Both Oars In Health Care for the Many is up to the One

Jul 24, 2009

I have worked for over a decade in a country with no real public health care program.  Without the medical relief provided by missionaries and world health organizations, tens of thousands of people would be lying in the streets of Port au Prince begging for help, instead of the hundreds who do.  No country wants to be without health care for its citizens—rich or poor. It is demoralizing and destabilizing.  

 

As a missionary, I have also experienced firsthand the frustration of lacking sufficient resources to help a person in need of medical care.  I have painfully learned that the person asking today does not want to hear about the person who came yesterday and received the last of the funds. Unfortunately, no matter what I did, funds always ran out before the needs. The nagging truth about health care may be that, no matter what we do, not everyone will be served.

 

Nonetheless, I believe that basic health care, like water, should be a public utility. Maintaining public health benefits everyone. Healthy mothers have healthy babies. Healthy babies given the proper immunizations and occasional antibiotics become healthy, productive adults. Open access to basic health care is in everyone’s best interest. We do not want people dying unaided in our streets. We do not want people to end up in emergency rooms that could be served by a general practitioner. We want people to get fair treatment reliably and economically.

 

The problem is that health care is not a commodity like water. It is easy to provide water to a whole city.  No one has a rare condition requiring water that costs a thousand times more than regular water. Water is relatively cheap; health care is relatively expensive.  Not everyone ends up needing the same amount of health care. Often those with the least left to give to society need the most care.  This makes it much harder to provide and to legislate medical care than other utilities.     

 

Health care is more akin to education; although, it is easier to define basic education than basic health care. It is also easier to accept that some will go on to a State subsidized university while others will terminate after high school than to accept that some will get extraordinary care to prolong their lives and others will not.  Education is important, but it is not life and death. No wonder we have accomplished public education ahead of national health care.      

 

I asked a priest friend who is a medical ethicist what the obstacles to universal health care are. He typed out fourteen stunners, ranging from the lack of a shared definition of what health is to the fact that life is not easily reduced to dollars and cents. Morally, the patient is normally the best decider of what treatment to pursue or decline. Economically, it is the payer. Therefore, the more disjointed the payer and the patient, the more room for abuse.

 

Another man who thinks a lot about universal health care is Peter Singer, a Princeton ethicist famous for his controversial views on life. I do not agree with Singer’s philosophy or most of his conclusions. However, no one holds a mirror to our face like Singer. While we argue what we theoretically will not do on moral grounds, he shows us that we already are. In a recent article for New York Times Magazine, Singer quotes statistics that prove people with insurance often end up with better outcomes than those without it even in cases of emergency rooms where treatment is supposed to be blind to the ability to pay.  

 

Singer hits the nail on the head when he suggests that people are likely to vote for national health care and its unavoidable rationing under two conditions: “first, the option for private health insurance remains available, and second, they are able to see, in their own pocket, the full cost of not rationing health care.”  The better term may be “feel the cost,” but Singer is on target. The best program is a hybrid of State provided basic health insurance supported through taxes with the option for individuals or employers to buy additional private insurance at their own expense.

 

In the end, universal health care does not depend on the government, it depends on us. Are we willing to sacrifice for the common good?  Are we willing to lose weight and stop smoking to help lower medical costs? Are we willing to limit our right to sue doctors? Are doctors willing to accept a wage we can all live with? Are we willing to allow a “sin tax” to be added to fast food similar to that on tobacco? And, after all that, are we willing to accept that some will still find less than others? Are we willing to accept that the one who finds less may be “me”? I am because I have seen the alternative and it is indeed worse.