No blog subject – no matter how controversial – brings a quicker, more passionate and vitriolic response than does one discussing health care reform. The good news is that any blog dealing with health care reform causes an immediate spike in web site visits, but the downside is that most responses end with something to the effect, “I will never read your #?& blog again!”
This reaction was epitomized following my recent blog “Health Care Reform: Complicated Problem – Simple Solution.” Frankly, I was neither surprised nor offended by the negative, passionate viewpoints of many who read the blog. (Hell! I am just happy so many people read the blog.) But I am disappointed that many of the respondents exhibited such a lack of independent, individual critical thinking and instead fell back on the tired old pabulum of disingenuous arguments dished out by the insurance industry and other special interest groups that have a financial stake in the current health care system. (I know this attitude may upset those respondents, but they are unlikely to read this anyway; so who cares?)
I sometimes wonder if real people are actually posting these comments since their carping exhibits certain mirror-like qualities, and – most telling – they ignore the specifics of what was actually written in the blog. You’d think these hasty missives were generated by a seditious Internet “bot” that uses “health care” as a keyword to post these comments. (Am I being paranoid here?)
Missing The Mark
For example, the central theme of my health care blog asked one, simple question:Should basic health care be a right or a privilege for all American citizens?
That seems like a simple, straightforward, yes-no, binary question. Either you believe that basic health care should be a right afforded to all citizens just as they are guaranteed free speech, the right to vote, a public education and “life, liberty and the pursuit of happiness.” Or, you believe that receiving basic health care is a privilege available only for those who can afford and find it. In other words, it’s akin to attending a private school, flying first-class or buying a more expensive new car.
Yet, as simple a choice as that may be, not one of the respondents made an effort to address or answer that question. I guess this means the question was too complicated for them, they didn’t have the courage to take a stand, or they have the mental capacity of a parrot that can repeat, but not understand, the specific words and phrases said to them over and over.
Look, I can respect –even if I don’t agree with — those who sincerely believe basic health care for American citizens is a privilege available only for those who can afford and find it and not a right for the rest of us. After all, one of the rights we all have is the right to disagree. But I disdain those who lack the guts to take a stance by directly answering the key question. I even have a modicum of respect for health insurance companies (and we all know “corporations are people”) that have made it abundantly clear by their actions, lobbying and political contributions, their stance that health care is a privilege and not a right. It may not be possible for these blog bashers to be forthright in their response to the most basic question in the health care debate, but we can examine the logic of the arguments they make opposing health care for all Americans. Most of these arguments center on what they view as the sanctity of “personal liberty” and “right of free-choice.”
The argument as espoused is that individuals – not the government – should be free to decide if they even want health coverage, what form it takes and where they can buy it. For them, it is a violation of their “personal liberty” for government to “mandate” that individuals must purchase some type of basic coverage. I have no problem giving people the freedom to make that choice. But if they do decide to forgo health coverage for themselves or their family, they should be willing to sign a waiver agreeing that if they ever do get sick, they are fully responsible for all costs of care. Because if they don’t, you know who will end up paying for their “freedom” to decide not to have health care coverage. But more importantly, the issue is not about those who have the resources to “self-insure” or can find private coverage; the concern is for those who lack the means to buy private insurance (at prices set by companies) and those who have the resources, but can’t find an insurance company willing to issue a policy. Shouldn’t there be some option – private or public – for these groups to have the “individual freedom” to have access to and acquire basic health care coverage (which at the present time is made up of almost 50 million Americans)?
The real hang-up for those who oppose health care reform is the idea of a “mandate” coming from government requiring the purchase of some type of health coverage. For them it is the litmus test in the battle between individual freedom and government oppression. It is their sincere belief that government has neither the moral authority or constitutional power to compel an individual to do what they don’t want to do or to buy what they don’t want to buy.
This, of course, is ludicrous logic, which if taken to its full course, leads to anarchy. The essence of any government is the power to mandate compliance with the rules of society. Without the power to mandate, any government ceases to exist and soon thereafter, so will organized society. Of course the power of any government must only come as a mandate from the governed and it must be balanced in a way to benefit all of society, sometimes even at the expense of unfettered individual liberty.
The real problem in the health care debate is that the power brokers and special interests that oppose health care for all Americans have consciously corrupted the intent and objective of the “health care mandate” by tying it to the emotional issue of “individual freedom,” as opposed to what is best for society in general. People are being led to believe that they are being “mandated” to do something they don’t want to do and therefore their individual rights are being violated. But, that is not the case.
The “mandate” is simple and far less nefarious than people are led to believe. It starts with the assumption that everyone – rich, poor, old and young – need and want basic health care coverage. Then it says you have two options: You can either be covered by programs offered by the government or required to be provided by your employer or you have the freedom to purchase any private plan you desire and can find. However, for the overall protection and benefit of society, you are “mandated” to pick one of the options. And the reason why is patently (and fiscally) clear: If you don’t pick either option and get sick, then society will be stuck paying for the cost of your freedom to decide not to have health care coverage.
Unfortunately, the success of those opposed to health care reform to link the emotional issues of “individual freedom” and “mandates” together in a way that makes them seem in conflict, when in this case they are actually complementary, has led to some deeply irrational and kooky arguments.
An example of just how kooky things can get is one response to the previous blog on health care. It earns the first prize in the category of convoluted thinking. Here is the argument, reproduced as submitted:
“do people have the right to drive a car or is it a privilege. everyone needs transportation. must we then mandate that we buy everyone a car. As long as your asking someone else to pay your bills through a mandate it’s wrong. health care without some restrictions would drive the price out of site for all private companies and individuals. That’s what obamacare will do for everyone, but health care will be worse for most except the very rich.”
