Best For America?

I received an email that was sent to her friends list by a good friend of mine who is very concerned about what she insists on calling “Obamacare.” She had a list of questions about the Affordable Care Act (ACT) ending with the question: “Is all this going to work out and be the best for America??????”  I dare to say her concerns reflect those of a great many other Americans an alarming number of whom seem to have pushed the panic button and are convinced we are on the verge of Armageddon.

Now I don’t claim to be an expert on the Affordable Care Act. By no means. But I can read and I have checked a number of items. In spite of the glitches that have shown up in the early days — inevitable some would say — there are a number of questions that have yet to be answered. But, on balance, it would seem that the Act is a good idea though it has a great many rough edges yet to be ironed out. We must remember that this country is one of the very few “developed” nations with inadequate health care. Indeed, according to a recent story on PBS, health care costs in the United States are the highest, per person, in the world. And, despite the fact that for those who can afford it the care is outstanding, it is not clear that as a nation we are getting the most for our money. As the story relates, in this country

  • There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people — well below below the OECD average of 3.1.
  • The number of hospital beds in the U.S. was 2.6 per 1,000 population in 2009, lower than the OECD average of 3.4 beds.
  • Life expectancy at birth increased by almost nine years between 1960 and 2010, but that’s less than the increase of over 15 years in Japan and over 11 years on average in OECD countries. The average American now lives 78.7 years in 2010, more than one year below the average of 79.8 years.

The ACT is designed to lower costs and extend health care to most, if not all, of those who could not otherwise afford it. This, it seems to me, is a lofty idea and the overriding principle that should always be kept in mind when weighing costs and benefits. In the end, what matters is what kind of country we want to live in: one that worries more about the businesses that might suffer because of the enforced costs of extending health care to employees or one that cares about its citizens and their health regardless of the monetary costs.

We know, for example, that a great many young people who would otherwise have no health insurance can now be included in their parents’ insurance — until they are 26 years of age. My understanding is that thousands of young people are now covered who were not covered previously. And given the growing number of young people who are unable to find employment, this is an unmitigated blessing. Further, Medicade coverage is extended under this plan, thereby allowing a great many of the poor and elderly to receive care that they were not able to receive previously. In fact, the number of uninsured under this plan will be reduced by 32 million, a fact that cannot be ignored.

The number of states that have opted out of their commitment to the ACT has reduced estimates of the eventual financial benefits to the nation from $200 billion to $84 billion. Still, every little bit helps when it comes to the budget deficit. Despite the benefits in the form of a reduction to the national debt, however, there will be costs to small businesses — which concern my friend — and these must be factored in, since the Act requires that businesses employing more than 50 people must provide them with health care. This has resulted in all sorts of shenanigans by companies — cutting the hours of their employees to reduce the number of full-time employees, refusing to employ more than 49 full-time people, and the like.  The fact that small businesses that operate on a low profit margin will be required to assist their employees in paying for their health care will, in fact, place a burden on those businesses and in the end force some of them to close down, and it does appear to be the weakest link in the Affordable Care Act.  But, given the fact that an estimated 200,000 small businesses closed down during the recent recession, it must be admitted that small businesses are a risk and always have been and one suspects that with careful planning and intelligent cost-cutting fewer will go under as a direct result of the ACT than have been predicted by the knee-jerkers among us. In any event, one must wonder why a federal mandate is required to insist that employers take care of their employees’ health needs, which many regard as one of our basic human rights. In any event, the plan has generated more heat than light among the fearful due to its complexities.

And there’s the rub. My friend’s email stems from her fear that this plan will bring America to its collective knees. She starts with FDR’s famous quote that “the only thing we have to fear is fear itself,” which is a good thing to keep in mind. Any plan this encompassing that involves inevitable glitches and also involves controversial elements such as mandatory contraception will raise the hackles of the nervous element among us — and that element is growing as those who have political axes to grind have learned how easy it is to control the population through fear — of terrorists, or increased taxation, or sex education in the schools. But as I said above, it comes down to what sort of country we want to call our own: one that cares about the health of its citizens or one that cares more about “the bottom line.”

Taxing Situation

I have been reading a history of early British America — America before the revolution. It is intriguing. The Americans were a recalcitrant people who really didn’t want to cooperate with the British in protecting their own frontier. Further, they were a bit of a burden to the British who spent hundreds of thousands of pounds over seven years protecting that frontier against the French and Indians in the New World. It was costing the British about £350,000 a year to maintain their army in America even after the war.

Of course, the British had been fighting the French for centuries so that was nothing new. But the fact that they had to protect fiercely independent colonists across the pond against an ancient foe and their new allies was not something they welcomed. And the fact that it cost thousands of pounds and placed the Mother country in debt up to her ears created tensions between Britain and its New World colonies. The solution proposed by Lord of the Treasury George Grenville was to tax the colonists and recoup some of the losses.

The initial tax in 1733 (in the form of a “duty”) was on molasses that came from the West Indies and was used by New Englanders to make rum. The tax was generally ineffective and simply encouraged smuggling in the colonies. But when the sugar tax was levied in 1763, and actively enforced, it began to bring the disparate colonies together as one and to create strong resistance that eventually led to the Revolution. Until I read this book I was unaware of how independent each of the colonies was from the others and yet how the people in the distinct colonies all felt themselves to be British citizens — and therefore privileged above the rest of the world — but not the least bit beholden to the Mother Country for protecting them against enemies. But it was taxation that brought them together and actually helped to create some sense of unity out of the diverse — and very different — American colonies (think: Massachusetts and Virginia who were worlds apart in so many ways and never really got on the same page).

Taxation, especially the Stamp Act, got the colonists all riled up; it was something to be avoided like the plague. That has never changed. We still lump taxes together with death as the two things we fear most and neither of which can be avoided. And it is that attitude that has given birth to the Tea Party and its insistence that there be no more taxes — in the spirit of the early colonists about whom I dare say most Tea Partiers know very little, if anything at all.

The problem is that there is another side to the issue: taxes are essential for the running of the individual states and the country itself whether we like it or not. And as noted by one of my favorite blog-buddies, our country is taxed at a lower rate than almost every other developed country in the world yet we complain the loudest. Perhaps this is part of our inheritance (as noted above, we have a long tradition of complaining about taxes), but it is unseemly and also unworldly. Taxes are essential to the well-being of each and every one of us. As noted by another of my favorite bloggers, our tax money does immense good. Not only are taxes necessary to maintain a strong defense against terrorism (a point that is accepted by almost all) but they are also necessary to maintain social programs that benefit those who are most in need and ultimately make us a stronger nation (a point that is rejected by many).

To be sure there are abuses, as critics are quick to point out. They know — or have heard about — a fellow who takes his student loans and buys himself a new car, or, perhaps, $15,000 worth of weapons that are later used in a shooting in a movie theater. These things certainly happen. But this money also makes it possible for people in need to keep their collective heads above water, to buy food, clothing, and shelter for their struggling families. And we must never forget that. Instead of focusing on the abuses and the waste we can all attest to, let’s instead focus on the immense good that our taxes do to not only those in real need but all of us who benefit from health care and better schools for our children. After all, we are supposed to be a charitable people. We need to alter our mind-set and start to think of taxation not in conjunction with death, but with life itself.