Traditionally, most Americans placed a high value on personal responsibility. They believed people should provide for themselves by working hard, living within their means, and saving money for unexpected needs, notably illness. At the same time, they believed that parents should help children, children should help parents, siblings should help one another, and neighbors should help neighbors.
The traditional view no longer dominates. Many Americans emphasize rights more than responsibilities. For example, they believe health care is a natural right that government should guarantee for all citizens. This explains, in large part, why the Trump administration is accepting much of what was in Obamacare, including the required coverage for “pre-existing” conditions.
Legislators’ disagreement over health care is largely traceable to the stereotype that liberals empathize with poor people and conservatives hate them. This nonsensical oversimplification has created a situation in which liberals waste time accusing conservatives and conservatives waste time denying the accusations. Meanwhile, the issue of health care goes unsolved and the situation grows more desperate.
The key step in reforming the health care system is for both parties to get beyond oversimplification and acknowledge the complexity of the issue, which means accepting the following facts and conclusions:
In times past, the American family was extended—that is, consisting of a husband and wife, their children, and some combination of grandparents, aunts, uncles, and cousins, all living in close proximity, sometimes in the same house. When one or more individuals experienced physical or financial difficulty, the others would assist them.
The modern American family, in contrast, is nuclear—composed of a husband and wife and their children, or (increasingly) a single parent and his or her children, with few if any relatives living in close proximity. Moreover, especially in the case of single parents, the family income is insufficient to meet financial needs, and often as not there is no social network to provide assistance.
Throughout America’s history, the idea that all citizens are responsible for helping the sick and needy has been universally embraced. The idea has roots in both religious and secular thought—in the latter case, in the Golden Rule. Where people have differed is on the matter of who should provide health care. Those who believe such care is a natural, constitutionally protected right say the government is the appropriate provider; those who say health care is not a right but a responsibility of the individual person are less inclined to favor government provision. The issue is important because, if health care is a right, then the government must be its guarantor and that lends support to the idea of its also being the provider.
It is reasonable to believe that people should be responsible for their health care, as they are of their health. But honesty demands acknowledging that for a variety of reasons (understandable and otherwise) there will always be some who do not meet that responsibility and will thus eventually need care they cannot afford.
Having the government guaranteeing and providing everyone’s health care will tend to encourage irresponsible people to remain so. It will also discourage responsible people from continuing to behave responsibly. (Why give sweat and money to get something others get for nothing?) In addition, government bureaucracies are notoriously inefficient, a fact that is especially relevant at this time, when the nation’s resources are thinly spread and the national debt continues to rise. The inefficiency of large, bureaucratically framed programs also invites dishonesty not only among recipients of benefits but also among the private companies who contract with government agencies.
Who else, other than government, could provide health care for those who cannot afford it? Employers could do so, as many have done in the past. But that would leave the unemployed without a provider other than government. Private sources, such as charitable organizations, could do so, as well, but unless their efforts are well coordinated, there would be a danger that not all those in need would be covered.
The facts and conclusions discussed thus far should be acceptable to most members of both political parties, and that acceptance can provide a basis for the cooperative effort necessary to deal with the more difficult challenges of health care reform. Challenges like these:
How can health care initiatives avoid encouraging profligacy and irresponsibility among recipients of care?
How can competition be increased among insurance companies so that citizens can obtain quality health care at reasonable cost?
How can the price of prescription drugs be lowered? Even more important, how can doctors be made more prudent in prescribing drugs? All too often, they prescribe a second drug to overcome the side effects of the first drug, a third to overcome the side effects of the second, etc. to the point where the patient is taking half a dozen drugs and experiencing multiple side effects, in some cases dangerous ones. (No researcher, to my knowledge, has investigated the impact of this syndrome on people’s health and the resulting increases in health care costs.)
How can both the number of frivolous lawsuits and inflated jury awards for legitimate lawsuits be reduced? Together, these have caused doctors and hospitals to carry expensive malpractice insurance, the costs of which are passed on to patients and thereby increase the cost of health care, sometimes dramatically.
How can care for pre-existing conditions be provided without driving health insurance providers out of business?
In short, much of our legislators’ quandary over health care is due to their mutual mistrust. Only when they overcome this mistrust, find common ground, and address substantive challenges honestly will the the issue of health care be satisfactorily resolved.
Copyright © 2017 by Vincent Ryan Ruggiero. All rights reserved