Beside proving that he slept through his (mandated) middle school English class, give the writer credit for one thing: In one tortured, convoluted paragraph he is able to cover the entire waterfront of the health care debate even though his logic went out with the tide.
The person is correct when he writes that everyone needs transportation, but he seems to be oblivious of the fact that cities, states and the federal government spend billions of dollars to provide “public transportation,” that is available for those who exercise their freedom not to buy a car or cannot afford either car or bicycle. Of course, we are all “mandated” to pay for this with our taxes, even if we don’t use public transportation, or sleep through English.
It is hard to tell, but his paragraph seems to suggest that “individual freedom” for anyone who needs transportation is defined by their ability to find it on their own or do without. While it is a big leap from figuring out how to get to work to figuring out to how to obtain and pay for basic health care, his logic seems to be leading us to believe that “individual freedom” for those who need health care coverage but can’t afford or find it – is to do without. The writer clearly believes it is wrong “asking someone else to pay your bills through a mandate.” Which leads me to wonder if he has ever received benefits under Medicare, which, if he has, means that others have helped pay his bills? (Lest we forget, Medicare is a mandated government program requiring all to contribute to and participate; which, unlike Obamacare, offers no “individual freedom” to opt out and secure private coverage. Even if one can afford and find it.)
This person argues elsewhere that, “health care without some restrictions would drive the price out of site…” (sic) I could not agree more, but no one – specifically not Obamacare – is asking for health care without restrictions; just that everyone have a right to receive “basic” health care. This gentleman may have forgotten that one of the main Republican attacks against Obamacare was that there were restrictions on coverage. Does he not recall the infamous brouhaha raised by the Republicans over the Obamacare “Death Panel” that would supposedly restrict and control benefits?
In one final killer dagger to the heart of health care reform this guy nails it when he declares that under the mandate of Obamacare, “health care will be worse for most except the very rich.” What is worse than no coverage at all? And isn’t that the real problem now, that health care really only works for the very rich?
As long as we have gone this far, let’s address one final issue that is central to the health care debate. Many are genuinely concerned with the propriety (if not legality) of “mandating” individuals to “pay” for benefits received by others or to receive benefits “paid for” by others. One respondent put it succinctly: “Do I have the right to force someone else to pay for my health care? If so, then that person no longer has the right to their liberty. One cannot have BOTH the right of liberty AND the right to health care. I prefer freedom.” This person is obviously sincere, but once again, the reality and logic of her comments are faulty.
It is the fundamental nature of any insurance program – public or private – that the benefits received by one are paid for by others. For example, if you buy a $250,000 fire insurance policy on your home, you will never come close to ever paying $250,000 in premiums, but if your home burns down, you will receive a check for $250,000. Where does the extra amount come from? Do you think the insurance company just gratuitously ponies up $250,000 of their own money? Of course not; your benefits are paid for by all others who also have a fire insurance policy with that company. Likewise, if another person’s home burns down, a portion of the premiums you have paid will go to pay the benefit they receive. Is this wrong? No, it is how insurance works.
Consider Social Security. We are all “mandated” to buy into the program and pay “premiums” during our working years, so that we can begin to receive benefits at retirement. It only takes a few years of receiving Social Security payments for them to exceed the amount of taxes we have contributed. Does that mean the payments stop? Of course not, they continue for as long as you live. So who pays for these benefits? They are paid for by others who are still working and contributing to the plan; just as you did when you were working. Is this wrong? No, it is how insurance works. With universal benefit programs such as Social Security it is necessary for financial soundness to “mandate” that all participate. (The financial problems with Social Security are not the fault of the soundness of the plan, but because our friendly politicians have “borrowed” money out of Social Security to pay for other things.)
If it is determined that basic health care is a right for all citizens, then to work effectively and to be on a sound financial basis it must be structured like any other insurance program. As such, others will pay much of the benefits you receive in the program and some of your payments into the plan will be used to pay benefits for others. As with any universal benefit plan, all must be “mandated” to participate in order for it to be financially sound. But, unless you never go to a doctor or get sick, the benefits you receive will always exceed the amount you have contributed and those benefits will be paid for by all the other participants.
Give me Liberty or . . .?
The final part of the respondent’s comments argued that the concept of a “right” and “liberty” are mutually exclusive. That you can’t have both and you must pick between the two. This is faulty logic. We all have a “right” to a basic public education; does this mean that we lose our “liberty” to go to a private school? We have a “right” to police protection; does that mean we lose our “liberty” to hire a security service? We have a “right” to free speech; does that mean we lose our “liberty” when the government “mandates” that we can’t yell “FIRE!” in a crowded theater? When women were given the “right” to vote; did that mean that men lost their “liberty?” (Well maybe, but that is for another discussion.)
The beauty of this country and the government we have selected is that as “rights” have been recognized and made available to all, it has expanded “liberty” for all. All American citizens deserve the right to receive basic health care; if for no other reason than it is the right thing to do.
And the Moral of the Story …
This all leads us back to the fundamental question at hand: Should every American citizen have the right to receive basic health care? If the answer is “no,” then we are done. We are saying that we are satisfied with the current system that allows private insurance companies to ration health care with the objective of making a profit. We are satisfied with a system that excludes 50 million Americans from any coverage and provides inadequate, prohibitively expensive coverage to millions more. If the answer is “yes,” that basic health care should be a fundamental right of all Americans, then we have a lot to do. But the debate will switch from emotional and irrational arguments about the problem to finding ways to solve the problem. And we have always been better as a society when we have sought to work together to expand the rights of others in a way that expands freedom and liberty for all.