A Yankee Notebook: The public-private schism

I was checking out at the supermarket the other day, and as usual, fell into conversation with the checkout person, an elderly woman. She was sharing a bagger with the next lane over. When the bagger — another elderly lady — joined us, I noticed a pretty heavy limp. Happily afflicted as I am with the condition called "age-related disinhibition," I naturally asked her what was wrong.

The problem was a deteriorated hip joint. It'd been getting worse for years, and now was seriously debilitating. I asked why she didn't get it replaced; it's a fairly easy and quite successful operation. She couldn't afford it, she said. She was covered by Medicare, but it didn't cover nearly enough of the cost to make it possible. She was clearly resigned to her situation. It wasn't hard to see what was coming. The hip would get worse, and her debility would cost her the job, such as it was. And then …. ?

It was a reality check for me, I haven't gotten a medical bill in almost 25 years. I recall now that, prior to my 65th birthday in the year 2000, the medical insurance (if we used it) for just my wife and me cost us $14,000 annually: $8,000 for our premiums, and $3,000 deductible apiece. What a relief it was to give that up for government coverage, even though adding Part B cost about $200 a month for each of us. Later, when my wife's health began to fail, we added Medicaid (an incredibly complicated process for a senior citizen, though assisted cheerfully and competently by Vermont state advisers, who led me through the routine). The Medicaid premium was based on our income, and at the time, cost just over $1,000 per month for nursing home care that would have cost us at least $10,000 otherwise. You may conclude I'm a big fan of government health care insurance.

Which is why I'm mystified that we here in the United States seem to cling so tightly to our so obviously illogical system of health care. We claim it's the best in the world, but statistics prove otherwise. I have no problems with it myself, but I'm one of the lucky ones who can afford the supplementary premiums and the cost of prescriptions. What about the millions of my fellow Americans who can't?

The notion that private health care insurance is superior to government-run insurance is philosophically attractive, but in practice, laughable. The goal of any business is to provide a service or product and show a profit. Any health insurance business shows its investors the healthiest profit when it manages to pay the least in benefits. The recent fatal shooting of a health insurance company chief executive officer seems to have had its roots in this phenomenon. Reaction to the murder on social media has been interesting. While twisting themselves into knots to deplore the murder itself, commenters have surrounded the shooter with the aura of a Robin Hood.

It's not hard to see where the public-private schism first took root. Ronald Reagan, who spent his professional life reading scripts written by others, slipped into his 1981 inaugural address the notion that government was not only incapable of solving people's problems, it was the problem. That root has grown and blossomed into today's general mistrust of government. And private corporations, including many in the health care insurance industry, have made the most of it.

I realize that I'm but a naïf when it comes to the convolutions of actually governing (which includes the fine line trod by congresspeople between constituents and donors), but you know, the kid who saw the king as naked, was one, too. Almost all of us Americans have been raised to believe our country is the greatest in the world and in any dispute, we are the virtuous party. Those are demonstrably false assumptions. Pick any category —literacy, life expectancy, infant survival rates, even geographical knowledge — and we rank well down, or even off, the list. I can vouch from experience that the average Cuban school kid knows American geography better than most American adults.

There are no doubt many arguments against doing away with our current system of health care insurance. To claim the government is too clumsy or bloated to manage it, is a gross canard. To accept with resignation that the system is too entrenched to change, is bogus. To claim that government control is a step toward communism — can't we someday get over that old bogeyman? It should have been buried with Joe McCarthy and J. Edgar Hoover. We need to catch up with the rest of the world. As Woody put it so memorably, "If you stick together, boys, it won't be long."

Willem Lange is a regular contributor to Weekend Magazine. He lives in East Montpelier.