Robert W. Sewell, M.D., F.A.C.S.
Despite the fact that the Supreme Court has ruled the Patient Protection and Affordable Care Act of 2010 to be Constitutional, we continue to find ourselves at a fork in the road. The Republican members of Congress have pledged to repeal the law and start over with a patient centered healthcare reform act. While this sounds promising, the question remains, which way will we go this time? Will we continue to be lured down the path taken by most European countries and our neighbor Canada, where a central government-run system provides cradle to grave care, or will we choose to empower the individual with freedom of choice? It has been this road less traveled which has been and will continue to be the key to American exceptionalism.
Next week we celebrate the two hundred and thirty-sixth anniversary of our founding fathers telling the world that they refused to accept the tyranny of the British crown. They had witnessed the impact of higher taxation, restrictions on opportunity and forced subservience, and when they had endured enough they rebelled. They rightfully concluded that they were better off pursuing a course based on individual freedom and they set this country down the freedom road that has lead to unparalleled prosperity. It hasn’t been easy and there have been many bumps along the way, but there is no doubt it was the right choice then, and it is still the right choice today. The choice is between liberty and servitude, personal freedom and government mandates. So why is it that so many argue vehemently for a government run system? It all revolves around the concept of responsibility.
Since the beginning of civilization the “common man” has been typically subjected to the rule of kings, czars, emperors, dictators and various other demigods, sometimes willingly but often under threat of force. Frequently, aristocratic rulers declared themselves to be appointed by, or in some instances actually descendants of God, as a means of legitimizing their control over the sea of commoners. The masses accepted this form of centralized, top-down government in part because someone else assumed responsibility for many of the tough choices in life. Only when a ruler grossly exceeded the unwritten laws of human decency would the people rise up in protest. But, historically another ruler would invariably step forward to fill the void. It seems people must be reminded over and over again that “Power corrupts and absolute power corrupts absolutely.” (Lord Acton)
The alternative offered by the Great American Experiment has been individuals possessing the ability to exercise their own free will and accept responsibility for their own successes and failures. In a totally free society there isn’t a “higher power” waiting to bail-out the person who either makes poor choices or is simply unlucky. It is understood that there will always be winners and losers in a true “survival of the fittest” system. But man is no longer trying to simply survive on the planes of Africa. Our collective conscience compels us to adjust our social framework to one that provides a safety-net for those who are either born into poverty or have fallen on hard-times through no fault of their own. Herein lies the greatest challenge to any group of free individuals. On the one extreme, with total freedom you have “losers” who suffer while “winners” enjoy the opulence and privilege of the “elite”. On the other extreme you have a society where there are no winners or losers because the incentives that encourage personal achievement are destroyed by a collective philosophy. It is the state that ultimately decides how much individual success is allowed, “just to make it fair.” This is the basic premise behind socialism and communism.
Nowhere in modern civilization is this argument more prominent than in our evolving system of healthcare. Obviously, no one wants to see a child or an elderly person, or anyone for that matter, go without needed medical attention, but in our efforts to ensure against the socially unacceptable, we risk over-reaching, as we gradually come to accept the idea that no one should have to be responsible for themselves. Gradually, we have either turned over responsibility for our individual healthcare to a corporate insurance entity that offers some version of A-Z healthcare or accepted the idea that a government controlled system is the best model. In doing so we have lost control of the most important personal service any of us ever receives. We have in essence relinquished our personal responsibility in exchange for a sense of security, which rests in the hands of either corporate moguls or government bureaucrats. Benjamin Franklin summarized this dilemma when he wrote “They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.”
Certainly there are those for whom choices are limited and some form of government sponsored healthcare may provide the only option. Even for the majority who have the means and desire to choose for themselves, the options have become limited by those who benefit either financially or politically from maintaining control. The current mantra of both the insurance industry and the government is that healthcare is too expensive and therefore must be taken over by wiser and more responsible people, (i.e.) them, because they know what is best for us and have the resources to deal with the inequities of the system. It is to that assertion we must collectively say no thank you. After all, where do the resources come from, which they use to manipulate the system?
For the majority of Americans the best solution would be a free and open market where the cost and availability are determined not by an arbitrary government panel or an insurance contract, but by the basic laws of supply and demand. This can be accomplished by expanding on the idea of individual empowerment. Health Savings Accounts (HSAs) that are independent from employer based insurance is an idea whose time has come. People will become true consumers of healthcare only when they are making decisions about how to spend their own resources. Obviously, this only works if it is coupled with catastrophic insurance for major costs that are beyond the average individual’s capability, but isn’t that what insurance is for? There must also be competition in the marketplace. Anyone should be allowed to buy insurance from any entity, not just those who operate within the boundaries of the state where they currently reside. Both the catastrophic insurance and HSA should be totally portable and remain with the individual and his or her estate.
Our current system of healthcare financing does not empower the individual, in large part because of our current tax law. The vast majority of health insurance policies in this country are employer based. The employer provides health insurance as a benefit to employees and their dependents, and then writes off the premium as a business expense. Individuals who purchase their own health insurance are penalized twice. They are unable to benefit from “bulk rate” discounts that larger employers enjoy, and they cannot write off the cost of their insurance on their personal tax returns. This is blatantly unfair, and correcting this inequity should be a major part of any new healthcare reform act, and it should be part of the foundation of the promised Federal tax reform next year.
Currently, the American healthcare system is anything but a free market, and as a result prices are high, quality is in decline and availability is threatened for all. The solution will not be easy because it will require a return to the fundamental principle so eloquently stated by Eleanor Roosevelt when she said, “With Freedom Comes Responsibility.” Now is the time, in the wake of this historic decision by the highest court in the land, for all free men and women of this nation to renew our commitment to being worthy of our heritage. We must raise our collective voices and demand our individual freedoms be restored, lest we will all eventually become wards of the state; the very thing our forefathers rebelled against.
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The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.
Check out my web site at www.robertsewellmd.com