A very progressive friend of mine (well, we used to debate all the time back in high school, some 45 years ago) is dancing in the streets that the Affordable Care Act (AKA Obamacare) was held constitutional … even it meant as a tax.
Among the examples of why it is right for the country he cites that among his many other talents, he was once an RN, administrator and educator (now he is COO for a computer game software company) is that experience gave him the view that the American health care system is broken, because he was always broke (that is if I understood his Facebook comment correctly, which I might not have).
My question would be: Why was he always broke and does that mean the health care system is broke? Furthermore, when we are talking about health care, exactly what does it mean?
What is health care? Is it the treatment and care for medical issues or is it the way that treatment and care is paid for? Those are two separate issues and quite distinct from one another.
This debate got my dear sweet wife (who is a Canadian national) and me in an interesting discussion of the Canadian system. For those who don’t know, it is a single-payer system for hospitalization, but significant chunks are not covered (like drugs and other things like certain tests, etc.). And what is covered is breaking the banking in the provinces (except maybe Alberta but they have so much oil in the ground, who cares). She is the first one to point out that the Canadian health care system is not “free”. Nope, people in Canada not only pay a sales tax to the province (the PST) they are in but also to the federal government in Ottawa (The GST). It is like 13 per cent right now, since they merged the two levies so people wouldn’t notice who was getting what and it would be uniform across Canada (The HST).
Now, Canada had a problem, according to my wife, about 15 years ago with the costs of health care going through the roof. The Solution: Cap the pay doctors could get. Now, the problem is that they don’t have enough doctors to go around. Funny, give people less incentive to do something and they stop doing it.
Now, how does this pertain to what is happening in the US? Well, the problem in the US is not so much health care per se, but how are we going to pay for it. That is what the debate is all about. I know we all went through this in 2010, but the court ruling has once again brought it back to the forefront.
Now, the question arises: Whose responsibility is it to pay these bills? The individual? Private charities? The employer? An insurance company? The state government? The federal government?
Therein lies the rub; we can’t make up our minds.
In our federal republic, is it truly the role of the federal government to ensure that everyone can pay for the health care they need? Well, I don’t think so, but the people who think like me have been outvoted by those in Congress, so I have to accept the majority’s decision that it does.
Now, let me dispose of one fallacy: Health care is not a “right”; nor is housing, transportation, food, clothing or a job. Sorry, but those are not rights. Rights are things that are not handed out by governments, rights are those things that we are endowed with by “our Creator” (to quote Thomas Jefferson, who was a very bright man). As he would put it, our rights are Life, Liberty and the Pursuit of Happiness. You can’t buy and sell those. They are just there.
Now, one can make an argument that we do have a right to own property, particularly our own labor, which we have the right to buy and sell as we wish. Radical notion there, but I tend to agree with it. Not all cultures and societies agree with that notion, but it is one that basically underpins the American one. We all have the right to own property. We all have the right to own our own labor (id est: that means we can’t be held as slaves) and we have the right to negotiate to benefit from that labor.
As with all rights, we have corollary responsibilities. Sort of like, if you have good you have to evil, or how else would we know what good means.
If we have life, then we have to give life. In other words, if we have the right to live our lives, then we have to be willing to let others have the right to live their lives as they see fit, with each of us being willing to accept the consequences of our own actions and not necessarily expecting someone to pick us up if we fall (We will leave that choice to someone else). If we have the liberty to do something, then we have to give others the liberty to do things differently. If we have the right to pursue our own vision of happiness, then we have to be willing to let others have the right pursue their visions, even if we disagree with them.
Of course, there is one limitation on any right and that is what we do as individuals must not infringe on the ability of others to exercise their same rights
Pappy taught me that individuals have the right to be stupid. We don’t have to like that, but they do. Only thing is, if you are stupid, then you have to pay the consequences of being stupid, or foolish, or silly … or whatever.
My friend posted a picture on his Facebook comment from the Elect Obama site, of a woman holding a sign that says: I am Obamacare and then going on to outline her various medical conditions she recently found out about and couldn’t find anyone else to pay for. Now, this woman says she is 34 years old. That means she has been an adult for 16 years (according to US law, when you are 18 you are considered an adult and therefore responsible for her own actions). As a responsible adult, what has she been doing to protect herself on the day the inevitable happens? Ah, nothing? Hello, does everybody remember the old fable about the grasshopper and the ant? This person qualifies as a grasshopper.
Ok, the question is fellow ants (adults): Do we let the grasshopper die or can our federal government require us to help her? Actually, that is not the question. We could voluntarily choose to help her, but Obamacare makes it mandatory that we help her. So, is it right and proper to make us help this woman (multiply it by millions of other grasshoppers) or should she be asked to a) face the unfortunate consequences of her own inaction or b) find willing ants to help her? I would say the latter.
I am not being hard-hearted here. Heck, if I knew the lady, I probably would chip in to help her, but I don’t think it is the government’s job to tell me that I have to. I think that is part of liberty for us to make that choice.
The problem is that when you remove consequences, then you remove achievements. In other words, you can’t have good without evil. You can’t have encouragement, without the corollary discouragement. You can’t have incentive without disincentive.
Any person familiar with human behavior will tell you that you get a lot more out of positive rewards than you do negative punishments. Granted, fear of punishment or retribution is not a bad incentive, but things work so much better when people think they might get a reward if they do “good”.
Obamacare is an effort to remove those negative rewards and as a result it also eliminates rewards for positive behavior. That, I contend, is a very bad idea.
Besides, it doesn’t really work. Take away incentives and rewards and we all fall back on the default position: Let somebody else do it, it ain’t in my job description.
One final point: Demand is unlimited, supply is limited. No matter how you slice it, there will never be enough health care to meet demand. It just isn’t going to happen. That means it has to be rationed and that rationing will be done through access. The only two ways that access can be rationed is by waiting times or by financial incentives.
As my brother, the surgeon, once told me: Americans long ago voted their pocketbooks on this issue and that is the health care system we have. Financial incentives win over waiting times. Oh, and guess what? Canada is mulling going back to allowing private health care alternatives to the government supplied system … one where the individual can pay extra not to have to wait for treatment or care.
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