True Health Care Reform: Do We Dare to Hope?

Having recently returned to the U.S. after living 17 years in Japan, I find myself following this election cycle with great interest. I remained informed and voted via absentee ballot. Even so, since the elections did not directly affect my life in Japan, it was more an exercise in civic duty, my choices guided by a broad, liberal ideology that I had to start with. Now, however, I find that I no longer identify with the Democratic Party, nor do I find the Republican Party a viable alternative. Yes, OK, I will admit that this election is interesting because of the candidates. We have the first maverick Republican candidate in what could be the twilight of the neo-conservative movement. We also have the first viable female candidate and the first viable African American candidate. What makes it even more interesting, however, is that they are talking about issues that seem to directly affect our new lives in the country. The first, and most important issue to my family and our tenuous life here, is health care.

Given that I was not able to participate in the political system in Japan, I tended to view it cynically while idealizing the political system in the U.S. Since returning, my views have changed. Although democratic, the Japanese system is not known for transferring power and ideas from election to election.  What it is good at doing, however, is ensuring that the people are well taken care of, educated, and relatively prosperous, all the while perpetuating what is perhaps the most economically egalitarian society in the capitalist world.  

Healthcare premiums are progressive in Japan, like federal income tax here.  The more you make the more you pay.  As a high school teacher in Japan I made around $88,000 a year, and at this income level, I paid more for our insurance than most people. Even so, our insurance was - at $320 a month - quite affordable.  Now, as a middle school teacher in Southern California, to insure my entire family through my school district would cost over $900 a month.  Given the fact that I now earn $2600 a month after taxes but before health care insurance, to fully insure my family with the school district's plan would leave us with only $1700 a month to live on. After considering our $1500 a month two-bedroom apartment in pricy San Diego County, you can see the dilemma we are in. Just like in the case of Hillary's delegate count, the math doesn't work. Unfortunately, unlike Hillary, we can't just ignore it and plod on, nor can we politely concede to an opponent. We have to find a way to make it work. With two small children to keep in the pink, losing isn't an option.

All three candidates are talking about health care reform, and quite frankly, any improvement from the current system is welcome. Under Hillary's American Health Choices Plan, she claims to be able to lower the costs while improving quality. So we can have our cake and eat it too? She claims she will bring down costs by "removing hidden taxes, stressing prevention and a focus on efficiency and modernization." People will have the choice of a public plan or keeping their current private plan. Everyone will be required to buy insurance and no one will be discriminated against. Obama's plan is a little less detailed but similar. He also claims to be able to provide cheaper coverage with more quality and adds the idea of portability. He will do this through efficiency and modernization. One difference is that he will not require everyone to be insured. He also seems to throw the problem back at the people, asking them to discuss the healthcare problem with friends and family and to write in their ideas to his website. Is this a type of town hall forum or a way to fill in the details with other people's ideas? John McCain states that he will make health care insurance innovative, portable, and affordable. He'll do this by using competition in the marketplace, fiddling with the tax codes and by encouraging health care savings accounts. This fits in nicely with the Republicans love of the free market, hate of taxes and promotion of individual responsibility. And we thought they didn't care.

Let us remember, however, that just because all three candidates have a health care reform plan does not mean that health care will be reformed. Politicians have tried before and have had to settle for small, sometimes local pilot plans to increase coverage for children or the elderly. With a new president and new congress, will there be the political will to push through true health care reform? Is it possible to take on the powerful drug companies, health care companies and all the other companies, institutions and people who benefit from the current system? I too find myself daring to be hopeful on this issue from time to time, but I have also prepared a quiet part of my heart for the more likely possibility of health care reform lite.

 

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