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Be Not Afraid

"When I moved to Canada in 2008, I was a die-hard conservative Republican. So when I found out that we were going to be covered by Canadas Universal Health Care, I was somewhat disgusted. This meant we couldnt choose our own health coverage, or even opt out if we wanted too. It also meant that abortion was covered by our taxes, something I had always believed was horrible. I believed based on my politics that government mandated health care was a violation of my freedom."That's the opening paragraph of a detailed and thoughtful reflection titled "How I Lost My Fear Of Universal Health Care" by "Melissa", a young mother of self-described "Protestant Fundamentalist" background, writing about how her experience of Canadian health care has worked on her, and both calmed some of her fears and changed some of her thinking over the past few years.Despite the fact that Melissa comes at these issues (including abortion) with a different theological and ecclesiological background that most Roman Catholics do, she shares many of the same concerns. And, despite the fact she share many of those concerns, some of her conclusions most likely aren't the ones many of us would come to.But what I like most about her essay---and why I think it's worth discussing---is that it's an excellent example of the power of lived experience.

We see this in Massachusetts with the high levels of public support for "Romneycare", our version of near-universal access to health insurance. Despite (or because of?) the bad economy of the past few years, the law enjoys higher public support in the Commonwealth now than when it was first enacted in 2006.We've had a somewhat similar experience with same-sex marriage. Eight years after the first gay and lesbian couples legally got married in Massachusetts, roughly 60% of voters surveyed support the new status quo, while nearly 90% support some sort of legal recognition and protection (i.e., marriage or civil unions) for same-sex couples. Only a small minority prefers the status quo ante.I can't prove, but I suspect that in both cases (as in Melissa's case) the change in public opinion has happened primarily because the fear of the unknown was worse that the reality:

  • Massachusetts health care costs haven't skyrocketed; in fact, Massachusetts is slowly but steadily dropping down from its previous #1 spot as the most expensive state for health care. (And no government bureaucrat comes between you and your doctor.)
  • Same-sex marriage has had no discernible impact on the strength and stability of other marriages in a state that already had a relatively low divorce rate.
  • Canada, as Melissa discovered, has a lower abortion rate than the United States.

"And suddenly I could see why that was the case. With Universal coverage, a mother pregnant unexpectedly would still have health care for her pregnancy and birth even if she was unemployed, had to quit her job, or lost her job. If she was informed that she had a special needs baby on the way, she could rest assured knowing in Canada her childs health care needs would be covered. Whether your child needs therapy, medicines, a caregiver, a wheelchair, or repeated surgeries, it would be covered by the health care system.Here, you never heard of parents joining the army just so their child's "pre-existing" health care needs could be covered. In fact, when a special needs person becomes an adult in Canada, they are eligible for a personal care assistant covered by the government. We saw far more developmentally or physically disabled persons out and about in Canada, than I ever see here in the USA. They would be getting their groceries at the store, doing their business at the bank, and even working job, all with their personal care assistant alongside them, encouraging them and helping them when they needed it. When my sister came up to visit, she even commented on how visible special needs people were when the lady smiling and waving while clearing tables at the Taco Bell with her caregiver clearly had Downs Syndrome."It's unclear whether the Affordable Care Act will ever be fully implemented. In fact, if Republicans sweep the national elections (House, Senate, White House) in November, there's a good chance it won't.But if the ACA is fully implemented over the next few years, then I suspect we (or our children's generation) will look back at much of the current debate and wonder what all the fuss was about.h/t: John Aravosis

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I was a die-hard conservative RepublicanAnd Hillary Clinton insisted that she was a "Goldwater Republican."I believed based on my politics that government mandated health care was a violation of my freedomAnd now, Melissa the agnostic, believes based upon her current politics that government mandated health care is great.Looking at her other posts on her blog, it is clear that her experience with the Canadian system did not change her mind, rather, her change of politics changed her perception of the Canadian system.

Bender, I'm not sure that what you wrote even makes sense, let alone that you could actually demonstrate the truth of it. It would be good to know what province she lives in (did I miss her mentioning it?), because that can mean a lot in terms of benefits and access to services in Canada.I think that the point she makes about access to support that doesn't immediately fall under the category of health care is as important as the health care itself. My own experience leads me to agree with her. As a parent, I have found that the government is actively pro-family in terms of the support it offers families with children (and by government, I'm referring to the federal, but even more so to the provincial--which in my case is Quebec). I could make this a really long post by talking about the various tax credits we get, but I will instead just say that it makes a huge difference.With respect to health care, as the parent of a kid who was diagnosed in utero with a serious condition, I find myself even less able to grasp the negative response to universal health care that so many Americans demonstrate than ever before. When I imagine what it would have been like for us to have our child in the States, my guts just turn to water. I am quite serious: I just start sweating bullets. A nation with a pro-family agenda wouldn't put families into that sort of situation.

