The Case for Universal Healthcare

The U.S. healthcare system is broken.  No one seriously disputes that any longer.  The current national discussion is all about how far to nationalize healthcare.  This presupposes both the existence of a problem and that the free market cannot fix it.  But do we know the latter assumption is true?  How long has it been since the healthcare market was even reasonably free of the twin tyrannies of government regulation and health insurance providers?

There seem to be two groups who are advocates of universal healthcare: those whose liberal ideals make the idea of healthcare as a right feel like a good idea and those whose conception of their moral obligations to others make universal health care take priority over individual rights.

The first group I dismiss out of hand.  Feelings, no matter how well intended, are no reason to get out of one’s chair and walk from here to there, let alone allow the president to spend $1.5 trillion to make universal coverage a reality without offsetting economic justification.  Indeed, taxes will be raised to offset some of the cost; the rest is, like so many of Washington’s grand plans, “unfunded”.

Defending the proposal, Barack Obama says that the massive spending effort will “make families healthier and companies more competitive, but over the long term, it will also help us bring down our deficit”, but the first of his claims is supposition, the second is highly improbably, and the third is a politician’s pipe dream.

Do we have a moral or ethical obligation to pay for healthcare for those who can’t afford it for themselves and/or their children?  Many Christians believe so.

I had a discussion this very evening with a friend who fits more-or-less into the second group, those who believe universal healthcare coverage is required of us on a moral basis.

My test case was this:  Assume two neighboring families, one of which has 2 working parents making perhaps $125K/year in total and whose personal/employer medical insurance contributions are around $12K/year.  The second family lives off of welfare and charity and performs no work of any kind.  Should the children of both families be entitled to the same healthcare as a matter of law?

The Bible teaches that we are not to oppress widow and orphans, an instruction that many Christians extend to children with parents as well. 

My friend used this teaching to say, “Yes, to deny the children of the non-working family healthcare is blaming the children for their parents’ non-action.”  And hence, not providing the same level of healthcare to their children is anti-Biblical, anti-Christian, and simply immoral.

The parents, he went on to say, were entitled to nothing unless they were disabled and unable to work, which made sense to me.

My position is that it is the parents’ responsibility to provide all kinds of care for their children, including healthcare.  If they are unwilling to do so, is that society’s problem?  More specifically, is it a Christian’s obligation to provide charitable relief to the children?  And how does that change if the parents are utterly unable to provide for their offspring?

Taking the last two questions first, yes, Christians are obligated to provide charity for those in need.  That’s not optional.  But ultimately it’s up to the individual to decide to whom and to what extent their giving extends.  I don’t believe there’s any Christian obligation to support a government-based solution to what is essentially a local problem.

For instance, if a parent of one of the kids in my bible study class came to me crying and said, “Little Susie needs an operation or she’s going to die!”, I’d almost certainly whip out my checkbook and give.  What, exactly?  Hard to say until you’re faced with it.  Depends on the situation and, in truth, who is involved.  But the obligation is there nonetheless.

Returning the question of whose problem it is, the economic reality is that society will suffer if poor children don’t get the care they need to thrive.

Whether that is better or worse than the result of a welfare state in which disincentives for working and caring for one’s own children are created is highly debatable, however.  The U.S. currently provides hundreds of billions of dollars in government aid to poor families with little in the way of results to show for it beyond a continuing cycle of poverty.  The unyielding nature of a market-based system may seem harsh, but if it produces better results for most citizens, doesn’t it make sense to go that way and let private charity handle the remaining hard-luck cases?

(The fly in the ointment in this free market scenario is those people who underachieve and/or simply do not attempt to provide for their children, then refuse charity out of damn fool pride.  A government program is somehow acceptable to people I know who fit this description.  I suppose because it can be looked upon as a right of citizenship and therefore acceptable.  But it’s difficult to see this sort of edge case as a deciding factor.)

Regarding the free markets issue, here’s a sample case.  My wife recently had her gall bladder taken out.  The procedure took about 90 minutes and our insurer was billed over $10K for the procedure.  Without questioning the expertise of the staff or the quality of the facility involved, this seems exorbitant for what is now a routine procedure with no overnight stay or follow-up care.  Could a free market for medical services really be any less efficient?  And couldn’t we afford to simply pay cash for many medical scenarios if the direct doctor-patient relationship were restored?

Suffice to say that my friend and I had to agree to disagree.  What say you?