Health Care and Climate Change: Two Frustrations

It’s hard to say which is more frustrating to the reasonable thinker, the opposition to dealing with climate change, or the opposition to U.S. health-care reform.

For me, the most interesting parallel between the debates in the U.S. over how to stop heating the planet and how to reform health-care insurance is the response both have generated in my own brain.

For years now, the failure of a sizable portion of the American public to accept the need to sharply reduce the primary causes of anthropogenic global warming has elicited frustration and, at times, fury. Similar emotions jump across my synapses in the face of daily news reports of the paranoid reaction of what is probably the same demographic to proposals for government-run health insurance.

The irrational, anti-intellectual, conspiracy-mongering positions of climate change deniers and pseudoskeptics have long puzzled me. I just don't understand why so many people would choose to reject the expertise of those who have devoted their professional lives to the study of a subject that doesn't lend itself to armchair quarterbacking. Much has been written in the past couple of years about the lack of respect for science in certain American circles (Unscientific America by Chris Mooney and Sheril Kirshenbaum, The Assault on Reason by Al Gore, The Age of American Unreason by Susan Jacoby) and there's a long list of explanations. None of which do I find satisfying.

But the opposition to public health insurance makes even less sense to me. I've found my Canadian-raised self explaining to true blue Americans why a single-payer public system ends up costing a country less and produces superior results (longer life-spans, healthier citizens, fewer dead newborns and mothers, etc.). For some reason, they just can't accept that private health insurance will always cost more because you have to add a profit margin to the bottom line.

"Why are you so attached to paying more and getting less?" I ask. You can almost see the logic circuits frying. I am reminded of the episode in Star Trek where Kirk and his crew shut down the evil androids by feeding them logically impossible statements.

It's not brain surgery. It's not rocket science. It's not even high-school math. It's axiomatic. And yet there are plenty of people in Congress who insist that any reform legislation that includes a public insurance option is a non-starter. The numbers at this juncture, and hints from the Obama administration, suggest that we could end up with a bill that includes only non-profit cooperatives rather than what used to be the core of the plan: government-supplied insurance.

Some might argue that if all we get is a bill that makes it illegal for private insurers to deny insurance for pre-existing conditions and caps out-of-pocket expenses at a reasonable level, then we should be happy and move on. This is America in 2009, after all, and radical change isn't as popular as it was 230 years ago. What such an argument ignores, of course, is that a public option represents an enormous compromise from the only genuinely sustainable system: single-payer, universal, government-supplied health insurance. Not to get even a public option isn't compromise; it's capitulation.

Which brings us back to the climate campaign, which has also made massive compromises to get something before Congress.

Waxman-Markey, the cap and trade bill still to be ratified by the U.S. Senate, is the result of the same modern-America pathological fear of meddling with the status quo. It includes the core idea of capping fossil-fuel emissions, but waters it down by allowing emitters to avoid any real emissions reductions for a dozen years or more through the use of offsets – offsets that will prove exceedingly difficult to guarantee or verify. It's such a colossal compromise from a scientific point of view that one wonders why industry is mobilizing elaborate and dishonest astroturf campaigns against it.

I try to stay optimistic by telling myself that just passing a theoretical cap-and-trade bill would represent enormous progress (otherwise, industry wouldn’t be working so hard against it, right?) and we can always go back in a year or two and close the loopholes. Maybe this is wishful thinking. But it turns out that even theoretical climate change mitigation is too much for some senators. As a result, we may be about to capitulate on that one, too.

Health insurance reform, by comparison, is actually less urgent. Sure, millions are uninsured and people are dying because insurance companies are spending fortunes on the salaries of employees whose sole job it is to find legal ways to deny coverage to deathly sick subscribers. But unlike climate change, there is no ticking clock, no irrevocable and devastating tipping points lying somewhere in the future of health care.

So why do the dwindling prospects for substantial, economic, and ethical health insurance make me even angrier?

When I moved from Vancouver to Saluda, N.C., four and half years ago, saying goodbye to the Canadian health-insurance system in favour of expensive and unreliable private insurance was among the most difficult things I had to do. As a freelancer who has to cover my own insurance costs, rarely does a day go by when I'm not reminded of the danger of financial ruin if I become genuinely sick. My wife and I agree that in the event of a serious health problem, we'll probably have to return to Canada, as much as we love our remarkable and beautiful small-town home in North Carolina's mountains.

So when Obama rode to victory on a campaign that included genuine health-insurance reform, it was hard not to feel like the tide was turning and everything would be OK (or at least less absurd). I guess I just haven't had time to get used to being disappointed with the lack of progress on health insurance reform. For that, I'll need something similar to what 20 years of banging my head against the wall of climate change denialism can do.