Over the past five years of the Bush presidency, Republican congressional majority and political ascendancy of the religious right, the term "values" has gained currency in our national lexicon. So-called social values issues such as gay marriage, "intelligent design" and the Terri Schiavo case have helped to determine close elections.
During this time, I have been dismayed, as an American and as a physician, that little sustained emphasis has been placed on a "value" issue worthy of our national focus: the lack of health care access for all Americans.
The case against our great nation is profound. We provide our citizens less health care access than most Westernized nations. Census data from last year show that more than 46.6 million Americans are uninsured. This includes nearly 9 million children. Every year, more than 2 million uninsured Americans are financially ruined by the unexpected cost of profound illness or injury. According to the Institute of Medicine, more than 18,000 Americans annually die needlessly because of a lack of health care access.
To be fair, bipartisan federal failures for decades have allowed this problem to develop. However, neglect by the Bush White House and Republican Congress has made this national crisis much worse. Indeed, since President Bush's first inauguration, the number of uninsured has risen by more than 6 million.
Mr. Bush's recent advocacy of free-market health savings accounts is a Band-Aid solution to a problem requiring major surgery. The Government Accountability Office determined that, at best, 5 million Americans would benefit from health savings accounts. Mr. Bush, by focusing on these accounts, implies that the other 41 million uninsured Americans have "no value."
The Iraq war raises an interesting contrast. Part of the American long-term military plan for that country's reconstruction is the development of a nationwide network of 144 health care clinics to allow health care access for all Iraqi citizens, according to media reports.
All people should have access to basic health care. But why is this fundamental human value a component of our foreign policy and not yet a prominent part of our core domestic agenda?
The objection will be made that we can't afford to pay for universal health care. I would note that we are already paying - but in the worst possible way.
The Congressional Budget Office has estimated that a basic health care access plan for America's uninsured would cost about $90 billion annually. That is a lot of money - until you consider the corollary to the CBO analysis: that the annual cost of not insuring all Americans is more than $150 billion in lost worker productivity and tax revenue.
We need to phase in a two-tiered health care system in our country, analogous to our education system.
In the United States, every child, regardless of economic means, has access to public education through high school. If a family has the desire and means to send a child to private school, it can do so. Yet, in this country, we treat health care access as a luxury and not a fundamental human need - as fundamental as education, perhaps more so.
A two-tiered health care system would preserve the private health care system that affords 85 percent of Americans quality health care, provider choice and convenience. For the 15 percent of uninsured Americans, a public health care system could come through an expanded national health clinic network or, in the other extreme, the nationalization of the very successful Medicare program. In a multiyear phase-in program, preliminary funding could be achieved by rolling back the recently extended tax cuts for the wealthiest Americans. Instituting a national sales tax (instead of raising income taxes) would also offer the virtue of simplicity. In the long run, providing health care for the 46.6 million uninsured would improve their work productivity and raise additional tax revenue.
As a nation, we need to confront and debate the mismatch between our professed core beliefs and our current public policy. Our national health policy appears to place little "value" on the suffering of more than 46 million fellow Americans.
David Doman is a physician, a clinical professor at the George Washington University School of Medicine and the author of "Heartbeat," a novel about America's uninsured. His e-mail is email@example.com.