As a nation, we remain divided on the issue of universal healthcare coverage. There are many who do not see healthcare as a universal right for all, regardless of ability to pay.
Unlike other "first world" nations today, as a body, we still believe that it is OK for some people to have access to the highest quality of care and blame the uninsured and underinsured for their inability to afford or access any care at all. As long as a powerful-enough group of citizens chooses to blame the poor for their circumstances, we will not, as a nation, have the will to make the changes that are required to provide coverage for all.
Medicaid expansion is one piece of this puzzle. Even with the Affordable Care Act, insurance premiums will not be affordable for many working people. Medicaid expansion is a tool proposed to help bridge the gap to coverage for those who won't be able to afford the premiums for coverage even as all of the components of the ACA come into play over the next couple of years. The proposals are not perfect; working towards universal coverage is a process that has taken, and will continue to take, time and the collaborative efforts of many factions of society. Do we have the political, financial, and psychological will to make this happen in our country?
Fundamentally, we must ask ourselves: Is medical care a right, or a privilege? For those who believe that it is a privilege, the question of universal care is mute. For those who lean towards the notion that universal care is a right, or, at the very least, a humane and decent way for a society to care for its members, there are many challenging questions that must be addressed. Primary among them, before we can even begin to address substantive policy issues, stands the fundamental question of whether healthcare is a human right.
Do we believe that the family of four down the street, where dad and mom work long hours at minimum wage jobs with no benefits, earning just enough to be ineligible for Medicaid or other social services, yet struggling to keep a roof over their heads, clothes on their backs, and food on the table, deserve access to medical coverage for themselves and their children?
Do we believe the single African-American "welfare mother" of three, living in a housing project in a major city, deserves medical care? Or, the unemployed man who desperately wants to work but cannot find employment? What of the single, white mother of four, living hand-to-mouth in a rural county? Or, that nice working couple, barely getting by? Do we care for the college-educated, middle-class alcoholic who lost her job because of her substance use? Do we care for the addict on the street?
Do middle-aged men who've never held a steady job deserve coverage? What about young men and women in their 20s who've completed college but choose to spend a year "finding themselves" before settling on a life-path? Do we, as a nation, choose to make medical care available even to those who choose not to access it or who reject preventative services only to find themselves in need of much costlier emergency services or treatments for preventable diseases down the line?
Are we willing to contribute, each of us as individuals and collectively as a nation, to the care of all, regardless of circumstance, luck, life choices, or lifestyle? If not, if we cannot answer wholeheartedly, "yes!" to each of the scenarios outlined above and any others that you might have encountered or imagined, then universal healthcare will remain a noble dream to some, a wasteful nightmare to others, a political quagmire, and a topic for endless debate, while people in every corner of our country continue to “go without.”
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