There is no doubt that political discourse in this country is overwrought with emotion and misinformation, often preventing intellectual integrity and fact to rule the day. The health care debate is especially susceptible to this problem because two sensitive issues—health and wealth—must be considered, on both the individual and societal levels. Financial implications from personal savings accounts to corporate profits resound. The simplest medical treatment, multiplied by millions, taxes the system even as it benefits the individual. The situation is dauntingly complex and it is tempting to view it solely from one’s own perspective. The satisfied do not want change, the disgruntled call for reform, and some have no voice at all. So where do musicians, actors, and dancers fall among these three groups?

Everywhere. Artists in various stages of their careers may find themselves in stable or precarious health care situations, depending on their own success and/or the stability of the organizations that employ them. Freelance artists have the most difficult time because of their mobility and the piecemeal nature of how they earn money. According to the U.C.L.A. Center for Health Policy Research and the Urban Institute, as of April 2008, 18 percent of artists in the United States had no health insurance. That’s about 300,000 people and is now likely to be more. Of those who do have health insurance, about half are self-insured. A quick search on the Internet reveals that numerous nonprofit organizations are forming to help these freelance artists find affordable, and effective, health insurance. Unions and other trade organizations are providing group insurance options as well. 

Artists working for midsize arts organizations are experiencing hardship because of the increased expense of employer-provided health insurance. Across the board, premiums are going up, service is going down, and sometimes insurance is even being canceled. Only the most stable, top-level professional and academic organizations seem to be handling the crisis effectively—so far. What can you do? It is important to know what is happening and all of the resources at your disposal, especially if you are about to enter the workforce. As this debate rolls on, it behooves us to be as informed as possible about the facts and forces driving this debate. Here’s a brief history:

As medicine entered the modern age in the early 20th century, its evolution from a collection of professions into an industry brought with it inevitable increases in cost. To cover this cost, various solutions ranging from private (nonprofit) philanthropic insurance companies to new government programs emerged. However, in the United States, our capitalist instincts aroused visceral resistance to governmental solutions. From Harry Truman’s first attempts to start a national health care system through the Clinton administration’s initiatives to President Obama’s current efforts, resistance to government-led change or reform has been, and still is, formidable.

The establishment of Medicare and Medicaid during the Johnson administration in 1965 was a big deal. (Truman was the first to enroll.) These programs were meant to assist the nation’s elderly, poor, and disabled. Not long after, commercial (for-profit) insurance providers entered the scene. At the same time the U.S. system was evolving, other countries were developing national health care systems. Costs in those countries were addressed through higher taxes, another anathema to American sensibilities.

It is easy to see how competing forces in the system started lining up for a “title fight”: the ideals of the Great Society versus one of the core values of a capitalist economy (creating profit)—both heavyweights. In robust times, all was fine, but eventually the vagaries of the world economy and, ironically, the increased cost associated with new medical breakthroughs, brought these forces into conflict.

Health insurance companies found themselves caught between customers needing care and their constituents (stockholders) wanting return on their investments. To complicate matters, the latest, best treatments for serious illness also raised costs and reduced bottom lines. Profit considerations started to weigh heavily against care options. Gradually, insurance companies reduced coverage and raised payments, dropping patients with certain conditions and refusing to add others from “risky” demographic groups. As companies could no longer afford the insurance they obtained for their employees, the number of uninsured rose to include not just the poor, but also the lower-middle class, families, and even the gainfully employed. This is where we find ourselves.

So what about this “public option”? About 10 years ago, Jacob Hacker, then a Yale professor, proposed a plan to allow employers to either fund their employees’ health insurance directly or pay into a publicly funded plan that would also be open to citizens not currently employed. This plan has turned into the derided public option. Its antagonists are motivated by everything from an aversion to big government to fears about quality of care to profits. Debates on these issues are intriguing and worth investigating. You may find your own notions of democracy, capitalism, and basic human needs competing with each other. 

One argument against the public option is that a government-run insurance program would have an unfair business advantage over the insurance industry. This seems like a reasonable concern to a good citizen of the free-market system. On the other hand, workers in small companies and the self‐employed (i.e. freelance musicians) do not have the same leverage as large organizations when negotiating costs versus benefits with an insurance provider. Isn’t this an unfair disadvantage? It seems that the public option would remove this disadvantage and be a real help to freelance artists, orchestras in financial trouble, and small arts organizations. Can you see the dilemma? Isn’t it worth a serious, honest debate to determine if these legitimate, competing concerns can be reconciled?

We are trying to reform a system that sets in opposition our economic way of life and basic instincts about how we care for each other in a civilized, democratic society. Inherent in this effort will be conflicts between constituents from all sides. This is not a struggle between good and evil but, rather, a search for a prudent solution. Caught in the middle are senators, congressmen, and a president trying to balance what best serves their constituents with what’s right for a nation. As in all human endeavors, there will be those who truly desire the best solution and those who care only about their own personal agendas and ambition—often couching them in virtuous terms. It is our challenge to discern between the two and consider calmly and wisely the content of arguments rather than the ferventness of their delivery. I have come late to the debate and only started to grasp its implications and the consequences of “getting it wrong.” I am sure that more considered, respectful, and less ideological debates between friends can only lead to the same from our leaders—but only if we insist upon it.