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.

Saint Rodney

I met Rodney at a time that I needed the very inspiration he offered.

I had been accepted into graduate school during my last year of college. On a path towards a career of working in the church, I had majored in religious studies while in college. Between college and graduate school, I took a summer job at a Christian publishing company.

The transition from college to graduate school was not easy for me. In college I had enjoyed the freedom to take any position and support it with evidence; in graduate school, I was expected to agree with the professors on most positions. Political turmoil within the denomination increased tension on campus: students joked that the salt shakers in the cafeteria contained microphones to transmit our conversations to the office of the school’s president, while the pepper shakers contained microphones to transmit our conversations to the office of the denomination’s president. Uncomfortable with the campus environment, I decided that winter to take the spring and summer off and to use that time to decide whether to return in the fall.

Those months away from school I shared an apartment with a friend, working an evening job in fast food and a daytime job at the Christian publishing company where I had worked the previous summer. Meanwhile, Rodney had been hired at the publishing company. He was of Japanese-Hawaiian origin and was a large man who had been a sumo wrestler and had played on the offensive line for the University of Hawaii’s football team. He was not yet a Christian during his college years, and he had abused alcohol and drugs at that time, causing chronic health problems that would continue to plague him later in life.

Rodney became a Christian and then became a pastor in Hawaii. Here is the kind of pastor Rodney was: he had given his name and telephone number to the downtown bartenders so that, if they had a customer who was despondent and needed help, the bartenders could call Pastor Rodney and he would drive to the bar and provide Christian counseling. The spring we met, Rodney was taking graduate classes at a Christian college and also receiving regular medical treatment for the failure of his kidneys.

Our boss called Rodney his dreamer. Every week Rodney had a new plan for his life, a new thought about how he could be involved in Christian outreach, bringing the Gospel of Jesus Christ to those who were lost. He was waiting for a kidney transplant, but he had already declined offers of live donors, preferring to trust the Lord and medical treatments to carry him until a suitable kidney was available. Rodney spoke with wonder about the form of dialysis he was receiving, one that used the abdominal cavity to provide the filtering he needed for his blood. He spoke of it as a God-given back-up kidney hidden in the human body.

Rodney died while receiving treatment at the hospital on May 6.

His infectious enthusiasm for serving the Lord and his Church contributed to my decision to return to school that fall and muddle through the program until I received my degree and certification. Every year I remember Saint Rodney on May 6, and I thank God for the part Rodney had in my professional development. J.

The social contract

All people have rights. When we all try to exercise our rights at the same time, we fall into conflict. Therefore, we make an unspoken agreement with one another. We surrender some of our rights to the government, and we give that government the power to protect our remaining rights. Which rights we surrender and which we maintain—that is the difficult question. Nations differ from one another in their answer to that question, and citizens within nations argue with each other about the answer to that question.

Like many ideas of western philosophy, the idea of the social contract has its roots in the writings of Plato and Aristotle. The idea first reached its full structure in the writings of Thomas Hobbes, John Locke, and Jean Jacques Rousseau. All three agreed that government is a necessary evil. All three wanted to see the size and the power of the government limited. Hobbes even compared human government to the Biblical monster, Leviathan, writing that it must be tamed as much as possible, because things would be worse without it.

All people have rights. Locke summarized these rights as life, liberty, and property; in the Declaration of Independence of the United States, Thomas Jefferson rephrased the third right as “the purfuit of happineff.” (All his Ss looked like Fs—Stan Freberg.) Governments exist to protect the rights of their citizens to life, liberty, and property; they do not exist to take these rights away. Locke, and later Jefferson, said that when a government fails in this basic duty, citizens have an additional right to take power from their government and give it to a new government. Locke saw that very event happen twice, first with the end of the Puritan Commonwealth and the restoration of the monarchy in 1660, and later with the Glorious Revolution bringing William and Mary to power in Great Britain in 1689. Jefferson was, of course, key in seeing the same thing happen in the British colonies on the Atlantic coast of North America.

All people have a right to life, but government can deprive a murderer of life, since that person has deprived someone else of life. All people have a right to liberty, but government can put a convicted criminal in prison to protect its other citizens. All people have a right to property, but the government can take property away from some people in the form of fines if they have broken certain laws. Citizens surrender to the government the power to seek, capture, convict, and punish criminals rather than having each citizen responsible for defending his or her life, liberty, and property all the time.

