Who Needs Health

What passes for health care discussion these days is enough to make you sick.

The prevalent sound bites in fact have almost nothing to do with health care and are instead a guide to greed and selfishness in an ever-escalating battle of “my ox will be gored more than yours.”

The question that matters on health care is, “Am I my brother’s keeper?”

If you believe that America is the land of the free, the home of the intrepid, self-sufficient pioneer, and that the essence of capitalism is every man for himself and to each his own, then you may happily conclude that your brother can damn well carry his own water. If you’re of that opinion, the discussion is already over. Those who can afford to pay their own way do just fine in our system, and it’s no skin off your nose if about 1 in 7 of the rest of us can’t afford it. I encourage you to think about that number for a moment, though: If you talked to one different person each day for a week (say a parent, a sibling, a pastor, a coworker, a neighbor, a waitress and a delivery driver), on average one of those people would be unable to afford full health care.

If, on the other hand, you believe that America is the great melting pot reaching out to the troubled masses and that we are the United States, stronger together than individually, then you will feel that “He ain’t heavy … His welfare is my concern.” Then the discussion becomes about how best to lift up your brother. More precisely, it becomes about how you and your brothers, all of you, can best share your burdens so that each of you can get through the rough patches.

Pooled resources of the many, made available at need to individuals, is the essence of insurance: Shared strength is the whole point. Some undoubtedly gain nothing more than a sense of security, because they never file a claim, so perhaps they are losers, if only in the same sense that a man who builds a strong fence has wasted his time if there are no wolves to keep out. Still, security is itself valuable.

There’s a bit of fudging in the 1 in 7 figure, because that’s the estimate of 45 million to 50 million Americans without health insurance, which is not exactly the same as 1 in 7 unable to afford health care itself. Perhaps many of these people can go to a general practitioner or a dentist for a basic checkup, but surely any emergency room visit or overnight hospital stay quickly outstrips their resources. Perhaps the best way to help these people is to consider a system of free clinics for basic health care — yearly checkups and preventive care such as immunizations.

Now we’re getting into the question of just what would be successful health care reform.

So let’s back up a bit. Those of us who are not islands unto ourselves accept that we share a common interest in providing for each other’s health. What are we to consider the measures of our national health, and what do we consider is the minimum standard each of us should be empowered to achieve? National figures on longevity, teen pregnancy, child mortality, prevalence of immunization, frequency of outbreaks of communicable disease, and, yes, per capita cost of medical care might be considered. In most of these measures, the United States is less successful than the rest of the industrialized world. Only in spending money do we outstrip other nations. On average, therefore, we spend more for show rather than for value.

So we are at best ignorant, at least greedy and selfish, and at worst heartless.

We battle ignorance with information, and ultimately with regulation as necessary. For instance, medical science has compelling data on risk factors for infant mortality, yet as a nation we have a rather high incidence of avoidable factors such as early teen pregnancy, drug abuse and inadequate nutrition. We can work harder to get the information out, but as with drinking and driving (or even texting and driving), many people are well aware of the risk but are quite sure that they can handle it — they are not like the “ordinary” people to whom the information applies. So, we have to make laws to force people to do what makes all of us safer, even if that cramps the style of some freer spirits.

Here is where conservatives and liberals often part ways, with conservatives railing against a “nanny state” ordering people to do what should be common sense and liberals seeing a need to protect against the indifferent evil that men do.

It will take some imagination to determine consequences for a health care scofflaw. How do you punish someone who can’t be bothered about his own health? Perhaps, as with drug addiction, the lack of concern for health is because there is a physical dependency that must be treated by medical care. How does a nation provide care for such people yet find some way that they pay the price of any actions of their own that contributed to the condition? And which bad habits are punishable? Alcohol and drug abuse are generally frowned upon, but is the jolly fat overeater who will eventually need expensive diabetic care to be subject to similar censure?

These are the real issues of health care reform, and we will continue to ail and die at rates that would embarrass underdeveloped nations as long as shouting “Nazi” in a crowded room passes for expressing an opinion on these issues. The ones who shout the loudest are really saying, “Mine! Mine! Mine! And the rest of you can just die for all I care.”

That is the true echo of Nazi insanity.

We talk about banks and car companies and say they are too big to fail, yet we allow our family to die and call it fiscal conservatism. I guess when it comes to a nation, the old saying goes a little sideways: You can have all the money and possessions you want, but if you haven’t got your health, it’s probably not important.