An open letter to Congressman Brian Bilbray

Dear Congressman:
I have worked in community health here for 15 years. However, one need not do so to understand the difficulties faced by residents who lack adequate health insurance. Children go without dental care; seniors choose between food and medications; families are bankrupted by illness. For nearly a century, various presidents have sought to provide guaranteed health care to all citizens. At every turn, vested interests — insurance companies, doctors’ lobbying groups — have invoked the terms “socialism” and “nationalization” to protect their profits in the face of comprehensive health reform.
I believe that health care should be a right, not a game of chance. We are the only wealthy nation in the western hemisphere where a child’s likelihood of receiving health care is tied to the socioeconomic status of its family. I know that more than 30 percent of health care costs under the private insurance system fund “gatekeepers” who decide whether a patient will receive the care their doctor recommends. That is called “rationing.” I know that none of the reform legislation under discussion will force anyone to give up their current insurance; or to fund others’ abortions; or to agree to euthanization — false claims meant to foment opposition to reform that is, by every measure, in the interest of all nonwealthy Americans.
In an Aug. 5 press release, you list the principles that guide you in this debate. You state that you support reform, increased access to care, and improved health care quality. Yet you speak repeatedly of proposed reforms as creating a “nationalized system of health care.” You note that you will not support a system that “decreases motivation of investment in the companies creating innovative solutions to our nation’s health challenges.” If you are referring to private insurance corporations, please identify the innovative solutions for which they are responsible. I believe that America’s health insurance corporations have innovated primarily in finding ways to deny needed care.
In fact, none of the pending legislation creates a “nationalized” health care system. It may create a voluntary public insurance option to compete in the marketplace with private options. Yet you seem to believe that competition is good until it threatens to offer people of humble means better care options at the cost of a portion of private insurers’ profits. You state that “we can fix the system without letting bureaucracies gain more control over our lives. If you don’t recognize that the existing insurance corporations are tremendous bureaucracies making care decisions for millions based on the profit motive, you either are significantly ignorant, or highly disingenuous. I believe it is the latter.
I know that health care reform is not simple. There are many complicated considerations relating both to process and to cost, and access to care never will be unlimited. However, what I know with particular certainty, based upon my years in the trenches, is this: your fear mongering about “nationalization” stands in direct opposition to the needs of your most medically vulnerable constituents and to the majority of Americans who do not have the gold-standard health insurance options that you enjoy as a member of Congress. We already have a national health care option. It is called Medicare. It has provided — perhaps, in your mind, at great risk to our national character and values — the opportunity for my parents and yours to move through the latter portion of their lives secure in the knowledge that they can access care and maintain a measure of dignity.
A suggestion: If you are more concerned about the sanctity of private-sector profits than the health of children and the stability of working families in your constituency, you should set an example by stating publicly that you will refuse Medicare at the time of your eligibility. That would be philosophically consistent on your part. And the next time one of my health center doctor colleagues must tell a patient that we cannot help them access the specialty or surgical care they require, you can call them and explain that their personal tragedy is not in vain — it is a blow struck in the name of a core American value — I just can’t remember whether it’s morbidity or mortality.

Joshua Lazerson works with a number of community health centers throughout San Diego County.


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