Healthcare as a moral imperative

The Boston Globe, November 27, 2004
Healthcare as a moral imperative
By James J. Mongan  

This article was adapted from remarks made Nov. 16 at the Blue Cross Blue Shield Foundation Summit on Access.

AFTER AN ELECTION season in which health care took a back seat to the Iraq war and gay marriage, it is refreshing to see that universal coverage for the uninsured has moved to center stage in Massachusetts.

The most important thing to do to move the universal health insurance issue forward in Massachusetts and across the country is to start with a frank discussion about funding. And I would argue, to address the funding issue, we ought to start a real dialogue about values.

As an analysis by the Urban Institute for Blue Cross Blue Shield Foundation’s Roadmap to Coverage points out, providing universal coverage costs money, beyond what we are currently spending — in the form of taxes to pay for subsidies, or employer mandates which are in effect taxes.

The elephant in the room in this discussion is, and has been for 30 years, how to get public support for additional revenue.

This is not just a public finance issue, it is a real values issue. Specifically, in a supposed time of ascendancy for “moral values,” I’d ask what happened to “social justice” as a moral value. I’d ask why we aren’t focused on social justice issues such as poverty, retirement security, and health insurance at the same time that we focus on issues like gay marriage and abortion. You see, I think I know why social justice issues get left behind — because dealing with these issues takes money — our tax money to help other people.

As we as a nation moved beyond the Depression, World War II, and the poverty program and civil rights struggles of the 1960s, we became, over the past 30 years, a relatively affluent, consumer nation and began to focus more on our own needs and wants.

It has been an age of individualism or self-centeredness or perhaps even selfishness. This culture fed the driving political force of the past 30 years — the antitax movement.

The antitax tide swept social justice issues aside, and left them behind in its wake. As a result, in recent years, every politician from the Courthouse, to the State House, to the White House feels they must run on an antitax platform. Just look at the consequences:

Our national tax level, as a percent of the gross domestic product, is at the lowest level since 1959.

In our state, tax cuts over the past 12 years have left us with $3.8 billion less in state revenue, which could have been available for covering the uninsured. We now rank 47th out of 50 in taxes and fees paid as a share of personal income.

Let’s look at what happened in Washington three years ago, when we passed a $1.6 trillion tax cut. We could have taken another path, and passed a $1 trillion tax cut, the largest in history, and used $600 billion to fund a comprehensive health insurance program for a decade.

When Uwe Reinhart, professor of economics at Princeton University, talks about that tax cut, he says budget decisions like this are like a memo to God. Reinhart says our nation’s memo said, “Dear God, we had to decide between health insurance and a tax cut, and we took all the money as a tax cut. We hope this pleases you — signed a grateful nation.”

After 30 years of waging the battle for broader health insurance, I am convinced the debate over universal coverage is more about values than it is about specific plans. If the resources were made available, we could easily develop a plan. We should focus on the question of what happened to social justice in an era of moral values. We should all look in the mirror.

Dr. James J. Mongan, who was associate director of the White House domestic policy staff in the Carter Administration, is President and CEO of Partners HealthCare.