No Public Option and Publics With No Option

Remember the psychological experiment in which participants were asked to press a button that would cause pain to someone whom they could not see? The results were depressing: those with the button were quite willing to cause pain, ratcheting up the voltage with abandon.
As a nation, we are experimenting with social policy along these lines. The removal of the public option from health care reform is one more upward tick of the voltage. Some people may feel pain, but they are, after all, people whom we have learned as a society not to see.
Most of the individuals and families who are are uninsured fall into one of two groups. One group is uninsured because they lack employer-provided coverage and are unable to afford or unable to be approved for private plans. A second group is uninsured because their employers offer plans that require contributions that are too high or because employer plans will not accept individuals with specific pre-existing conditions.
This is what we know about the uninsured. About 79% are citizens, according to a 2005 report by The Office of Health and Human Services. Blacks are slightly over-represented in relation to their proportion in the population, comprising 12% of the population but 15 % of the uninsured. . Hispanics are considerably over-represented, comprising 14% of the population but 30% of the uninsured. Whites are under-represented: they make up 67% of the population but only 47% of those without insurance.
Most uninsured individuals are below the age of 35, and the vast majority, work at full (46%) or or part-time (28%) jobs. Although some are relatively wealthy individuals whose incomes are above 300% of the poverty line, over half have earnings that place them below 200% of the poverty line. And some of the individuals in the wealthier group may have pre-existing conditions that make them unable to obtain insurance.
It is important to note that most individuals are not chronically uninsured. For most, the lack of insurance comes and goes with job changes or with changes in the terms of employer-offered benefits. Here, something like a lottery structures their ability to afford medical care.
And many other individuals, of course, are underinsured or simply lack the financial resources to meet co-pays in the face of catastrophic medical expenses. These individuals help account for the very high proportion of personal bankruptcies attributable to medical costs.
But, like addicts in a state of denial, we as a nation have learned to see only what serves our purposes. Our addiction is to the status quo, and what we have learned not to focus on is the pain suffered by those who lose under the current arrangement.
Like any practiced addict, we don't just deny. We rationalize and justify. Just as every addict can explain fluently why his or her situation is unique, why that case of beer finished in one afternoon does not, in his or her particular instance, constitute binge drinking, opponents of public health insurance can explain why they are not morally bankrupt.
We explain that the uninsured could get better or steadier jobs; that they could eat more tofu and less Cheetos; that those who have insurance should not be forced to pay taxes to support losers; that no-one that whom we know personally has these problems or, alternatively,that if they do it's because they were not as careful as we were. And many of these uninsured individuals belong to groups that make us uncomfortable in any event.
And we have another problem.
Like good addicts, we have developed an attachment to our suppliers. They've done well by some of us, after all. As long as you have money to pay, the dealer is your pal. We know what we need to do to keep the arrangement going. And our suppliers have said they feel the pain of the uninsured- they're going to help them out. Oh, sure, we'll still be addicts, but the suppliers will try to arrange things so that our buzz isn't ruined by noise from the losers outside.
These suppliers- the insurance, pharmaceutical, and medical industries, along with their representatives in Congress- assure us that they will co-operate on a solution. We can continue to use, but it will be a kinder, gentler sort of addiction. And how long will this co-operation last? If history is any example, just until the impetus for reform begins to nod out.
Any recovering addict can tell you this: for an addict, supply creates its own demand. One is too many and a thousand is never enough, the saying goes. You either quit or you don't. In the end, the surest -and in the case of health reform the only- route to recovery is to go cold turkey.