There are many reasons one might feel skeptical, or at least less-than euphoric, about the recent healthcare legislation, and none of them make you any less of a feminist. Let me lay out the spectrum of healthcare skepticism, both for us skeptics and for those who don't get where we're coming from. You might be skeptical of the healthcare legislation because:
- You don't believe in the principle of a social redistribution. You think the government is for providing basic public services and regulation only, and that people should help others privately if they choose to do so.
- You believe in the principle of social redistribution in theory, but you think the government is ill-equipped to do so, or that the government being involved might stifle economic growth, which will lead to less wealth for everyone.
- You may or may not believe in the principle of social redistribution, but you think the government should not be involved in regulating healthcare, which should be a private transaction between patients, doctors, and insurers. You think the government's involvement may be create distortions, inefficiencies, privacy concerns, or other problems.
- You think it's fine for the government to be involved in health regulation, but you're not sure this bill focuses on the right things. You may believe that repealing the tax subsidy for employer-paid health insurance would do more to control costs than the current bill, for example.
- You think this bill does the right things, but doesn't do enough of them. You wanted a more comprehensive bill, and are disappointed because passing this one means less political will for passing stronger reform.
- You think what is needed is a total overhaul of the healthcare system, including possibly going to single-payer government run care, and you feel this bill doesn't further that goal. You may feel this bill takes too many cues from conservative healthcare plans, and helps private enterprise more than public interest.
Personally, my skepticism comes from a mixture of reasons three and four. I'm worried that the government is not the right entity to make decisions about appropriate healthcare, and I also worry that this bill offers several fixes to improve coverage without really addressing soaring costs. For the first concern (and you should remember, I am pro-choice), I think the Stupak kerfuffle is case in point about why it's worrying for the government to be making care decisions. This bill strengthens the governments hold on determining what basic healthcare entails and what it doesn't, and the decision to exclude abortion from government-sponsored plans tells me the government cannot make these decisions agnostically. I think evidence shows the government is not very good at making policy in keeping with cutting-edge science (witness how long it took to change the federal dietary guidelines when it was clear they were out of step with modern nutrition science), and the price for this in the healthcare realm is large.
The second concern doesn't keep me from liking the current bill, but it does give me a sinking feeling about where healthcare is headed, and what the unintended consequences of this legislation will be. In my opinion, healthcare is unaffordable largely due to our distorted view of what health insurance should be. Health insurance in the US is not insurance at all, it's a payment transfer system that breaks the link for consumer between how much healthcare they consume and how much they pay. What I mean by this is that health insurance doesn't just cover unanticipated events (what insurance is designed to do to allow the efficient transfer of risk from one party to another) but rather all health needs. When someone is very ill, they know that they are consuming a lot of healthcare, and the care they consume is largely non-discretionary. However, when someone is healthy and simply getting their normal tests, checkups, and prescriptions, not having to internalize how much these things cost can cause over-consumption. And once again, the government is not very good at setting guidelines. There has been countless damage done by over-screening for cancer (prostate cancer is one egregious case), that likely never would have occurred if consumers had set the amount of screening with their pocketbook instead of insurance executives and policy-makers with opinion polls and outdated science. Consumers naturally weigh the costs and benefits of purchases in a way no policymaker has yet been able to replicate.
I believe a driving reason behind the "over-insurance" phenomenon is the tax subsidy that allows employers to compensate employees tax-free if they do so through healthcare. As a result, including more things in health insurance that employees would spend money on regularly became a way of funneling more tax-free compensation to employees. Naturally, not only things that constituted true insurable risks would be included, because there were so many other things that could be included and that employees spent money on. If a health insurer spent that money instead, the employer could pay the employee less, and pay the health insurer tax-free. As a result, we have a system where health insurance isn't insurance at all: Your car insurance doesn't cover oil changes, but your health insurance covers dental cleanings.
So there you have it; I'm skeptical. I'm not upset about the bill being passed or militantly opposed. I'm just less than euphoric, because I have concerns. And that's ok. I'm still a good person, and I'm still a feminist. What I'm trying to say (in this now very long post) goes beyond healthcare: I want this blog to always be a safe place for dissenting opinions, even (and especially) those that go against our own. There are a few things I'll always consider unacceptable (homophobia, sexism, racism, weight bigotry, and religious discrimination are part of the list), but beyond that, no opinion is "taboo" on femonomics. Celebrating women means celebrating that women are diverse. So please, join in in the comments!