THE BLOG
05/29/2013 12:22 pm ET | Updated Jul 29, 2013

Health Care Reform: Us vs.Them

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It's no news flash to say health care reform is politicized. Our country is increasingly polarized, "us" versus "them" and "either/or" instead of "both/and." But it's one thing to say it, it's another to watch it play out in the implementation of health care reform across our United States.

The latest CNN poll, released on Memorial Day, shows 54 percent opposing Obamacare. Putting aside arguments about the veracity of poll data depending on questions, etc., if you look a little deeper, you learn that 35 percent oppose it because it is "too liberal" and 16 percent because it isn't "liberal enough."

I wonder how many of those polled really know what health care reform, as passed by Congress and upheld by the U.S. Supreme Court, means. I say that without cynicism because, working in public policy and health care, I spend an enormous amount of time staying current on the law, and the multiple complexities of its ongoing implementation.

Like a disturbingly increasing number of important issues in our country, health care reform is politicized, pure and simple. I've also worked in children's policy for a couple of decades. How can funding programs for low-income children become a political issue, divided along mostly partisan lines? Yet it is. I don't see any difference in health care. How can anyone oppose the common sense idea that everyone should have health insurance and access to quality health care? It makes sense morally. But if that doesn't work for you, it makes sense economically.

Instead of exploring that basic fact, we hear very silly and politicized (not to mention false) rhetoric that health care reform is tantamount to socialism. Instead of passing a jobs program, which might fix things like crumbling bridges and provide jobs for people who really need them, House Republicans are going for a Guinness book record in voting to repeal a law upheld by the Supreme Court.

So I'm beginning to wonder if people have enjoyed having annual and lifetime caps on their insurance policies. And pre-existing conditions excluded from their insurance coverage. And not having free preventive care, like vaccines and mammograms. Oh, and allowing insurance companies to spend as much as they like on administration and marketing, instead of actual health care for you, their "customer," thereby racking up billions in profits? Have people enjoyed taking out a new policy for their young adult children at the age of 21, instead of keeping them on their plans until age 26? How about that really fascinating phenomenon when you develop a very serious (and expensive) illness, and out of the blue, your insurance company discovers a "mistake" on your insurance application that you completed eight years ago and your coverage is summarily "discontinued"? Yes, those were the good old days before Obamacare.

Now we are on the brink of probably the most politicized aspect of reform, the Medicaid expansion, which the Supreme Court declared "optional" for states. Somehow that is even more "liberal" for some people. Perhaps because, for many, the people who qualify for Medicaid are "them," not "us." Do people know who falls under Medicaid coverage? Low-income children and some of their parents, people with disabilities, older Americans who need nursing care. Until health care reform, low-income childless adults did not qualify. Well, if you don't identify with any of those people personally, and if you don't believe health care is a fundamental human right, perhaps you could look at the economics?

It costs more for people not to have coverage. Pure and simple. It costs more. It's one of the most significant reasons why the U.S. has the most expensive health care system among industrialized countries. People who are sick do not vanish into thin air. They usually go to the only place available -- the emergency room. And they wait until they are really sick because they can't afford preventive care. And by that time, care costs even more.

An article by Robert Pear points out that in those states that refuse the Medicaid expansion (and coincidentally all these states have Republican governors), the poorest of the poor will be the ones who do not get coverage. Whether you believe that is morally wrong, or whether you believe these folks should simply get more money, the same truth holds. It costs more for them not to have health insurance. And we all pay for that with higher insurance premiums. Or did you think the insurance companies would absorb the costs on principle?

An excerpt from Pear's article:

Bee Moorhead, the executive director of Texas Impact, an interfaith group that favors the expansion of coverage, said: "A lot of people will come in, file applications and find they are not eligible for help because they are too poor. We'll have to tell them, 'If only you had a little more money, you could get insurance subsidies, but because you are so poor, you cannot get anything.'

"That's an odd message, a very strange message. And if people are sick, they will be really upset."

And, I would add, their care will cost us a whole lot more in the long run.

The health care -- and the insurance -- industries are exceedingly complex. Reforming it all is exceedingly complex. And we have historically paid for care based largely on quantity, not quality. Changing all that is challenging to say the least. But complexities aside, it's not simplistic to say that political polarization, based on very little actual knowledge, is threatening the well-being of our country, physically and economically. Unless you are among the top 2 percent of the very wealthy who may be relatively unaffected by the economics of health care reform, what happens to "them" (uninsured) will affect "us" (insured), one way or another.

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