In any political debate, there is rhetoric used by both sides to imply how obviously correct their position is. The current healthcare debate is no different, with “healthcare is a right” being a favorite phrase of those on the left. Those that use the phrase take it to mean that every person deserves some form of healthcare. However, this is not what a “right” is. Rights are those properties of a human being that are granted to us because, and only because, we are human. They are granted a priori, and cannot be denied us except through force and submission. Healthcare does not fall into this category. Healthcare is something that is consumed, and is therefore granted by those that have it to those that do not (usually in exchange for some other good, mostly cold, hard cash these days). Nothing that falls in this category can be a basic human right, as the providers themselves have the right to determine who they provide to.
Whether or not healthcare is a right, however, is not the debate. Rather, it’s a tactic used by one side to make an argument in a sentence instead of in a carefully constructed thesis. What those in favor of healthcare reform are trying to push for is the idea that we, as a society, have some moral imperative to force the provider’s hand and provide some level of healthcare to all, whether providing such care is beneficial to the provider or not. This is an argument for a restriction of rights, which, paradoxically, is something goverments have been granted the right to do by their citizens.
The question then is how much we are morally obligated to restrict the freedoms of healthcare providers in order bring the general health to some acceptable level. This is a very difficult question, made more difficult by the fact that the value of healthcare changes with time and economic prosperity. This is a terrific example of imperfect duty, a duty which is never complete but which we are morally bound to strive to make progress on. We have made great progress too. Healthcare as it exists today is better than at any previous point in history and available to more people. It does seem to be the case, however, that society feels that too many of its members are in a situation where they do not have access to the kinds of care that should be available to all. This probably doesn’t include very expensive experimental treatments, but does include expensive but common procedures and treatments like those used to fight cancer, heart disease, and other widespread diseases.
The current legislation is too large for me to really know what’s in it, but the goals are fairly clear. The bill is meant to require health insurance for almost all Americans, require coverage for those with preexisting conditions, make selecting insurance options more transparent, facilitate keeping your insurance between jobs, and providing some form of publicly funded insurance. These components really try to kill two (or perhaps 3 or 4) birds with one stone. In addition to the much touted coverage for those that are currently without, a large portion of the bill is designed to make health coverage more manageable by individuals. That sounds great to those of us that have healthcare that we really don’t even know how to use, but doesn’t really take steps towards fulfilling our society’s imperfect duty. Perhaps that’s why we don’t hear a whole lot about that part of the bill.
Whatever ends up in the final bill, it seems to me that it will not fulfill any of its goals. The less talked about goal, that of making health insurance more manageable by its own customers, is not something governments are particularly good at. It’s difficult to regulate complexity. The best way to achieve this goal is competition. This would require insurance companies to market straight to consumers instead of their employers. You can be sure that insurance companies will become more transparent in a hurry when they have to convince you that they are actually better than the next guy rather than your company’s HR department. Auto insurance, for instance, is substantially simpler than its healthcare counterparts.
Where government is probably not the best answer for reducing the complexity of the healthcare system, government has become the preferred vessel for carrying out society’s obligations to itself. In the current debate, this has translated to “we must provide insurance to the uninsured”. This seems noble enough, except that the insurance model itself is deeply flawed. Those of us that already have insurance can see this quite obviously. We do not know the cost of healthcare, nor do we care. Co-pays are minimal, so we take what healthcare we need and bill the insurance company. For those of us with insurance, healthcare is near free and limitless. It stands to reason, then, that by providing insurance to those without, they will also have unlimited, near free healthcare.
The question then becomes, is unlimited, free healthcare the fulfillment of our moral obligation? I believe that it is not. Society should not be asked to cover the costs of keeping the elderly around longer than is prudent, nor should we be asked to bear the burdens of an individual’s poor decisions. Society should provide the level of healthcare that most of us enjoy to as many as possible, but we should not give a blank check.
Many are disgusted by the idea of trying to figure out who should get what healthcare. It does not seem ethical to have “death panels” or enforce that your bypass will only be covered if you didn’t eat bacon for a year. Should we provide orthodontics, which seem like a luxury until you look at the importance of good teeth in the white collar world? Again, this is one of those things that government does a poor job of regulating, and again, these decisions should be left up to the individual. How we do this is something that the current legislation doesn’t touch, and I believe is absolutely necessary for true healthcare reform.
Structuring the system to provide individual responsibility while still providing healthcare to those that cannot afford it seems fairly straightforward to me. Offering insurance policies with very high deductibles and supplementing them with health savings accounts ensures that an individual can determine their own regular healthcare needs while still being protected from unexpected disasters. Both the policies and the savings accounts can be subsidized or provided by the government, with the expectation that the individual contributes what they can. This simple combination seems to be the best bet for minimizing government’s interference in an individuals healthcare while still providing them with the level of care the rest of society enjoys.
There is a serious caveat to this seemingly simple solution. That caveat is that all health services, not just disasters, are obscenely expensive and getting pricier. I believe this is a direct result of the structure of the current private insurance industry. Since nobody except for the insurance companies care what the cost of health services is, and the insurance companies are buying in bulk, there is a strong incentive for the hospitals to reduce the costs of those services that the insurance companies will object to while increasing the costs of those services that are cheap by comparison. Added to the burden is the cost of patients that are unable to pay. The effect of the hospitals “making up” money by increasing costs of routine services is that all healthcare services are more expensive, without any incentive for them being made cheaper.
The current proposal for dealing with the cost problem is for the government to provide a public option to “compete” with the private insurers. I don’t understand this reasoning in the least, but it hasn’t been well explained by its proponents, so I could be missing something. Regardless of its ability to provide competition in an already highly competitive market place, the public option is fundamentally flawed since its structured like a traditional insurance company. It will have similar incentives, none of which will encourage lowering the costs of routine healthcare.
A better method for controlling costs is to make sure individuals are aware of them. If people are asked to pay for routine health services, they will pay much closer attention to the costs of these services. The best way to get individuals to pay for routine services is the same method by which we should cover those without insurance: through health savings accounts combined with high deductible insurance policies.
If those that can afford insurance are on a plan similarly structured to those that can’t, then we have a system in which the market can drive down the costs of things that should be cheap while insuring that those things that are not affordable are available to those that really need them. This seems to be the easiest and least error prone method of reforming healthcare.
There are a number of ways to fulfill the nebulous goal of providing healthcare to everybody in America. One way is to buy into the current system and ask society to pay for it. Another is to restructure the system in a way that benefits everyone and only then ask society to provide those minimal services it has deemed morally necessary to provide to its citizens. The latter seems like the more prudent, more moral, and simpler way to make this generation’s contribution to that imperfect duty that is healthcare.