Friday, March 19, 2010

Separate And Unequal

Roughly 52 years ago, the Supreme Court (this was back when we had a Supreme Court, understand) ruled that separate is fundamentally unequal.

The subject at the time was education, public education, and the problem was that there were several million young black children, predominantly in the South at that time, who were going to segregated schools. Not because they wanted to; because they had to.

They were getting a vastly inferior education, if they got any education at all. They suffered from this treatment, their families suffered, and, if anyone stopped to think about it, the whole country suffered, as well. Suffered from a loss of moral authority, by virtue of turning its back on its own best values and highest principles, and suffered from a loss of economic opportunity, by squandering the human capital represented by millions and millions of young Americans.

It's 52 years later, and we have a segregated health care system. Segregated not by race, at least not officially; but segregated by wealth.

In America today, if you have a job and it happens to have benefits attached to it, you have health insurance. If you don't have a job, but you have money, you can buy health insurance--usually. Unless the private companies that get to decide who does and doesn't get health insurance rule you out of the system.

If you are poor or on the cusp of poverty, or if you're unemployed, or if your job is one of the millions that no longer offers health insurance as a benefit, well, then you're separate--and unequal.

Then if you get sick, you end up in the emergency room of your local public hospital. That's the most expensive and wasteful care there is. Back in 2001, one study said that it costs Americans about $35 billion to pay for the health care of those of us who are uninsured; another study said that the costs of health care that wasn't provided--and resulted in health problems--totaled between $65-130 billion. And that's just the monetary cost. As with education in America in the 1950s, there are social costs, there are moral costs, there are individual, family, and community costs. Most of the time, it's not about the money--it's about the social capital that we squander.

We have two health care systems, at least. One for the wealthy and the employed (never mind the fact that the attaching of health care benefits to jobs is an accident of history, an FDR concoction designed to allow some kind of improvement to workers' pay packages at a time when wages were frozen), and one for the poor and the unemployed.

They are separate and inherently unequal.

Put aside the insanity of allowing private, for-profit health insurance companies, which pay their CEOs outrageous salaries, in the tens of millions of dollars. (Which I wrote about when I asked what would it be like if Aetna owned the Grand Canyon?)

Think instead of a system in the richest nation on earth that has two side-by-side health care systems, separate and unequal, and pretends that a system like that is just fine. No need to change. It's working quite well, thank you, at least it is for the employed and the wealthy, kind of like the schools in the South in the 1950s.

What would you call a system like that?

Back in 1958, the Supreme Court called it unconstitutional. Citizens were being denied equal protection. Citizens were being denied equal opportunity. Citizens were being denied their inalienable rights.

Tell me: how is the health care debate any different?

How is separate and unequal good enough for 30 million Americans without health insurance?

How is it good for the rest of us, who do have it?

How is it good for the country?

All Rights Reserved 2009 (c) Alan Webber, Rules Of Thumb