My plan was to begin a new series on philosophical pragmatism and its damaging effects on society, but I will delay that topic until my next post so I can talk a little about “government solutions,” which, in my view, is more of an oxymoronic exception than it is an actual truth. In a number of exchanges with my Facebook friends recently, I have seen expressions of skepticism and a lack of faith in the capitalist system of the United States. Yet their alternative to resolve the “evils of capitalism” always seems to be more and bigger government, as if government represents some paragon of virtue and ethics that the unenlightened masses lack. My view is since government is made up of fallen people, then it has the same imperfections as the fallen people that make it up. This means that those in government who are supposed to represent the people can have personal agendas that are counter to the will of the people, and can enact legislation that may be ultimately bad for the people. This is particularly a problem at the federal level, since all people are affected, and is precisely why the people should hold government accountable, which includes getting the federal government out of areas in which it lacks competence or purpose.
"While the 10th Amendment explicitly limits the power of the federal government, today it has become little more than a quaint, and toothless, sentiment. But that wasn't always the case. The Founding Fathers were no fools. They understood that those who are inclined to power are also tenacious defenders of that power once they have achieved it."
Let’s take for example the current healthcare debate, with some feeling government-run healthcare is a “fundamental right.” I don’t agree with this because fundamental rights are, and I believe should, be strictly within the limits of natural law. In other words, those rights given by the creator that are unalienable: life, liberty, and the pursuit of happiness. Beyond that, we have rights based on the social contract that people make with government which gives it authority over certain moral and/or political obligations. So I don’t see healthcare as an unalienable right, but as a potential policy directive added to the social contract between the people and our government. Otherwise, we could go on forever with people continually declaring certain rights, giving more control to the government that coerces others against their will to pay for those rights (since a right costs something if some good or service must be provided to honor that right). You will ultimately get more and more people demanding rights with less and less people to actually pay for them. So regardless of where the debate over healthcare goes, healthcare is certainly not an unalienable right.
With respect to healthcare, I believe free market capitalism, though it is not perfect, provides for the most win-win scenarios based on a free exchange of market-based services. And within a framework of rule of law and property rights, the free market system works beautifully. Somehow, though, people expect it work perfectly, which is anything but realistic. Based on human nature, there will always be market bubbles that form and burst and there will always be creative destruction as technological advances are made. The healthcare system demonstrates the very issues that have come about with the advancement of innovative, life-saving technologies over the past five decades. But these technologies come at a price and have contributed to about half of all growth in costs (with preventable illness making up 90% of all healthcare costs, much of this due to obesity and smoking). Yet If we look at the way that people live now compared to 100 years ago, we see that due to capitalism, people now enjoy a far higher standard of living. Still, Americans are not satisfied that we have an exemplary economic system which needs to be defended, even though it isn't perfect.
My understanding is that most people who go to a doctor when their medical situation is advanced, or go to the ER, are those that can afford insurance but choose not to purchase it because they have other priorities. The ER is for those that need critical care regardless of whether they have insurance or not, with the insured bearing the full burden. But the ER is also used by those without insurance even if the need is not critical, which the insured pay for as well. The truth is we will always have those that don't purchase insurance when they can afford it, who drive up costs in the ER, and those who make poor health choices in life that drive up insurance premiums directly or indirectly based on whether they have insurance or not. People of today behave irresponsibly mainly because they can, since social mores and personal responsibility don't have the value they once did, and of course, the fact that the government will step in with other people's money in exchange for cheap votes and expanded powers. So I am certain that government-run healthcare is not the solution, since it won’t fundamentally change human nature.
The truth is any solution will be imperfect. Yet I continue to believe strongly that capitalism and our system of government as framed by the founding fathers is the best system to respond to the current issues in healthcare. What is needed is more competition rather than less, with the federal government not involved as a player in healthcare, but involved only in policy that facilitates the free market system. This would include the federal government getting out of Social Security, Medicare, and Medicaid, remanding these to state and local governments that will provide this safety net for the truly needy in a more personal and efficient manner. Within the free market system, there should be a premium to pay for those who don’t (or won’t) accept responsibility for their lifestyle choices that cause preventable diseases. That is why it is perfectly acceptable to me that insurance companies be able to set premiums based on the lifestyle choices of the insured, and practical limits on how much care they will pay for. Those who refuse to purchase insurance when they can afford to should not be able to take unlimited advantage of the ER, particularly for non-emergency care.
The bottom line is Americans need to become more physically active and more responsible about their life choices, and if they don't, accept the consequences. It is unreasonable for someone to smoke, drink to excess, and live a generally unhealthy lifestyle expecting someone else to foot the bill. The government should not enforce this, but should work with insurance companies and healthcare providers on common sense policies that support their efforts to provide the best possible balance of coverage that would include preventive measures and reasonable limits on care based on objective criteria. We are all going to die some day, so we shouldn’t expect to be kept alive when our time has come solely because medical technology allows it. Doctors, along with their patients and patient families, have been making end-of-life decisions for generations, long before insurance. The blessing of private insurance has greatly improved the availability of healthcare, so let’s celebrate it and accept the fact that it has limits, while looking for ways to make it more available that preserves the efficiency and efficacy of the free market.
* References:
Jamieson, Bob, in Letters section. "Could America Ever Become the Not-So-United States?" The Wall Street Journal, 20 June 2009. Available from http://online.wsj.com/article/SB124545060728632553.html. Accessed 20 June, 2009.
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