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The New Politics of Health Insurance

Seniors and the poor are caught in crossfire of healthcare debate


Doctor talking with patient in doctor’s office
Martin Barraud/OJO Images/Getty Images

Published September 19, 2011

Politics in America is quickly becoming a matter of life and death.

That grim reality was made clear during the recent CNN-Tea Party Express Republican presidential debate on September 12 [2011] by U.S. Rep. Ron Paul's answer, and audience response, to a health-care question posed by debate moderator and CNN journalist Wolf Blitzer.

Blitzer laid out a hypothetical scenario for Paul, asking how society should respond if a healthy 30-year-old man with a good income, who chooses not to purchase health insurance because he doesn't think he needs it, suddenly has some terrible experience that leaves him needing six months of intensive care.

"Who pays for that?" Blitzer asked.

Paul, a physician, said he would advise the young man to have a major medical policy.

"But what he should do is whatever he wants to do, and assume responsibility for himself," Paul said. "That's what freedom is all about: taking your own risks. This whole idea that you have to prepare and take care of everybody . . ."

Blitzer interrupted: "But Congressman, are you saying that society should just let him die?"

Before Paul could respond, there were enthusiastic shouts of "Yeah!" and "Yes!" from the audience.

"I practiced medicine before we had Medicaid, in the early 1960s when I got out of medical school," Paul said, after the shouting died down. "I practiced at Santa Rosa Hospital in San Antonio. And the churches took care of them. We never turned anybody away from the hospitals.

"And we've given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves, our neighbors, our friends; our churches would do it," he said. "This whole idea -- that's the reason the cost is so high. The cost is so high because we dump it on the government."

Millions of people simply can't afford health insurance
The problem, with Blitzer's question as well as Paul's answer, is that most Americans who lack health insurance are not uninsured by choice. They aren't middle-class 30-year-olds with good jobs. They are seniors and children, and the unemployed or underemployed, many of them living in poverty. Most uninsured Americans either can't afford health insurance or have been denied coverage due to chronic or pre-existing conditions.

According to the U.S. Census Bureau, which released its annual report on income, poverty and health insurance coverage the day after the Republican debate, the number of people in the United States without health insurance coverage rose to 49.9 million (16.3 percent) in 2010.

That's the highest number since Medicare and Medicaid were established in 1965-when millions of seniors, low-income families and people with disabilities gained medical coverage for the first time-and the highest percentage since the 1976 recession. In 2010, 9.8 percent of children under 18 (7.3 million) were without health insurance; for children living in poverty, the uninsured rate was 15.4 percent.

Can churches and communities really replace health insurance?
Relying on people-helping-people rather than government services may sound good in the abstract, but there are simply too many variables with that approach to ensure that everyone who needs medical care will receive it. Although many Americans are both compassionate and generous, few people who are uninsured have a network of friends and family members with the means to provide them with health insurance or to help pay their medical bills.

Texas, the home state of two Republican presidential candidates-U.S. Rep Ron Paul and Gov. Rick Perry-shows the fallacy of that theory pretty clearly. Twenty-six percent of Texans are without health insurance, and the state has the nation's second-highest number of uninsured children.

The notion that churches and community organizations will fill the gap left by cuts in government services has become a mantra for politicians who want to dismantle America's social safety net--Social Security, Medicare, Medicaid, unemployment benefits--or oppose new programs such as universal health care. Yet, Paul's memory of the good old days, when neighbors took care of each other and no one was ever denied medical attention, is wishful thinking at best.

People who can't afford medical care often go untreated. Some die as a result. That was as true 50 years ago as it is today.

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