31 March 2010


While the administration and congress have forced through a radical health overhaul certain basic questions have not been directly addressed. Are we responsible for keeping everyone who is living today alive? Does this mean everyone in the United States or does it also mean the developing world as well, as some would have it? These are difficult moral questions, but there is nothing in the constitution to suggest that the state has any responsibilities along these lines. One could stretch the meaning of “life, liberty, and the pursuit of happiness” in the Declaration of Independence to encompass this, though it is unclear to what extent the state could guarantee life any more than it can guarantee happiness.

Are we responsible for taking care of those who will not bear the cost of taking care of themselves? Those who cannot already have support systems, no matter how imperfect. Clearly before any attempt to overhaul the health care system is attempted these basic questions ought to be thoughtfully addressed given that there is no consensus on them.

The left would establish a “right” to health care for everyone, thus assigning the state the responsibility for life itself. On the other hand many on the right emphasize the sanctity of life and oppose abortion and euthanasia and would involve the state in these matters. Thus there is an odd convergence of opinion that the state ought to be involved in some sense with the matter of life, although understandings as to what this means differ widely. For any overhaul to be acceptable there has to be some agreement on fundamentals. Any new right ought to have the broad base of a constitutional amendment, if not an amendment itself.

Health care literally constitutes the fundamental “cost of living.” For countless centuries basic human needs have consisted of food, shelter, and clothing. Over the past hundred years as life spans have increased due to medical innovation, health has become another need, in that people can live into old age to the extent they are healthy. In prior centuries little could be done to extend lifespans and the average person died at a considerably younger age. What was “old” in the past is now relatively young. This is what accounts for much of the increase in health care costs over the years. This is the real “cost of living,” and the administration’s health care program would effectively make this a responsibility of the state, thus transforming a need into a right. Even if such a right was established it does not follow that government should manage it, anymore than it manages our choices in food, shelter, or clothing. But they go even further, not only creating a right but a requirement.

However most of the innovation has come from society’s institutions, not the state, whether it be new drugs, medical devices and procedures, or cures for disease. Can the state effectively “control” this innovation? Or will it stifle further improvement? Part of the reason American health care costs are so high is that we are effectively subsidizing the rest of the world in terms of innovation, as reflected i.e. in domestic drug prices. As long as innovation continues unfettered there may well be an increase in the cost of living, unless or until yet other innovation leads to cost savings. This is clearly possible, as in the case of procedures that once required extended hospitalization and that can now be done on an outpatient basis. Thus innovation cuts both ways, but once the government takes control this engine will be stifled. The fallacy of the Democratic health care plan is that conditions that exist today are going to prevail in the future. Thus apart from cost factors, the Democratic plan represents a closed system based upon present day assumptions. But no one can accurately predict the future more than a few years out. Rather than expanding care it would effectively freeze it.

In addition to costs, the long term consequences of state control have not been seriously thought out. Suppose a procedure to extend lifespans was developed. There would certainly be a cost involved with this, which would effectively add to the cost of living. Would it then be then the responsibility of the government to guarantee an extended lifespan to everyone, regardless of their living habits? Prudence would indicate that we ought to think through exactly what responsibilities the state would assume. Unless and until there is a broader consensus change should be incremental at most and this monstrous legislation must be undone.

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