Health Care ‘Haves’ and ‘Have-Nots’

Posted on August 7, 2009


There are two fundamental goals for health care reform in America. The problem is, many of us accept one goal but reject the other.  Therein lies the conflict that is roiling town-hall meetings across America this week. This is democracy in action.

The two goals for health care reform:

  1. Universal Health Care. That is, make health care accessible to all people in America, even the poor and unemployed.
  2. Reduce the Costs of Health Care. Americans pay more for health care than any other people in the world. And health care costs are increasing at an alarming rate, with serious consequences for the American economy.

The great majority of Americans currently have health insurance, mostly through their employer’s group health insurance plan. A lot of these Health-insurance Haves are happy with their current coverage, or at least find it acceptable. Many of these folks are afraid –– “fear” is central to the debate — that they will somehow lose the good health insurance they have, and be forced or coerced — “autonomy” is also central to the debate — to accept a government plan. And people are afraid that the government health care plan, whatever it turns out to be, could be deeply flawed. Many are reflexively opposed to what they think will be “socialized medicine.”

The Health-insurance Haves are well aware of the rising costs of health care. People know that their employers are hurting from increasing costs — many companies juggle health plans yearly in search of the cheapest alternatives. 

Employees, too, are hurting from increasing costs. It seems like every year, their paycheck deductions for health insurance go up, and so does the out-of-pocket co-pay for every visit to the doctor’s office.

Bottom line, the Health-insurance Haves, both employers and employees, are deeply concerned about rising health costs. The Health-insurance Haves heartily support reining in health costs as the primary goal of health care reform.

Some of the Health-insurance Haves don’t give a fig about universal health care, that is, providing for the Health-insurance Have-Nots. And some of the Haves are very afraid that helping the Have-Nots might endanger their own existing health insurance.

Meanwhile, many people in America  do not currently have health insurance, because they are self-employed or work for a small business, or they are unemployed or work part-time, or they have a pre-existing condition, or they simply can’t afford the health plan offered by their employer. These are the Health insurance Have-Nots.

And what about the insecure middle-class and working-class people, who have a job and health insurance today, but understand that they could lose both tomorrow. These are the Worried Workers.

Universal Health Care, in some form, is the urgent priority for the Health insurance Have-Nots and the Worried Workers. If you don’t have health care, then practically any system is better than nothing.

Like the Haves, the Have-Nots and the Worried Workers also want to rein in health costs. But for them, reducing health costs is a secondary goal, and one that can be accomplished over the long term.

What we have here is a classic clash between Haves and Have-Nots. It’s also the familiar American balancing act between rugged individualism, on the one hand, and the good of the greater community, on the other.  It’s as simple, and as complex, as that.

— Bernie Hayden