It's really no real exaggeration to say our system of government has evolved into a vast social insurance system with a side-line business in defense. Social Security makes up about 23% of of total federal spending; followed by Defense (18%), Medicare (15%), Medicaid & Children's Health Insurance (8%) and Income Security & Unemployment Compensation (10%). Rounding out the top six categories is the interest on our National Debt (6%).
I find this new role as a social safety-net system to be mostly appropriate - a humane response to deep changes in our society - and it offers basic security to those who otherwise would be homeless, hungry and without access to health care. Others likely find it distasteful that we spend our collective monies to help our friends and neighbors who are less fortunate. And while I may not agree with them, I respect their point of view.
But whether you agree with this new role or not, this federal government as a social support system is our reality. Social Security and Medicare aren't going away. Individuals pay in every week through wage withholdings and expect it to offer them some type of income and care as they age. It's hard to imagine our society without these things (even though they did not exist prior to FDR and 1965).
This week the Senate is working behind closed doors to discuss how they may want to change and re-shape the federal component of Medicaid & Children's Health Insurance (8% of the budget). The House of Representatives already weighed in suggesting significant cuts to these programs to fund a tax break for a small segment of our society. While it's all part of the mantra of "repeal and replace" or "healthcare reform" - it's no secret that the largest issue at hand is healthcare for those with pre-existing conditions, for the poor, and for the socially vulnerable.
Congress and the President certainly may choose to simply transfer this issue to individual states to solve. The discussion is framed as "block grants" to the states - but it really is a shift of responsibility to individual states for their vulnerable populations. If that is indeed the case, some state legislatures will rise to the occasion and work to solve the issue; others will simply allow their most vulnerable to go without.
There is much to be addressed and fixed within healthcare. I'm not suggesting we have a perfect system at all. There are many areas for improvement. We could discuss the need for pricing controls, tort reform, and reduced complexity in medical payments ad nauseam.
But the thought I'd like to leave you with today is simply this - when you think about the second great commandment (the one about love thy neighbor as thyself) - when do you think our moral and ethical responsibilities begin and end? Do we have a responsibility as a society to care for those who have lost everything (including losing their way)? It's not a soundbite answer. Or at least I hope you think more than a few seconds to process an answer. Growing up in very poor, rural America, I've always believed "...but there, for the grace of God, go I...."
History will be the final judge of our decisions - and whether we have strengthened or diminished our people and our democracy by caring for one another. I wish I had the magic bullet answer. I'd love to make a dent in this unfair universe. All I have to offer is my voice, my hands and my actions. And regardless of what Washington does (or doesn't do) I will continue to advocate for those who do not have the strength, the health, nor the resources to advocate for themselves.