Thinking about Health Care

 

A lot of people are talking about health care. Some have talked for a long time, and some have talked a lot. For all the talk, not nearly as many people sound like they have thought much about health care. They sound like they are using a selection of standard phrases over and over, as a caregiver might sound throughout an ordinary day of dispensing common medicines, prepackaged bandages, and mnemonically-framed treatment regimens. All the talk gets acrimonious, and it gets old. Instead of talking about health care I have thought about it. I ask others to give it some intense thought as well. Once we have rethought health care, I think we will be better prepared to forego unnecessary talk and actually act in a way that can transform our healthcare system. Think with me.

Think about the reasons that the federal government exists. This is neither a test of one’s creativity nor a rhetorical question. The reasons that the government of the United States was established are laid out in clear and concise terms. We, the people of the United States, ordained and established a legal basis for the federal government in order to, among other things, “provide for the common defense,” and “promote the general welfare.” These phrases should sound familiar. They are generally understood to mean something specific—defense against military attack—and something general, such as conditions in which people might fare well and prosper. On second thought, though, nothing in the first phrase restricts “common defense” to military defense against attack. It makes the general statement that the government was formed to provide for the defense against threats people share in common. The common cold is a threat we share in common. Cancer, in its random affliction, is another common threat, as is the threat of encountering a drunk driver or a driver who is sending a text message. It makes no more sense to defend one’s self against these threats individually that it does to confront a military attack individually. Shared threats are best defended by the combined force of the community. The military example provides a perfect metaphor for how the federal government was constituted to provide for the common defense. It does not require much thought to realize that we the people share other threats in common, and it makes perfect sense for the government to include those threats when providing for our common defense. We the people should require it.

Think about the phrase “general welfare.” This means that all people in general should fare well. To fare means to make one’s way. It means performing honest labor. It means working. It is the responsibility of the government to promote the ability of the people to fare well. It is not the exclusive domain of free enterprise to capitalize on fear among people that they might not fare well. The marketing concept behind insurance rests on this fear. As a direct result, insurance companies in a free economy aggregate the risk of individuals, and in return for the perception of reduced risk they take a reasonable profit from each individual. The end result is that insurance companies concentrate profits in the hands of a few shareholders. They promote the specific welfare of these few and the relative welfare of their customers, not the general welfare of all people. In order to fare well, people must be well. The government has a primary responsibility to promote this wellness.

Think about who should pay for health care. Think about who pays for the military. We do not rely on private militias for our common defense. Instead, we pay for a national military force. Those most willing to pay for the military, and the many acquaintances of mine who have served and still serve in the military, have reconciled themselves to the notion of paying the ultimate price for freedom. Interestingly, many of the people who are willing to give their lives for the freedom of strangers are vehemently opposed to giving their money for the health of strangers. I’ve thought and thought about this conundrum, and have decided that I would much rather pay for a stranger’s lung cancer treatment than die for his right to smoke.

Finally, think about how often we hear about the need for affordable health insurance. No sick or injured person ever cried out for insurance. Those in pain cry for treatment. The primary need, therefore, is for care, not insurance.

Think about these points before entering another discussion about health care. I have, and I think single-payer universal health care for all Americans is a logical, moral, and constitutional imperative.