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The Politics of Compassion, Part Four: Health Insurance, or Affordable Care


There is nothing so compassionate as ensuring that everyone has full access to health care (that is, medical care.)  There are so many anti-compassionate features of society today that it is hard to know where to begin to describe them.

The first and most obvious health problem is that of the homeless population: about half a million people in the United States are homeless on any given day, and 1.5 million experience homelessness at least once in a year.  Many of these people suffer from psychiatric problems that would have guaranteed them a bed in a psychiatric hospital prior to the late 1970’s.  Through a series of errors, compounded by the government’s dropping the ball, the mental hospitals were mostly closed down in the seventies and eighties; replacement outpatient mental health centers were never adequately implemented by the responsible government agencies.  As a result, many of those housed in the community were unable to maintain their medication or therapy and relapsed into a psychotic state in which they were likely to be evicted or just wander away.  Roughly one-third of the homeless are mentally ill.

The medical problems of the homeless are compounded by their lack of shelter and thus treatment involves first, providing them with homes.  This is, unfortunately, a problem best solved by nonprofit organizations like the federal government.  Unfortunately, we can’t rely on Ben Carson as secretary of the Housing and Urban Development department to get anything done.

The second, more pervasive, problem is the inability to pay for needed medical care, usually due to a lack of insurance coverage.  The ACA or Obamacare has made some inroads into this problem– roughly twenty million more are insured than eight years ago.  The high price of copayments has limited the success of insurance, however.

The ideal form of healthcare insurance would be a program that covers all people in one insured pool.  This would reduce the price to a manageable average by including the young and healthy as well as the old and sick.  Current health insurances suffer from inadequate pool size in many cases.  The form of health insurance that would suit best is often called “Medicare for All.”  However, the price of copayments is still a problem, particularly in relation to drugs.  The Medicare Part D program suffers from a large amount of patient payments and appears to be a sop to the insurance companies that administer it as well as the drug companies that supply it.

The ideal way to provide health insurance is to insure everyone; all citizens would be covered and would pay a progressive tax for health care.  The tax would be graduated so that poor people would pay little but rich people would pay more… just as income tax is supposed to be progressive (although current Medicare and Social Security payments are not progressive and make up a large proportion of a poor person’s taxes.)  Non-citizens could pay a specific premium to be included in the health care system– or they could simply be taxed the same as citizens.  Costs for medical care, housing, and drugs have to be covered by this insurance; copayments must be limited to avoid burdening the poor, who are inevitably sicker and greater users of medical care.

Compassion for everyone is the best policy.  Dividing people into separate groups with different rights, privileges, and duties segments society and strains the social ties that hold people together.  In the past, historic governments have tried to manage people by separating them into distinct groups by their gender or race (a specific, inborn makeup) but the result has inevitably been tension and strife between groups with different interests.  The Democratic Party must be the party of unification: everyone should have the same rights, protections, and duties, regardless of their status as man, woman, white, non-white, straight,  gay, or transgendered.  Universal health care is an important part of this universal compassion.

Some conservatives say that liberals will fail if they stick to “issue politics” like LGBT rights, and by extension, the rights of blacks to not be shot by police.  These issues both involve compassion, and how much compassion you have will determine where you stand on them.  Lack of compassion is the primary error of the Republican Way; compassionate government must therefore over-rule Republicans at every turn.  Elsewhere I have described the ingredients needed to beat the Republicans: access to the ballot, turnout, propaganda, a good platform, and a charismatic candidate.  Turnout is the most critical aspect of winning.

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