Health Care in the U S

A society in which the citizens all have adequate security, justice, housing, food, education, transportation, health care, and a clean and safe environment is better than one where these things are inadequate.  True love, great sex, tropical vacations and warm clothing are good too.

All these necessities and niceties of life are beneficial.  These measures of well-being are the concern of any society.  Yet how they are provided is not self-evident.  With whom does responsibility for their provision lie?   Who assures justice?  Who provides education?  How much education?   Is responsibility with the individual or does it belong to the state?  Such questions are the essence of most politics. 

(See: https://s-marty-pantz.com/rights-and-entitlements-are-not-the-same-thing/)

Some things here are more straightforward than others.  Security and justice, for example, are almost universally ascribed to the state; so too is the responsibility to protect the environment.  It is the very nature of these things that make them collective responsibilities.  Food and warm clothing, on the other hand, are pretty much left up to the individual.  In the middle, there is much to debate. 

Perhaps the thorniest issue of all these goods and services is health care.  Most agree that the current system of health care delivery is largely broken.  How to fix it is tough issue.  Who should be responsible for its provision of is at the heart of the debate.     

Education, unlike health care, has historically been a service provided by government. Why is that?  Early in US history, there was a well-developed concept of what was involved in education, at least as related to the inculcation of our younger citizens with the basic skills necessary to manipulate words and numbers.  It was accepted that governments would provide fundamental education.  Years later, this was expanded into a significant state role in higher levels of education as well. 

With health care, however, there wasn’t much to provide.  Barbers pulled teeth and midwives delivered babies.  Presidents were bled to death.  Affordability wasn’t much of an issue because there wasn’t all that much to be afforded.  The poor suffered but the rich weren’t much better off.  As medicine became more capable of dealing with human maladies, it became more expensive.  In time, those with a proclivity to finding government solutions to all things great and small, looked to government to provide adequate, fair, and equal access to health care for all citizens.  

Health insurance provided by the employer rather than government is almost a quirk of history.  Henry Kaiser needed workers during WWII but could not attract them with money because of emergency wartime wage and price controls.  Employers competed for labor by offering non-cash benefits and so Kaiser offered health care to attract workers to build liberty ships.  Others followed suit and the practice became an embedded part of doing business, even if not quite an established standard.  Employment-based health care, however, is variable in scope and does not extend to those whose employers do not offer it, nor to those who are unemployed.  Employer-based coverage is a flawed system.      

But why government for universal coverage?  After all, token programs notwithstanding, government generally does not house the ill-housed, feed the under-nourished or cloth the ill-clad.  Why then should the government provide health care?  

One problem with health care is that it is far more complicated than other potential public goods and services.  While we as a polity do not provide universal health care, we have decided that to turn someone seriously ill from the hospital door would be barbaric.  We have made a societal decision that any seriously ill person who presents himself at a medical facility cannot, by law, be turned away.  When illness rises to an emergency level, those with neither insurance nor money are attended to by federal mandate.  But the law requires only that they be stabilized, not fully treated.  This is hardly genuine health care.  

One result is thoroughly corrupt medical accounting.  An uninsured patient may get elaborate reconstructive surgery after an accident. This is so even if he/she will never be able to pay for the service.  To compensate, the fully-covered patient across the hall is billed a dollar for a cotton ball in a system of medical funny money.  It is legally structured to work this way.  As a result, we de facto already pay for a universal health care system, but one which is at best dysfunctional; at worse, shear lunacy. 

Apparently. we already spend more than enough in the aggregate to provide adequate universal health coverage.  That being the case, it only makes sense to rationalize the system to meet genuine health needs rather than feed insurance companies, bureaucracies, and slip-and-fall attorneys. 

The libertarian in me does not see a valid argument for government involvement in either health care or education.  Certainly, these are good things, but does the state have the right to coerce us to pay for these services for the benefit of others?  I can argue not. 

However, there is no doubt that an enlightened and prosperous society needs an educated citizenry.  Also, turning an accident victim away from the ER would be unconscionable.  The more practical part of me acknowledges these needs.  What I cannot justify to my philosophical self, I cannot deny to my practical side.  Clearly, education and health care are different from other more purely economic goods and services.   

Because I am loath to have the government run anything, I would personally favor vouchers for both health and education.  It comes down to comparative simplicity and fairness.  Every citizen gets an age-adjusted amount of money in the form of a chit redeemable for the service thereon specified.  This fosters choice for consumers and competition among providers.  In this way, the government would pay for, but not run health and education services.  Vouchers would require standards which would be subject to compromise, co-optation, and corruption.  This is unfortunately unavoidable.  Abuse of the system would therefore require severe consequences for those so engaged.   Vouchers do not provide a perfect solution, but there is no perfect solution.