Tuesday, April 19, 2005

At What Price 126,000 Insured?

In New York, my home city and very likely the center of the human universe, the city council is debating a bill called the NYC Health Care Security Act, which 'would require certain businesses to either provide their employees with health insurance or pay a fee to a city-wide fund to provide these employees with health insurance. The bill would affect medium and large businesses in the following five sectors: construction, building services, industrial laundries, groceries, and hotels. It would help 126,000 currently uninsured persons to become insured and would provide security to 446,000 people who currently have health insurance but might lose it. The bill would protect responsible businesses from unfair competition from businesses like WalMart who do not provide health insurance to their employees, thereby preventing a "race to the bottom".'

For context, consider that 1.8 million New Yorkers (in a city of 8 million) have no health insurance, of which 1 million either work full-time or have immediate family members who do. OK, so right there, nearly half the uninsured are left out of consideration by this bill because they're unemployed. Of the remaining million currently uninsured, only 126,000 would actually gain insurance from this bill. Which, I grant you, is a lot of people. But the question is, what's the political cost of supporting the bill, and is it justified by the gain of covering this tiny tranche of the uninsured population?

That may sound heartless, but here's what I'm getting at. For those of us who support a single-payer, universal healthcare system, breaking the irrational, philosophically contingent and deeply harmful bond between health coverage and employment is a critical step on the road to getting all Americans covered.

If we rally in support of this bill (Wednesday, May 4th, 1pm - 2pm, City Hall), we come out in favor of a reform that, yes, would provide relief for an objectively large number of currently uninsured workers as well as curbing scummy business practices by WalMart et al., but would do bupkis for remaining 1.7 million employed and jobless uninsured, and, crucially, would shore up the connection between health coverage and employment.

Is it worth it? I'm genuinely torn. It really does seem cruel not to support a measure that would provide coverage to so many people currently at unfair risk of their very lives. As a future doctor, can I justify that? But on the other hand, what's the strategic political cost of supporting this profoundly incomplete stopgap measure? I can't help feeling it amounts to perpetuating the misconceived system that put those 126,000, not to mention their 1.7 million ignored fellow citizens, at such risk in the first place.

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