The extent to which government assisted health care is justified is an ongoing topic. Disagreements about how to limit the system to the truly deserving are never-ending, and progress is stalled.
In 1651 Thomas Hobbs published “Leviathan,” his reflections on the reasons governments exist. He felt that the natural state of man is total freedom, with every person in conflict with every other, but this resulted in chaos and insecurity. The only way mankind could live contentedly was to combine power and strength into a covenant of all people. This “common-wealth” would provide protection to all.
Hobbes didn’t feel this covenant was formed for the greatest good since individual wants and desires lack sufficient uniformity for there to be any such thing. He did however believe in the greatest evil. His “common-wealth” was not a utopian desire to provide assistance to all, but rather a desire to minimize damage to oneself.
I feel this argument originally can also be used for health care.
A “common-wealth” binds all members of the nation into a greater body, providing health care to all. If the goal is the utopian vision of “the greater good” to all mankind, serious flaws rapidly appear. Nobody can agree on a definition of that good, partisan battle lines are drawn, and progress is stalled.
The current healthcare debate is therefore a battle between the natural rights of man versus the “common-wealth.” Those who favor the former feel a younger individual should be able to choose to not purchase health insurance. This lack of preventative care can with time lead to chronic illness, which they deal with as well as they economically can. Individuals with chronic illness spiral into increasing healthcare costs and decreasing coverage until they become sufficiently disabled for government care, with those costs passed on to all taxpayers.
As a surgeon in Kentucky, I have witnessed the effects of lack of coverage.
Individuals with fractures seen at outside treatment centers were not eligible for local hospital care, even if I offered to do the procedure for free. The inability to obtain proper medications resulted in medical complications from uncontrolled diabetes or hypertension. The temporizing efforts to address this in the past (forcing hospitals to provide free care to those in the emergency rooms, high-risk pools) did not resolve the issue.
These events created a large mass of chronically ill individuals unable to afford the high-risk insurance that was available, unable to find work, with no recourse other than to try for disability. The ACA improved the situation but high deductibles still made adequate health care out of the reach of the working poor — those who made too much for government assistance, but not enough to pay all of their bills.
The greatest risk for our society is a growing mass of sick and disabled people unable to contribute to society. We may not be able to agree on the greater good, but avoidance of the greater evil should be our goal.
Our commonwealth depends on a healthy workforce capable of addressing its needs, and minimizing the costs of caring for the disabled would benefit all taxpayers. Changes to the health-care system must be tailored to improve society as a whole by maximizing the health of our workers while minimizing the costs of caring for the disabled and infirm.
Elimination of the greater evil should be our goal.
Dr. Ronald C. Burgess of Lexington is an orthopedic surgeon.