To the editor:
The World Health Organization ranked the United States 37th for health care among the nations of the world in its last rating (2002). 1 was reminded of this when I heard Governor Chris Christie extoll the U.S. health system as "the world's greatest care system" during his keynote address at the Republican National Convention. Politicians of the Right frequently say this, perhaps to make us feel good about ourselves and lull us into inaction. The facts, however, are otherwise. Among the industrialized nations, the U.S. ranks 14th for preventable deaths, 24th in life expectancy, and 41st in infant mortality. France is 1st in overall health care, 1st in preventable deaths and 3rd in life expectancy. Perhaps France has something to tell us beyond how to make a good souffle. Still, some consider taking any lessons from Old Europe (much less France) as an affront to American Exceptionalism.
It is hard not to conclude that this continuing public health problem is linked to the precarious state of 48 million Americans who are uninsured. Of the industrialized nations, the U.S. is the only one without universal health coverage. In response. Congress has passed the Affordable Care Act (sometimes, as in this newspaper, derisively referred to as "Obamacare") which will cover the bulk of the uninsured. The Act features consumer protections such as allowing parents to insure their children to age 26, prohibiting discrimination based on health status, prohibiting exclusions for pre-existing medical conditions, prohibiting annual and lifetime monetary caps on coverage, requiring guaranteed issue and renewals of policies, and the like, all problems endemic to the current system. Insurance companies benefit financially by expanding their customer base thereby spreading their financial risk, doctors and hospitals will be paid for services rendered, the expensive and inefficient use of hospital emergency rooms will decline, and the impoverishment of patients should end.
The primary opposition to the Act arises out of the "individual mandate," the requirement that everyone purchase health insurance (with government help where necessary). One would think those of a conservative disposition would like this provision, as it seeks to eliminate "free riders," those who would benefit from the system without contributing their fair share; and, as we are told, it is crucial to the economic feasibility of the Act. It is well-known that the individual mandate is central to the plan installed by Mitt Romney when he was governor of Massachusetts. Less well-known is that the individual mandate originated with the conservative Heritage Foundation in 1989 ("Assuring Affordable Health Care for All Americans") and was a key provision of the Republicans' alternative to President Clinton's health reform bill in 1993. But that was then.
Perhaps the individual mandate is analogous in principle to taxation for public education. Everyone must pay, even those without children, who could very well complain they have no stake in the enterprise. There is, however, no opting out. Similarly, Americans will be required to either pay insurance premiums or, alternatively, a tax penalty. "We are all in this together," says the President. Most Americans, I would tike to think, agree.