regardless of their race, gender, sexual orientation, immigration status, age, economic status, religion, or political philosophy.