(MINNEAPOLIS) – Should the United States join with most other industrialized countries and have universal health insurance, spreading the cost of health care across the population? Should we remain as we are, with a complex system that seems to make no one happy? Or are there other alternatives? Often this debate moves immediately into a welter […]
(MINNEAPOLIS) – Should the United States join with most other industrialized countries and have universal health insurance, spreading the cost of health care across the population? Should we remain as we are, with a complex system that seems to make no one happy? Or are there other alternatives?
Often this debate moves immediately into a welter of specific programs. The Obama-Biden campaign website takes this approach. Their health care page is a list of upwards of a dozen specific programs and provisions either existing or proposed. But there is no discussion of overall principles and no mention of universal health insurance.
Rick Santorum’s campaign site leads with a desire to repeal the ObamaCare law and institute a further series of reforms. These reforms are offered in support of the goal of achieving “patient-centered health care” and insists that every American should “have access to high-quality, affordable health care.” The principle means of achieving that, inferred from looking at the list of specific reforms, is increasing competition and changing medical liability rules to reduce “defensive medicine.” But there is little explanation of how this would achieve the goal.
Ron Paul’s campaign website, by contrast, used to include a page directly rejecting the notion of universal health insurance on principle and arguing that health care could not be a right because anything that imposed costs on others could not be a right. That page is no longer available and has been replaced by a set of specific programs not that dissimilar to, but more sweeping than, Mr. Santorum’s.
How do we determine what is a “right”?
But before we discuss if health care can be a right, we ought to pause in appreciation of Mr. Paul’s attempt to lay out a principle for what is and is not a right.
Most debates about rights, and by extension, most debates about what values we should hold, seldom advance beyond assertions, or immediately dissolve into contradictions.
Ron Paul’s original web page argued that it couldn’t be a right because it involved taking from others. That is, the only way to pay for your health care, if you have huge expenses, is to be subsidized by others who have low expenses. And if we require everyone to be covered, then we are forcing people to provide that subsidy. If you accept his premise, then the conclusion follows.
Others try to locate our rights in the Declaration of Independence that stated “all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”
Assertions and contradictions
The Declaration of Independence, one of our nation’s sacred texts, claims these rights are “self-evident”. It makes an assertion and dared the British public and government to disagree. But we have disputes about rights, can we use Paul’s principle to decide?
Apparently not, because those candidates all have provisions in their health care plans that do involve coercion of someone. Perhaps they insist that pharmaceutical companies have to be regulated differently, or that “the needy” should always have care, or that insurance plans should have more options – forgetting that insurance is in fact a scheme of pooling costs and having some subsidize others.
Ron Paul expects charity to take up the slack, both charity by institutions organized for that purpose, and charity by doctors. In a moment that became famous, he was asked in a September 2011 debate about a hypothetical case of a person who would die without health insurance. While attention focused on the audience seeming to cheer the idea of this person’s death, Paul’s actual answer got overlooked: Paul, himself a physician, referring to his time in practice said, “the churches took care of [the needy]. We never turned anybody away from the hospital. We’ve given up on this whole concept that we might take care of ourselves or assume responsibility for ourselves. Our neighbors, our friends, our churches would do it.”
But, the contraction here is that his proposal is still a subsidy of one group by another. He proposes that a set of social expectations should exist that certain parts of society – churches and caring medical personnel – would take on the duty and expense of caring for people who couldn’t afford care. In other words, people will not take care of themselves, others will, at least in extreme cases. How is that different than insurance? One is voluntary, imposes costs on a segment of the population, and open to exceptions, the other would be universal and impose costs across the entire population.
Why this seems different to Paul and his supporters is that one approach relies on “us” cooperating, and the other is seen as “the government” imposing on us. This notion needs to be challenged.
Living together inevitably involves limits on our actions
Preserving rights inevitably involves limiting the actions of others when they would restrict our rights. The stop light takes my freedom to drive away so I will not collide with others. My free speech can be limited when it creates a harm to someone else. I have no choice to pay taxes for the police and fire and emergency services even if I take care of myself and live in a good neighborhood. Making the jury system works may take away a day or two of my freedom if I am called to serve.
The idea of the rugged American, standing alone, self-sufficient, dependent on no one, answering to no one but his own conscience (and likely owning a few guns) is an illusion. Humans do not survive on their own, or do more than barely survive. We don’t grow our own food, work in factories we built ourselves, drive on roads we made or use electricity we produce ourselves. And this mutual dependence is not a weakness but a great asset: it gives us the ability to build upon the gifts and skills of others.
When we agree as a society on something and vote that agreement: that is government.
Can we choose to create a right?
This brings us back to health care. Could our society decide it was a right? This flies in the face of those who claim that rights are derived from first principles or are given by God. But our own constitution has been amended numerous times, and many of those changes have been to establish rights: the right to own guns, the right never to become a slave, the right to vote and to vote at 18.
This more limited perspective would be a better starting point to discuss health care. We could start by recognizing that we can’t choose our DNA, we have little control over accidents happening to us, and we couldn’t control how much money our parents would have to give us. From that we could propose that we should share the risks of being human and we would be proud to live in a society that agreed with that idea.
This would involve, note, the right only to sharing the costs of health care – and would say nothing about how best to provide health care. That’s a very different subject.
About Contributor: JOHN NORDIN teaches in the Communication Studies department at the University of Minnesota. He holds a Ph.D in Transportation Systems from the Massachusetts Institute of Technology and has worked technical fields, been a Lutheran pastor and taught Computer Science in Kenya. He is a published poet, and has written articles on politics in Iran, humor in religious institutions, and database design, and has several unpublished novels. He has written an argumentation textbook that will be published by Pearson in 2013.
The views expressed in this article are the author’s own and do not necessarily reflect Mint Press’s editorial policy.