Brendan Gates

We have a huge national debt. Clinton balanced the budget, then Bush unbalanced it. Obama is taking it even further down the red line because of the “spend your way out of a recession” strategy. And now he threatens to take it even further, at least in the short term, with health care reform. So is that a big deal? Yes, debt is a big deal. But not all debt is created equal.

Defense spending for 2010 is 663.8 billion dollars, or about 52% of the total discretionary budget (source: OMB, Budget of the U.S. Government, table S. 12). It is far and away the largest chunk of the budget. Does that contribute to our debt? Absolutely. But it doesn’t invoke nearly the furor that debt due to health care spending or reform does. Why is that? It’s because defense spending is considered necessary, while health care reform is largely viewed as welfare.

Consider that our country has 308 million people (source: UCB, U.S. Population Clock), and estimates put the number of uninsured U.S. Citizens at about 37 million (source: FactCheck.org).  That means 88% of the country has insurance. Most of that 88% hear “cover the uninsured” and think “welfare”. So why should they care about that 12%?

Because it’s not about the 12%, and it’s not about welfare. It’s about all of us, and I don’t mean that in a some-of-us-is-all-of-us way, I mean that literally. Health care reform is about making health care more affordable and accessible for all of us.

One of those reforms is limiting the ability of an insurance company to reject an insured based on a pre-existing condition. The problem with this reform is that it flies in the face of all business sense. Willingly taking on high-risk insureds means you’re guaranteeing more payouts and lower returns in the future.

Take me as an example. I have aplastic anemia, a chronic and very rare disorder that puts me at a higher risk for needing a bone marrow transplant or developing other blood-related conditions like PNH or leukemia later in life. I am insured because my employer chooses to cover all employees. If I lose my job, I’m screwed. On the open market I’d be rejected flat out or presented with monthly premiums way out of my reach. And I would need help with that, so does that make me a welfare queen? I don’t think so. I work hard to provide for myself, and I plan for my future. I don’t rely on welfare now, nor do I plan to ever (I assume that social security or medicare may well be bankrupt when I retire).

But not covering me makes sense, right? Certainly from a business sense it does. I represent more risk, so no profit-seeking insurer would insure me without sufficient guarantees that I won’t cost them too much money. Allowing me to go uninsured is good business, even though that means I could die or go bankrupt getting care. And from any caring, human, normal or otherwise common sense point of view, that’s absurd. It’s exactly the reason that business goals (i.e. profits) and oversimplified business logic cannot dictate the direction of health care in this country. The greater goal must be to provide coverage. This bill has a lot of little first steps with that goal in mind, and even though it also has a lot of unnecessary pork riddled steps, it’s still a start.

As far as I can tell, Congress will vote on health care reform in about an hour. I don’t think it’s a perfect bill; without a public option it’s not even close. But if you think the business interests and lobbies involved want anything other than the status quo, then you’re kidding yourself. Any reform bill, from either party, would be met with similar resistance. So today’s bill is an important shift towards real reform, and for that reason I hope it passes.

4/16/2010 UPDATE: This post attracts a very high number of spam comments per day (selling car insurance, viagra, etc), so I am disabling comments to this post. If you are not a robot and you have something you’d like to add, please email me and I’ll turn comments back on.