Tons and tons of info, argument, fantasy and rhetoric floating around out there right now with regard to healthcare, so lets ask some questions that inform the foundation of how we think about this.
I don't hear these questions directly addressed that often, but the answers to them are important to and implicit in the arguments that are currently being thrown about.
A few of what I think are the basic questions that underlie this debate. How do you answer these?
- Is access to healthcare a fundamental right?
It's not explicitly addressed in the constitution or the Bill of Rights, should it be?
-Does the state have any appropriate role in the healthcare system?
- Should healthcare be a completely free market?
The Senate is struggling, maybe we should we let Mr. Smith's invisible hand fix Obamacare.
- Should hospitals/healthcare providers be allowed to turn people away based on their ability to pay for services?
We're talking the ER turning away gunshot wounds and impoverished children with broken limbs here. Market forces?
- Do you believe that a person's means/income level/social class should dictate (or limit) the quality of healthcare they have access to?
- Is healthcare an 'industry'? If it is an industry, is it fundamentally different than other industries (i.e. agriculture, manufacturing) in the way it responds (or doesn't) to market forces?
-Whether or not healthcare is a fundamental right, does the state have a compelling interest in investing in the health/well-being of its citizens?
-If the state has an obligation to provide access to healthcare, how should it appropriately ration scarce resources?
Some of these questions are rhetorical; some we have already answered. A more fundamental question to all of these is: what kind of society do we want to be? How you answer this question will substantially inform your thoughts on the above. We can treat healthcare as a right to be protected by the state and provide each of our citizens some minimum level of service funded by the taxpayers; antithetically, we can fully privatize the healthcare industry allowing market forces determine the allocation of resources and access to the "health" commodity. Perhaps, we should take a cue from John Rawls and ask ourselves in which society we would like to live provided that our socio-economic status was unknown.
ReplyDeleteCompletely agree, the "What sort of society do we want to be?" question is arguably a more relevant perspective than the "Is it a right?" one, if only because a lot of philosophical baggage comes with definitions of "rights".
DeleteAnother, maybe more evidence-based, way of looking at it is, "Is it useful?". By "useful", I'm meaning does it increase the total material wealth of the society?
By comparison, take education. Nowhere in the Constitution does it mention a right to education. But as a country we have decided that providing, as a government entitlement, free access to 12+ years of education is a positive for society as a whole. No one seriously questions that free education is a net good.
There are a lot of benefits to European-style health care that get ignored. Not many remember, but back in the '80s Lee Iacocca led a bunch of Detroit auto bigwigs in an effort to get a nationalized health care system implemented. The argument was that the Toyota, Honda and Nissan had a significant cost advantage because they weren't paying healthcare costs for their employees.
How much would the global competitiveness of US firms increase if they weren't paying health insurance benefits?
How much cheaper would the total health care bill in this country be if we adopted a European model?
I don't have good answers, but these are numbers that can be at least approximated with some study. It would be nice to have that to debate, rather the "Health care is a basic human right!!" or "Everything the government touches is a disaster!!" sides we deal with now.
Great thought Rich, I hadn't thought of framing it in the same context as public education, but I think that the 'net good' is an interesting way to look at it.
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