Our Imperiled Health Care

Today the Church commemorates Saints Cosmas and Damian, Syrian brothers, who were also physicians and who offered free care to the poor. Martyred under Diocletian in 303, they are accordingly venerated as patrons of physicians and other medical professionals. (The photo, taken by me in 2012 is of the site of their relics in the Basilica of Saints Cosmas and Damian, the lower part of which is in the ancient Roman forum and incorporates ancient Roman structures.)

Aside from such expressions of heroic sanctity, obviously doctors do ordinarily deserve to be paid, as do all health-care workers - and, indeed, all workers. Today's commemoration does however, remind us of the persistent problem in our society of the excessive cost of health-care for many - what we might call the rationing of health-care by the "death panel" that is American capitalism.

There are numerous ways for societies to provide adequate health care to their citizens, as exemplified in the diversity of systems across the spectrum of economically advanced societies. Among such societies, only the United States fails so dramatically at this important social and political function. And the reason for this failure is rooted in the perverse American approach to health care as primarily a vehicle for the few to make money at the expense of the many who are sick or may become sick.

The Affordable Care Act ("Obamacare") wasn't able to address, let alone solve, all the inequities in American health care, but it was a major step forward. Its guarantee of health care coverage regardless of pre-existing conditions and its provision for young people to remain on their parents' plans until age 26 have been among its most universally appreciated benefits, while the expansion of Medicaid has resulted in one of the greatest expansions of health care coverage. Since our dysfunctional Supreme Court permitted states to refuse to expand Medicaid, poor people in certain Republican states have missed out on this opportunity. That is just one more thing that will need to be corrected when and if it is possible to repass a more comprehensive version of the ACA, which may not be "Medicare for All" but which will need to be something significantly similar in its effects. (Richard Nixon considered "Medicare for All" in 1973. It is hardly a novel idea.)

Of course, the covid-19 pandemic has highlighted the inadequacies and inequities in our health care system even more dramatically. On the long-standing political principle that crises create opportunities for real reform, this is the time to respond to this terrible tragedy by finally universalizing access to adequate health care. Personally, I see no persuasive value in retaining a system of private insurance - a third-party profiteering from people's medical needs and diverting resources into bureaucratic mechanisms focused on denying care. However, there are several successful national health-care systems around the world which do incorporate private insurance. Were the U.S. to adopt something similar it would still be an improvement on where we are now. While I personally prefer expanding Medicare and Medicaid to include many more people as the best route to take, virtue-signaling squabbles over Medicare-for-All versus other approaches should not get in the way of the more important goal of increasing access to quality health care for all Americans.

This is especially so in view of the current crisis caused by the virtual certainty that some defender of the capitalist oligarchy's obsession with reducing Americans' access to health care will soon be sitting on the Supreme Court. Coverage for people with pre-existing conditions and the ACA's other accomplishments are again threatened by a lawsuit brought by several Republican states and supported by the Trump Administration. That case will be argued before the Supreme Court on November 10.

After two near-death experiences - one in the Court in 2012 (National Federation of Independent Business v. Sebelius) and another in the Senate in 2017, when the late Senator john McCain's vote saved the ACA - one would think enough was enough; but apparently health hath no fury like oligarchs determined to take away people's health care!

And all of this comes in the middle of a global pandemic that has already unnecessarily stolen the lives of more than 200,000 Americans! The Senate, that has been unable (a.k.a. unwilling) to legislate pandemic relief, is rushing to confirm yet another Federalist society acolyte, while it can still get away with it, presumably with the reliably safe expectation that such a Justice will compliantly fulfill the governing party's good of taking away people's health care.

All of which further highlights the immediate necessity of reforming and restructuring a Supreme Court that has for most of American history served us ill much more often than it has served us well.