Health care-what the revolt to freedom requires

Once we shift the focus of the health care discussion from caring for sickness to preserving health, one thing becomes clear immediately. If we wish to remain a free people, health care cannot be the government's business. Though would-be tyrants like Obama want us to forget it, lawful coercion (the force of law) is what ultimately distinguishes government work from other group activities. It makes sense to say that we will force people to be healthy only if our concept of human integrity (healthy human life or existence) includes slavery. But as Americans we long ago rejected this possibility because it is inconsistent with respect for the God ordained unalienable rights that are an essential aspect of human being, i.e., what it means to be what we are. Slaves may or may not have healthy bodies, but slavery cannot be a healthy human condition.

By beginning with this observation, we are led to reflect on the comprehensive meaning of human health- one that goes beyond the material condition of the human body to include the mental and spiritual aspects of human life. Undoubtedly, many diseases appear to be the result of merely material causes. But which merely material cause makes the difference between one person with the will to eat right, resist health impairing habits and keep up a healthy level of physical activity, and another who lacks the will? What merely material cause makes the difference between one person doggedly determined to battle cancer or infection for the sake of life, and another who confronts the same physical threats with despairing lassitude, or peaceful acceptance?

Sickness may be a material condition but health is also a state of mind. As such it is susceptible to material, mental and spiritual influences. These days it's not uncommon for people to pay lip-service to this fact. But when we consider the main preoccupations of the so-called health care proposals being debated at the moment, do any of them take it seriously in a positive way?

To do so requires that we respect the role that human will, conscience and spirit have to play in the critical decisions that influence a person's state of health. It requires that we accept individual choice and responsibility as the first premise of any health care approach. Though many opponents of the Obama faction's proposed socialist takeover decry its implications in this regard, how many of them are honest enough to admit that the third-party payer system it would replace just as surely eviscerates the exercise of responsible individual choice in any meaningful sense?

Responsible choices take account of both the benefits derived from a decision, and the costs it involves. But the third party payer system puts individuals in no position to do so. Sure, they choose an insurance plan. But at the point of delivery, they lack both the information and the incentive to react effectively to the relationship between the service they receive and the price set for it. This deficiency has at least two bad effects: a) Providers have little incentive to respect the power of individual clients; b) individuals have little incentive to resent or appreciate the price paid for the quality of service they receive.

Since it breaks the price/perceived quality ratio, the third party payer insurance system abandons a vital prerequisite of any free market system. It breaks the cost governing mechanism that generally allows the market to achieve equilibrium at a point of price efficiency that reflects informed, responsive decisions by the individuals whose activities make up its existence. These individuals are replaced by corporate (or government) bureaucracies driven by control/management and profit/budgetary preoccupations that have, at best, only a coincidental relationship to the actual price/quality ratio of any particular service transaction. How can it be anything but coincidental when it excludes from reckoning the perceived experience of the particular individuals involved.

As the result of what we might call this coincidental price structure, system resources are distributed with little or no regard for perceived cost-effectiveness. It's like running a restaurant based on aggregate decisions (how much of what kind of food to buy, how big a wait staff to hire and at what wage, how much to charge for each different menu item, etc.) that take little or no account of how individual patrons react to the service or the taste of the food. Meanwhile, individuals pay a flat fee to eat at the restaurant, choosing from menus with no prices on them. (The bill is sent to a company that insures access to restaurant services. Doubtless it began as a provider of starvation insurance for the cooking impaired.)

All these reflections point to what ought to be the first set of goals for a health focused approach to health care:

• It must respect the mental and spiritual as well as material aspects of health, beginning with the human right to liberty i.e., responsible individual choice.
  
• It must therefore be based upon a resource collection and distribution system that respects the requirements of liberty i.e., responsible individual choice.
  
• As things stand in America today, this means a) rejecting any socialist, single payer, government administered system; b) establishing a health insurance system that respects the prerequisites of a true marketplace; c) abandoning the third party payer approach in favor of one that recognizes individuals the as owners of the dollars expended for the health care services they receive, with full responsibility for the disbursement of those dollars at the point of service. This requires that individuals perceive themselves as directly gaining or losing value from all such dollars as they are expended.

In my next posting, I'll discuss some of the features that might be part of an approach to health care that reflects these goals. Be advised, though, that I won't be offering "my" health care proposal. The notion that people like me, whose main vocation has to do with the responsibilities of citizenship (the proper definition of politics) should be the source of remedies for health care is a symptom of how far the totalitarian socialist mentality has corrupted our common sense. However, because considerations of justice are relevant to all human affairs, I can try to make a useful contribution to thinking about how the possible features of a health care approach relate to the principles of justice that inform our identity as Americans. Stay tuned.