Health Care: Private or Public Good?

The narrow approval of the House of Representatives to repeal the ACA and replace it with a new health care act that will ultimately leave millions without health insurance, is an act so callous and cruel that I struggle to understand why the congresspeople did it. A New York Times editorial savages it: (https://www.nytimes.com/2017/05/04/opinion/obamacare-house-vote.html?smid=tw-share ) Yes there is a large money saving element to it and it will probably pay for a tax cut that will benefit the wealthy most. However that is not all there is to it. The conservative argument is based on the idea that health care is a private good like all others and should be allowed to follow the rules of the free market. Let those who need the most of it (the old, sick and infirm) pay more and those who need little of it (the young, healthy and active) pay less. Other supporters have expressed the view that one’s health is the result of a choice of lifestyles. Why should I pay for the poor choices e.g. smoking, drug use,lack of exercise etc. of others that result in poor health. Others came on board because the health care act leaves each state free to decide many of the rules it wants to follow. This has led to ignorant quotes like “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”( https://thinkprogress.org/roger-marshall-poor-people-do-not-want-health-care-obamacare-repeal-b49325664fd9).  In other words there are deserving and undeserving sick.

I would argue that health care is not like the other private goods that the free market is supposed to regulate, that health is not just the result of life choices, and that it calls for a national rather than state by state approach because it is a public good not a private one. Think about national defense for just a minute. No one would argue that it is something that should be left to the states rather than something the country as a whole should address. That is because “defense of the homeland” is thought of as a public good. We should think of health care the same way. Not just a Center for Disease Control to stop “invading” illness like Ebola, but also to stop the spread of diseases like cancer or to prevent birth defects. These diseases “attack” the country  because they limit the country’s productivity, shorten lifetimes of people who could be contributing to society,  and in the case of communicable diseases threaten our citizens. Even if the one percent may try to segregate themselves from the ill they are not immune. They should want excellent health care for people who care for their children, work in their homes, are employed by their businesses, and serve in their country clubs. How many of the ill are because they worked in mines or other dangerous businesses owned by the 1%? How about veterans who are suffering illness caused by their service or even people who just lived near where nuclear weapons or waste was stored?

I will not try to argue that some diseases are not the result of lifestyle choices. My father died of heart disease at 58, my mother of lung cancer at 69, my only sister of a stroke at 53 and all were heavy smokers. I do believe that smoking contributed to shortening their too short lives. We can argue how much of their smoking was individual choice and how much was insidious advertising, the corporate greed of Big Tobacco, governmental support of the industry, and outright lies about the safety of smoking. My point here is that rather than condemn them for their choices or point fingers at who is responsible, they would have been better served by the health industry working to extend their lives to make them longer-lived contributors to society. Although they all died too young, each of their lives was extended for a few years by medical care. Imagine a health industry that got from the federal government even a tenth of what we are spending on the military. Imagine a health care industry actually devoted to preventing disease as much as treating it. Imagine a health care system devoted to delivering health care to all rather than one priced so only the wealthy can get adequate health care or that is priced higher for those who need it most. All of these would be the result of changing our thinking about health care to considering it a public good rather than a private one. This health care “nirvana” is not beyond our resources or capabilities; at this point it is only beyond our will.

 

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