In additional ways, citizens surrender liberty and property to the government for the greater good. (In times of war, some citizens even risk their lives for the good of their country.) Many people want to travel between City A and City B. If each citizen made his or her own path between the two cities, many property rights would be threatened, and the environment in general would be harmed. With the agreement of the citizens, the government claims a strip of land between the cities, giving the owners of that property due value. The government then builds a road on that strip of land. The road belongs to the government, by agreement of all the citizens. Therefore the government can charge people money to use that road, whether through tolls or through gasoline taxes or through fees paid for vehicle licenses and drivers’ licenses. Because the government owns the road, and make and enforce rules about the road, such as speed limits, stop signs, and laws against littering. Citizens agree to use the road and to obey the rules. This is how the social contract works.

In every family, parents could teach their own children; or groups of families could band together to provide private schools for their children. However, the citizens living in a town or city have an interest in seeing that all the children are in school, both to keep them out of trouble and to prepare them for useful lives in the future. Generally in the United States public schools are funded largely by property taxes. Even households without children and families which homeschool or send their children to a private school pay for the public school, because it is in everyone’s best interests to send the neighbor’s children to school. This is how the social contract works.

Taxes are a visible result of the social contract, but most political controversies also concern the social contract. Governments decide how best to protect the lives and liberty and property of all citizens. Sometimes, however, the rights of two people conflict, and the government must decide which right to protect or how to compromise the conflicting rights. Does a child’s right to life deserve more protection than the right of the child’s mother to liberty and the pursuit of happiness? If so, when does that right to life begin—at conception, at birth, at some arbitrary time between conception and birth, or perhaps a certain number of years after birth? Americans disagree with one another about the answer to that question, as do the members of the American government. Because of the social contract, the government must provide and enforce some kind of answer.

In socialism, the government owns all businesses and industries and decides how much workers will be paid and how much products will cost. Socialist governments generally charge high taxes and then provide many services for free. These can include public transportation, education, medical care, and even housing. In capitalism, private citizens own business and industries. Those private citizens decide how much workers will be paid and how much products will cost. Taxes are lower, but people must pay for things that they need and want. Even in capitalism, though, a social contract exists. Citizens trust the government to inspect factories for the safety of the workers and the quality of the products (such as food and medicine) that are produced. Citizens trust the government to regulate industries to reduce pollution, noise, and other problems. Citizens trust the government to make laws about child labor, limits on how many hours of work a worker must perform each day and week, and even minimum wage rules. Some liberty is surrendered to the government for the good of workers and of customers. People debate the details of such regulations, some wanting more and others wanting less regulation, but very few people want absolutely no regulation of privately-owned businesses and industries.

Human life requires food and shelter. To protect the right to life, should a government guarantee that every citizen has access to food and to shelter? Locke and Jefferson would have said “no,” but today American government provides unemployment compensation, food stamps and other welfare programs, and low-rent government-owned housing. Citizens object to abuses of the welfare system, but few would say it ought to be abolished. Most Americans are willing to see some of their tax money spent to feed the hungry, shelter the homeless, and care for the poor people who are our neighbors.

Access to health care is also necessary for human life. Since the 1960s, American citizens have debated heatedly the question of government involvement in the nation’s healthcare system. Most Americans are opposed to socialized health care in which the government owns all the hospitals, medical clinics, pharmacies, and other health care institutions. In socialized healthcare the government pays the doctors, nurses, pharmacists, and other health care professionals. That same government sets rates for medical procedures, making the most essential procedures available for free to those who are poor. Most Americans prefer capitalism in health care. Most Americans do not want governments to own the entire system. Most Americans want doctors and other professionals to have freedom to do their jobs in the way they think is best. Most Americans want freedom to make their own choices among doctors, hospitals, and the like. Americans disagree with one another about how much the government can control the health system through regulation. The goal of government participation in health care is to protect the right to life of poorer citizens. However, the same government participation reduces the liberty of doctors and patients, and reduces the property of citizens who must pay taxes to support the system. Discussion of what compromises should be made among these conflicting rights is part of the social contract.

On another occasion, I will write more about taxation and the social contract. J.