As any Candian, Briton, Taiwanese, Japanese or European whether they would rather have coverage under the US or their own systems.I don't see any great rush to mimic the Country of Great Exceptionalism.

"But if the ACA is fully implemented over the next few years, then I suspect we (or our childrens generation) will look back at much of the current debate and wonder what all the fuss was about."But isn't Canada's system more like "Medicare for all"? That's not very close to what the ACA is going to be like.

Jim McCrea -- A+ for mentioning Taiwan, too often forgotten, but apparently with a splendid health care system. One of the most influential voices in the project for an eventual single-payer system here in Vermont has been Dr. William C. Hsiao of the Harvard School of Public Health who is, I believe, Taiwanese.

@Jim Pauwels (7/24, 9:17 pm) I think you're right about Canada's system.I think---based on Massachusetts' experience so far---that what will happen when/if the ACA is fully implemented is that for the overwhelming majority of Americans, access to routine health care will become...well, routine. No "death panels", no "government bureaucrats coming between me and my doctor", no "trillions" of dollars of added federal debt.And then millions of people will have experiences similar to Melissa's---not having to worry as much about each and every possible health care outcome and/or expense. So the cumulative result is likely to be a great easing of fear and worry---both fears of the unknown (socialism!) and fears that today are enormous, pressing burdens for many Americans (can I afford this test? this prescription? this operation? what if I get laid off and we lose our insurance? what about my/her/his "pre-existing condition"?) will cease to exist (at least, for the most part).

"No death panels, no government bureaucrats coming between me and my doctor, no trillions of dollars of added federal debt."Why would the GOP vote for the tax increases needed to supplant the required borrowings? Or are you just assuming they will be back in the minority by then so it would be irrelevant?

@MAT (7/25, 1:53 pm) Thanks for the questions. I'm not sure I understand them fully, but I'll give a try at answering.First, I'm fairly confident that the Republican Party is not going to become "irrelevant" at any time in the near-to-medium future.Second, my statement on the debt was based primarily on two recent events:1 - Mitt Romney's repeated lie (to use plain English) that "Obamacare adds trillions to our deficits and to our national debt." http://www.politifact.com/truth-o-meter/statements/2012/jun/28/mitt-romn... - The latest report from the Congressional Budget Office and Joint Committee on Taxation that the likely result of the Supreme Court's decision last month will be to reduce federal deficits by an additional $84 billion over and above the already-projected deficit reducing-effect of the ACA. http://www.healthcareitnews.com/news/cbo-figures-84b-saved-keeping-healt..., it's certainly possible that Republicans will sweep to power this fall and repeal the ACA. One result, I suggest, is that tens of millions of Americans will not have the experiences that Melissa had of what it's like to live in a society with (near) universal access to health care. Another result that seems likely is that there would be an increase in future federal deficits and an adding to the national debt.

"The latest report from the Congressional Budget Office and Joint Committee on Taxation that the likely result of the Supreme Courts decision last month will be to reduce federal deficits by an additional $84 billion over and above the already-projected deficit reducing-effect of the ACA. "I apologize. I misunderstood you. I thought you were referring to future levels of the US public debt. I did not realize you were referring to baseline budget projections excluding the HI trust fund. "Another result that seems likely is that there would be an increase in future federal deficits and an adding to the national debt."Given that there is no direct relationship between baseline budget scoring and future levels of the public debt, I would have to disagree with that. However, the notion that the PPACA will be "repealed" is absurd. The interesting question is will the GOP prevent the additional tax increases needed to make it budget neutral? I reckon they will.

Luke --This is a really dumb question. If ACA is repealed, what happens to Medicare, Medicaid, etc.? Were they killed by the passing of ACA ? Or will they continue to operate as before?Also, did the Supreme Court's decision, by eliminating those programs, also eliminate 85 billion dollars worth of medical jobs that would have started up otherwise? I fear that people often have little understanding that to cut government programs has exactly the same effect as outsourcing jobs -- elimination of jobs. Sigh.

@Ann Olivier (7/26, 4:24 pm) Not dumb questions at all. Here are my off-the-top-of-my-head answers. (Others should feel free to jump in with more.)Passage of the ACA did not kill Medicare, Medicaid, etc. If the ACA is repealed, Medicare and Medicaid will continue to exist as they were...unless additional action is taken to change or eliminate them. There are provisions in the ACA aimed at expanding Medicaid. The Supreme Court decision, by limiting Congress' ability to use Medicaid funds as leverage to further expand Medicaid, may, according to the recent CBO/JCT analysis, result in approximately 3 million people not having health insurance coverage. (That will also, according to the same analysis, further reduce future federal deficits since federal Medicaid expenditures would decrease from previous estimates.)I don't know anything about the overall jobs impact of the ACA, or of the Court's decision. My guess is that the overall impact will be to increase jobs in the health care field (broadly defined, e.g., including health insurers' jobs).

Thanks, Luke. I hadn't thought about an increase in private insurers' hiring. That would help the job market too.