Health care: privilege or right?

When John Locke and Thomas Jefferson wrote that human beings possess God-given rights, including the right to life, and when they said that governments exist to protect those rights, they were not suggesting that governments ought to provide every citizen with food, clothing, shelter, health care, and all the other things needed to sustain and prolong their lives. Instead, they were saying that governments should deprive no one of life without due process; furthermore, that governments are obliged to protect the lives of citizens from dangers posed by foreign attackers and domestic criminals.

Locke and Jefferson envisioned a world in which people provided food, clothing, shelter, and other necessities of life for themselves and their dependents through their individual wealth and through wages for their labor. Individuals facing extreme need found help from extended family, neighbors, worship communities, and charitable organizations. Ebenezer Scrooge might sneer that workhouses and prisons sufficed to meet the needs of the poor, but in many cases compassion and charity filled the gaps where hard work and diligence did not suffice. Had God’s Law been obeyed by all the Israelites, there would have been no poverty in Israel. In his Judgment Day parable, Jesus commended those who have the hungry something to eat and gave the thirsty something to drink; he said nothing about lobbying the government to provide resources for those who are hungry, thirsty, naked, homeless, and ill.

In the “good old days,” doctors made house calls. Sometimes they accepted vegetables or baked goods as payment for their services; sometimes they waived payment out of the kindness of their hearts. But in those “good old days,” doctors did not remove cataracts, provide knee and hip replacements, or use CAT scans to diagnose problems. Health care and medicine have come a long way since the “good old days,” which is why they are so expensive. People expect more from their doctors, hospitals, pharmacies, and therapy centers than ever before. Every year, research and development provide new benefits to conquer disease and to prolong life and health. Some research and development is funded by government grants, and some raises money through donations, but much is done by for-profit companies. They have the combined goals of making life better for all people and offering a return on the investment of their sponsors.

Health insurance was invented as a way to spread the cost of health care move evenly over time and throughout the population. Buyers of insurance gamble that they are going to get sick and need expensive care; providers of insurance gamble that most people are not going to get sick and need expensive care. Insurance is necessarily inflationary—an insurance company must pay workers, maintain offices, and return a profit to their investors, while still keeping their promises to pay the medical expenses of their customers. A complicated system of fees, deductibles, negotiated settlements, and other financial arrangements has developed out of these needs. Otto von Bismarck of Germany was one of the first government leaders to ask employers to contribute to the health insurance of their workers. Today a person struggling to pay medical bills may also be benefiting from the health care industry through investments that are adding to that same person’s retirement fund. Life is complicated that way.

In the free market, health care and health insurance may not always be fair. People with more money can afford more helpful health insurance, while those with less money have insurance that does less for them. Wealthy people can afford care that is unavailable to others. Within the free market, governments intervene to make sure that essential care is available to all. Doctors, hospitals, and clinics cannot deny certain kinds of care to people in need, even when those people cannot afford to pay. Defining “essential care” is a challenge faced by members of the government, who must negotiate with each other to write a law that meets that need.

Under pure socialism, the government would gain control of all hospitals, clinics, pharmacies, medical offices, rehabilitation centers, and therapy providers. The government would pay the salaries of all health care workers as well as all other costs of maintaining these facilities. Citizens could receive health care at no cost; although, to reduce the burden on taxpayers, the government might require fees for certain services that are not defined as “essential care.”

The Affordable Health Care Act of 2010 (known as Obamacare) stopped far short of socializing all health care in the United States. Much of the legislation in that package focused its attention on health insurance rather than on reducing the cost of health care. More innovation in the latter regard might solve some of the current problems in American health care without threatening greater government control or a trend toward socialism.

Education of health care workers is expensive. Many professional health care workers begin their careers with enormous debts. Government loans that are part of that debt could be reduced or forgiven when these professionals participate in health care benefits to the poor and deprived—providing health care through urban centers for the poor, homeless shelters, and the like. Medical facilities and equipment are also expensive. Government grants could make them available in low-income communities at less cost than it takes to promise free health care to all the poor in those communities. Research and development need to continue in the health care industry. Government grants and charitable organizations contribute to the costs of research and development, but private funding with a hope for a profitable return should never be excluded from the equation.

The world contains sufficient food that no one should be hungry. Food is not distributed fairly. Inviting the government to collect all the food and distribute it evenly would be wasteful and unfair. Charitable giving, with some government participation, solves the problem far better than would total government control.

Sufficient housing exists in the United States for all the people who live here. Problems of homelessness are complicated by mental illness, addictions, personal choice (in a few cases), and other factors. Forcing every American to live in government-provided housing would be wasteful and unfair. The free market—with some charitable help and some government participation—solves the problem far better than would total government control.

Health care can be provided for all Americans. Putting the government in control of all health care—or even in control of all health insurance—would be wasteful and unfair. People need to be allowed to choose among various options regarding both health care and health insurance. Charitable help, with some government participation (such as Medicare) solves the problem far better than would total government control.

Protecting each citizen’s right to life is not the same as meeting each citizen’s needs in every way. The free market always innovates and creates better answers than would total government control. Through further study, negotiation, and compromise, more help can be found for the needy. Socialism does not offer answer that would improve upon the current system. J.