Invisible and barely getting by

The rhetorical weight swung hardest in debates over socialized medicine is the ghastly number of Americans - over 40 million - who live without health insurance. Overlooked too frequently are the stories of Americans who can afford health insurance, but not comprehensive health insurance, who spend their entire lives fighting with their providers over plans, omissions, coverage gaps and reimbursements. They often find that themselves uncovered and unable to pay for crucial medical treatment and preventative care. What I found most powerful about Moore's SiCKO was not it's celebration of nationalized systems in Canada and Europe, but the haunting portraits of insured Americans for whom the system does not work.

Take for example, childhood immunizations. New reports indicate that children who are underinsured (as opposed to fully insured or uninsured) are the least likely to get vaccinations on time and at affordable rates. Working class families are left to choose: pay thousands for the injections, or let their kids go without critical preventative medicine. For families with good plans, the costs are covered - but many providers simply don't cover the vaccinations. And for those without any insurance, there's Medicaid and the FQHC system. As with so many other places in the American class system, its those who barely get by who feel the squeeze.

All the same, libertarians like John Stossel lambaste the type of government guidelines for providers that would close these coverage gaps:

Does it never occur to the progressives that the legislature's intrusion into private contracts is one reason health care and health insurance are expensive now? The average annual health-insurance premium for a family in Wisconsin is $4,462 partly because Wisconsin imposes 29 mandates on health insurers: Every policy must cover chiropractors, dentists, genetic testing, etc.

Absent those "intrusions", however, the full cost of health care is passed on to the people who are not able to pay, but who all the same are not the listless hordes of welfare-state-dependents that libertarians like to deride (a blogger at KXMC seems convinced that anyone who can't afford to pay for every health expenditure is a "lay-about").

Free marketeers and fiscal conservatives don't like to discuss the working poor because they defy easy stereotyping: they don't have much money but are demonstrably hard working; they pay taxes but still need state assistance. They make visible the long spectrum between dependency and autonomy that rabid individualists can't seem to grasp as the fundamental quality of social life.