Dean Lawrence’s timely message concerned those who “ensmall” their spheres of responsibility and accountability vs. those who enlarge them. By defining down those things for which we feel any responsibility, anything outside that circle becomes “someone else’s problem.” Whether it’s the cold chicken entree served by a flight attendant (“I serve ‘em; someone else cooks them” (or doesn’t)), or Gov. Mark Sanford‘s ensmalling of his public and private obligations to the citizens of South Carolina and his family, if you can define your spheres of responsibility and accountability narrowly enough, lots of hard things become someone else’s problem.
This describes a lot of what’s going on in the debate over health care reform right now. “I’ve got mine. The 47 million uninsured are someone else’s problem, not mine.”
This is a middle-class fantasy to a large extent. Your insurance company makes money by collecting premiums and denying claims. It’s that simple. Hundreds of thousands, if not millions, of your fellow citizens have learned the hard way that medical costs can drive to the brink of financial ruin even those with “good” insurance policies. Medical costs are the number one cause for personal bankruptcies in America, and no small number of bankruptcy petitioners thought their insurance was up to the task, only to find out otherwise, with catastrophic financial consequences. Even the Wall Street Journal seems to get it: health care crises don’t happen only to “them.”
Apart from the fantasy, though, there is the matter of ethics and public responsibility. Half of those uninsured are children. Most of the uninsured live in working households, but their employers don’t provide insurance and they are priced out of the market for individual health insurance. Nearly 90 million were without insurance at some time during 2007 and 2008. They live in our communities. Their kids go to our schools. Our employment-based, market-oriented “system” for financing and delivering health care goods and services isn’t working for the benefit of nearly one-third of the country (by any conservative measure, and the number is almost certainly much, much higher). When does it become “our problem” and not just “their problem”?