From a small northwestern observatory…

The debate in America seems to be split between two warring factions — the “I’ve got mine so screw you” group, and the “Basic healthcare is a basic right” faction.  Admittedly, constitutional strict constructionists could see it both ways.  The Preamble clearly states that it’s the role of the Federal government to ensure the general welfare, and that has usually been held by the Courts to mean some level of equality.   The Constitution says nothing about education, but once states began providing education to some citizens, Brown v. Board of Education held that it had to provide essentially equal education to all.  The commerce clause says nothing about running a lunch counter in a Woolworth Store, but once Woolworth started serving anyone, it had to serve everyone.  (By the way — why doesn’t this apply to people who make wedding cakes?  But, I digress….)

The reality is we HAVE very broad access to basic health care.  Admittedly, for complex procedures such as cancer or transplants, this generalization falls apart.  (Remember the old adage — all generalizations are false, including this one.) However, a child suffering a 104 degree fever, or a car wreck victim, or someone suffering from a stroke will generally not be denied basic health care in America, albeit admittedly it may not come as immediately or as nicely as it comes to TheDonald or…. me.

I’ll digress again.  Quite a few years ago, we lived in a major city with one big public hospital and a couple of private ones.  For a variety of reasons, our health care plan required we use the public hospital.  As the father of four small (at the time) children, one can guess I made more than one visit to the emergency room.  It was not the nicest place in the world.  Patients with open wounds were stacked up in the waiting room, having been triaged by a nurse and now waiting patiently to see a physician.  Often, treatment waits were hours, but everyone got treated.  Later, I had a much more liberal health plan that allowed us to use one of the private hospitals.  Guess what?  Completely different emergency room.  Subdued lighting.  Music.  Comfie chairs.  Almost immediate service.  Almost no wait.  Felt like a 5-star hotel.  I was shocked they didn’t have a wine list.

What we have in America is a health care FINANCE problem.  Quite frankly, I pay top dollar and expect the best health care.  However, I don’t deny that my less-fortunate neighbors should also get good, basic health care.  I drive a nice car.  I don’t deny my neighbor the right to drive on the same road as me, albeit in a less-nice car.

We recognize that some form of transportation access is a basic right, and indeed an economic necessity if everyone is going to get to work.  However, not everyone gets to ride in a limo.  Some folks ride the bus.  From an economists perspective, we need to figure out how to provide FINANCING for everyone, so that the folks with no insurance don’t just randomly pass off the cost of their health care to me.

That said, I don’t mind the fact that there should be some personal mandates, but perhaps not the way you think.  If my neighbor, who drives a crappy car, wants to share the highway with me, then he also needs to have a drivers license and insurance and tags on his car.  If he repeatedly refuses to do these things, he’s not denied transportation, he’ll just have to get his transportation via the city bus.  Similarly, there is a shockingly large number of folks who only go to the physician when they have chest pains.  These folks should be required to see a doctor regularly and get regular check-ups and inoculations and vitamins and such.  If this sounds totalitarian, it’s no more onerous than what we require for you to drive a car.

I thought Article 1 of the health care plan that went down to defeat last evening was fair and reasonable — leaving kids on their parents policies until age 26, and not denying insurance for pre-existing conditions.  The system has to accomodate the kids and the pre-existing conditions one way or another, and so providing for these within the health care finance system is reasonable.  The roster of basic rights (maternity care, screenings, portability, etc.) were also economically reasonable.  The bill went down to defeat for two reasons.  First, the White House was comically amateurish.  I believe Jed Bartlett’s west wing staff would have handled this much better, and provided Paul Ryan with the tools he needed to twist arms.  That said, this White House has zero clout on Capitol Hill, and that basically means we have no government for the next 3.75 years.  While that may sound to some of you like a good thing, wait until some random crap hits the fan, as it always does.

Second, the very deep conservatives in the GOP don’t want ANY sort of government involvement in health care.  They really do believe that health care is not a universal right.  It has nothing to do with finance – it has to do with the fact that when they go to the emergency room, they don’t want to be sitting next to a poor person.  They really do have the view that if you can’t afford food, you can starve.  (Remember — this government denies — with a straight face — the linkage between a good breakfast and school performance.)  If you can’t personally afford health insurance, under their theories then the door to the hospital is barred.  Pence was, reportedly, giving a talk recently and was asked what does a person have to do to get the same level of health care as he gets.  Pence replied, “join the Air Force.”  Ahem…. that pretty much says it, doesn’t it?