Tuesday, February 16, 2010

Health Care Fantasy

Health care is often described as a "market".  But I think this is wrong.  How could anything like a market exist when some people are going to have life experiences that make them 100x more costly than others? If we compared health care insurance to auto, life, house, or other forms of insurance, it would be like certain people living in houses on fire, or driving cars with broken steering wheels that continually crash into other vehicles!

The reason we get around this today seems to be that there are structural systems that manage risk. The first would be employee pools, next pre-existing conditions, and finally just really high insurance costs. But such a system depends on a high degree of callousness. Those in fields where no employee pool exists, or the where wages don’t support it are kicked out. Then those with a pre-existing condition are left out. Finally those who can’t afford it are left out. And here we arrive at the high level of uninsured, those who don’t get medical treatment, and those who simply die.

To me this comes down to basic morality. We as a society can afford to cover everyone. Maybe more clumsily, but adequately. Our taxes will be higher, but our economic system won’t collapse. It hasn’t in every other Western country that guarantees some form of universal HC. Yet we choose not to. Throughout history societies have chosen different levels of compassion, having decided on different moral standards. Our American system of health care right now depends upon on tolerating a certain level of human suffering.
This is a moral determination. All sorts of fancy economic or philosophical reasoning is put forth. But in the end it seems a simple matter of morality. Yet one that also seems to depend (as limited compassion usually does), on a failure to empathize because of a failure to witness. Few people would argue that we deny people access to emergency rooms, should they not be able to pay. Yet having no insurance isn’t much different. Yet the situation is less clear-cut. It happens on calm afternoons, when medications are not picked up from pharmacies, when problems go undiagnosed, when bills pile up and homes are quietly foreclosed. The story becomes part of that elusive tapestry of unacknowledged, unwitnessed poverty.

It is here that the sweeping philosophical and economic rationalizations for our current system reside. Here in this emotional vacuum the specifics and details crumple into dust beneath grand gestures. The human lives that hang in the balance are absent. They cannot enter, for they would immediately disrupt the natural symmetry between our present system and a most basic level of human sympathy. In this way it is not that opponents of HCR are without compassion, but that they must actively disengage from the reality of their position’s consequence.

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