Below the Fold

Build It and They Will Come: Massachusetts Universal Health Insurance

Michael Blim

Last time, I wrote about a world without the rich. Among other things, I pointed out, not too originally I thought, that the rich do as much as they can to make society work for them, the effect of which is to make things worse for everyone else. They also are pretty successful at getting everyone else to think as they do. This includes getting us to believe that they are superior beings and deserving of their money and power.

For them to be superior, the rest of us by default must be inferior. Since we do not want to believe that we are inferior, we dedicate great energies to prove we are not by aping the rich and passing along the stigma of inferiority to any other persons or groups we can. Emulating the rich, the middle classes, for instance, press their brief that they are among the more superior after the rich, and thus they deserve their cut of the money, power, and privilege that they have been able to garner. Those below them, just as the rich figure themselves, are the less or not deserving. Working class and poor people have what little they have because they don’t deserve better.

This is the common sense of American society, and other societies such as our own with enormous economic inequality. It is also good, if banal sociology.

Most people forget the premise of the argument: that the rich make society work for them in part by getting us to believe that they are more deserving of everyone else. There is the indispensable and buried – and false — premise. Every comedian knows that a joke is only as good as the absurdity of its premise. The trick is the audience accepts the premise because they expect a good joke. If the audience buys the premise, they’ll buy the bit, and the joke is funny. “So, there were these two geese standing by the drinking fountain, and one says to the other…” Think New Yorker cartoon.

The problem with the belief in the deserving rich and the undeserving poor is that it is factually false, and when it is used to deny persons the fundamental necessities of life, it is pernicious.

Working class and poor people live in an American society that begrudges them basic necessities. To cover the malice entailed by this stance, the society following the cue of the rich and the institutions they control argue that working class and poor people are fundamentally undeserving. The rich and others who consider themselves superior conclude that these same working class and poor people are so deluded or incapable that they don’t look after their own interests. They don’t seize upon opportunities for betterment. They trap themselves in a cycle of poor education, low salaries, no savings, no benefits, and poor housing.

So, what is one to make of the fact that when the Commonwealth of Massachusetts offers anyone who cannot afford health insurance subsidized premiums and access to basic health care, the program becomes over-subscribed with persons who want to improve their health status and avoid financial ruin? Why have they grabbed the Commonwealth’s helping hand in such numbers and with such enthusiasm?

The Commonwealth originally hoped to enroll 136 thousand people in the new program that comes into force at the end of this year. It now estimates that at least 180 thousand persons will enroll by next June – a 32% more than the Commonwealth had expected. As one state senator remarked: “It’s a good problem to have – people are getting insured and hopefully getting care.” (Boston Globe, 11/18/07, 1)

Massachusetts, as the Globe reports, has committed itself to subsidizing insurance for persons who do not receive coverage on the job and who earn less than 300% of the federal poverty level. This means that a person earning less than $31,000 is eligible for subsidy. The state pays for the total health insurance build for very low income residents.

Over-subscription has the state agency responsible for the program worried about funding and cost increases, which is to be expected.

But there are several points that should be underscored.

First, if we build it, they will come. Massachusetts is providing universal access to health insurance, and by doing so, to health care itself. Everyone is eligible for help if they need it. People responded immediately and participated far above expectations because they were convinced that the program would meet one of their most fundamental needs.

Second, the Commonwealth wanted the program to succeed. So, it did what any other vendor with a product would do: it hired an ad agency that got the word out to people in need. You can apply on line. You can link to insurance providers for enrollment. You can do it all by phone too.

Third, the new law contains “incentives.” Every Massachusetts citizen must have health insurance. The key is that the Commonwealth enables citizens to meet the insurance requirement by connecting them with insurance plans that could meet their needs. People are offered assistance in sorting out insurance plans, benefits, and their ability to pay.

Fourth, because the Commonwealth recognizes universal access to health care is a paramount responsibility of government, no stigma is attached to participation. Quite the opposite: it is your civic duty in Massachusetts to participate, and you are rewarded – not denigrated – for doing so.

There will be no head shaking and muttering in the emergency room as when people on Medicaid seek treatment. No eye rolling as when a grocery store customer pays with a Food Stamps credit card. No implicit condemnation passed on persons for living in public housing or being on income support.

Honoring people’s rights, treating people with dignity, AND providing them access to the human necessity of health care liberates one crucial part of people’s lives from the blame game of a class-biased society whose motto is that if you are not rich, you are lacking something. In the case of working class and poor people, they are adjudged to lack the good sense to secure their necessities, to take advantage of opportunities, and to seek better lives. Working class and poor people by virtue of their infirmities and collective inferiority are told over and over again that they get what they deserve — fewer resources and poorer life chances.

In Massachusetts as regards health care, everyone regardless of privilege has the hope of getting what s/he deserves – health care and a better chance of a decent and fulfilling life.

Changes of this sort, as fundamental to human happiness as they are, will not bring forth in a burst “a world without the rich,” the subject of my last column. I will have more to say about how to make that world in the future.

But there can be small blessings along the way – as I hope Massachusetts can provide in the coming years for all of its citizens.

Finally, thanks to all of you who wrote in about the “world without the rich” column several weeks ago. You added immensely to the discussion for which I am just glad to have so briefly started.