Monday, May 18, 2009
Sunday, May 17, 2009
I’ve been thinking much lately of the national discussion shaping up around national health care programs (or not). It’s been fascinating for me to watch my own thinking, as limited and clumsy as it is, developing on that topic. I have always listed myself as Independent (in New Hampshire, this is my actual registered "party" affliation) while definitely leaning toward the conservative republicanish column. I am finding such labels less and less useful. To be honest, my current political position seems to mesh liberal amounts of libertarian gush with sizable piles of communitarian hoohah, a few globs of personal pork, and good dash of wwjd philosophy. That odd blend tends to create a certain degree of dyspepsia. When I apply it to the healthcare debate, I find myself in places I never thought I would.
Republican objections that I have heard seem more knee-jerk than thoughtful and substantive. Hysterics about bureaucrats taking away your ability to decide about your health care when such decisions should be “left up to you and your doctor” just strike a false note with me coming from these corners. You can’t accuse the Democrats of using that as a smoke screen to push through abortion legislation, and then use it as your own smokescreen. And the warnings about “rationing” are a bruised reed. Healthcare is already rationed, just not in a rational way. It is rationed by chance and circumstance. In the aggregate, you might barely be able to argue that it works, but if you look at the direction of the aggregate is actually going now, indications seem to be that it is not working.
It could be that I listen to NPR way too much. I’m hearing words like “unsustainable” and “untenable.” These could also be hysterics, but the seem right to me. This may be in part because my own view is skewed heavily by my own currently unsustainable and untenable economic condition – and the economics of my personal and family healthcare are a big part of that. I am paying easily 20-40% of my monthly income (my monthly income varies) toward just my insurance. This does not include actually paying for any actual healthcare we receive. Needless to say, I don’t go to the dentist very often.
The argument I hear most speaking against some form of consistent national health plan is that it is not the responsibility of government to provide such a service. I can see that argument. The constitution clearly delineates the role of the federal government and that of the states. Providing an army for the national defense is in there. Providing health care is not. And yet I think this may be placing the emphasis on the wrong principle. A national health care plan is not forbidden by the constitution. Such a need could not have been envisioned by the founding fathers to either forbid or recommend. We have to find our own way.
Let’s stipulate for a second that providing health care is not rightfully a responsibility of government. So then, whose is it? Right now it falls to business. But why does it make any more sense, on principle, for business to be saddled with that responsibility. It is the job of business to provide value for customers through products and services, and value to shareholders through profits, and value to employees through pay for services rendered. Who says this OUGHT to rightfully include health care? What does Acme Plumbing know about health insurance? What does Atomic Widgets know about managed care? There is a strong argument to be made that business should be freed from this additional burden so that our economy can grow.
Oh…but if government takes over managing healthcare then we are “letting employers walk away from their responsibility.” First, I would dispute that is really their responsibility. Second, they are already walking away from it by cutting their own costs, reducing benefits, pushing premiums onto the individual. That is the irrational rationing I spoke of earlier.
Will it be expensive? Oh, certainly. But what costs are we bearing now that are not accounted for? And wouldn’t a healthy population become part of our common wealth. We invest in roads and sewers because we all benefit. Such infrastructure helps us to conduct our lives, exercise out liberty and pursue all that happiness. If providing more consistent and rational healthcare coverage would move us in that direction, I think I’d be for it.
I also think that it is possible to design a system that could do that. It won’t be perfect, but I think it can be done. We’ll see.