America’s Socialized Health Care System

If nothing else, the most interesting thing about the Terri Schiavo case is that it reveals that Americans already have a socialized system of health care and have a deep commitment to the concept of socialized medicine. What is puzzling is the degree to which they are in denial about this. Particularly those on the far Right who seem most deeply committed to the concept.

Last night the Congress voted on and President Bush signed legislation allowing a Federal judge to hear the arguments of Terri Schiavo’s parents who want to reinsert the feeding tube that was removed last week. Unstated in all of this discussion is "who is paying for all this health care?" In a sense, it doesn’t matter, for implicit in the Republican argument is the notion that every individual should be kept alive at all costs -- at all costs. I find this stance pretty rich since a study released last year estimated that 18,000 Americans died last year for wont of health insurance or resource to pay the costs of their health care. The Miami Herald last week reported that her medications are paid for by Medicaid and that the Hospice where she stays now provides free care. But while all this has been going on, the US House of Representatives cut $20 billion from Medicaid for next year.

The Terri Schiavo case speaks volumes about the health care debate, or lack of it in this country. In 1993 Michael Schiavo received a $700,000 medical malpractice settlement. That money is almost entirely gone now (due to legal fees and medical costs - the Lawyers have not been paid in 2 years and a judge approves all costs), which begs some interesting questions of Republican attempts to cap malpractice claims at a lower level than this.

We already have socialized health care in this country if by this we mean that society has a commitment to keeping everyone alive at all costs and seeing to it that no effort is spared on account of resources. Businessweek reports that 17,000-35,000 people in America are currently alive in what is diagnosed as a persistent vegetative state and this costs the system between $1 billion and $7 billion a year. It seems clear that across the board, American’s share this commitment to extensive care regardless of a person's ability to pay. How many Americans would stand by and think nothing if told on the evening news that a man had been run down in the street and left to die because he had no insurance and little money, no ambulance would transport him and no hospital would take him? The fact is that few would. Given this, it seems reasonable to accept that Americans believe in socialized medicine, believe in a socialized system of paying for health care, but simply cannot agree on a rational way of organizing the payment of this care and the organization of the delivery system.

I don’t know enough of the facts to comment on the Schiavo case itself. But I would like to know how a member of Congress comments on his or her vote last night to bring Schiavo’s case to a Federal judge in an effort to keep her alive, on the implication that taxpayers and the health systems built-in cost shifting should continue to pay for her care, and on the refusal to fund Medicaid adequately or to tackle the issue of national health care reform. A poll just released indicates most American’s take a dim view of Congress’ efforts. Nevertheless, Democrats are keeping a low profile (witness the 52 votes registered opposing last nights legislation in the House) other than muttering about the political motivations on the Right. This is a shame since it is an opportunity to engage in a national discussion about health care and health insurance that should be at the heart of the Democratic message.

UPDATE: Matthew Yglesias points to Mark Kleiman who has a different but more compelling take on the Schiavo affair.