This critical question spins off two more vital questions:
“If Health Care Is A Right, What Are The Implications Of Further Extending Entitlements In Our Society,” and “If It’s A Privilege, What Are The Implications For Social Cohesion And Cultural Unity?”
As is the fashion these days, let me be real transparent – I do not believe that health care and/or health insurance is a right. I believe that there is no constitutional imperative dictating it, and that, like other social needs – housing, food, jobs – you get what you deserve based on the choices you make and the risks you’re willing to take. I am a minimalist when it comes to government and social guarantees because I believe it gives individuals the greatest opportunities for self-realization and success (as well as self-destruction and failure). And as I’ve written before, both, I believe, are essential for maximizing human potential and freedom.
But, after having taken that position, I have to admit that I have serious concerns about the shredding of our social fabric, if we unequivocally reject a “public option” and all that goes with it. I wonder if we have gone so far down the entitlement path and so raised people’s expectations to be care-taken by entities outside themselves, that we could be on the verge of creating an irreparable schism in our culture.
I cannot remember a time in my adult life, when so many people in public life promulgated so many entitlements, and offered to remove so many risks from people’s lives. And this comes from individuals of a myriad of political persuasions. I think it is fascinating, that as Obama’s poll ratings fall, a lot of folks seem to agree with him that health care is a right, and that we need to do everything possible, to remove risks from our lives. I have never believed, as some on the right do, that Obama is anti-business (just look at how much money and subsidies have gone to Wall Street). I do believe that he and his administration are anti-risk, and are doing everything in their power to punish risk-takers and risk-taking. This culture was built by people who put everything on the line, and created opportunities for the masses that never before existed in the history of the species.
There is a very interesting connection here, between one of the causes of our current economic crisis, and the debate over health care reform. Beginning in the 1970’s a movement began in the Congress to “open up” the single family housing market to a broader spectrum of the population. Basically, to people who heretofore couldn’t afford to buy a house. This movement culminated in enormous legislative pressure on Fannie May and Freddie Mac (and the banking sector in general) to lend money to people, many of whom had no chance in hell of ever paying it back. What do you think drove this movement? The belief that every American deserved to live in a single family home. That they had a right to it. So, de facto, home ownership became a right. And we have now seen what a mess this created.
This extension of “rights” raises a very knotty question, that, I believe we are right up against, as a society. “Where Do Rights End, And Individual Responsibilities Begin?” About a week ago, I was invited to a showing of Michael Moore’s film, “Sicko.” It is an extraordinarily well done piece of propaganda on the ills (no pun intended) of the American health care system (and our culture in general), and a celebration of the systems in England, France, Canada, and Cuba. It was fascinating to see what was highlighted, since I have a fairly extensive knowledge of three out of four of the countries (I lived in England, had a Canadian business partner, and traveled extensively in France and went to school with many French people). I was particularly aware of two things during the movie. First, the unquestioning scorn of American culture on the part of many in the audience. And second, my own reaction, especially during the segment on the French system. As I watched the depiction of house calls by French doctors, free medical care for everyone, in-home parenting assistance for new mothers, almost free childcare, and on and on, I found myself, at first, feeling like – “Damn, this is amazing! Maybe this total nanny state stuff isn’t so bad after all.” It was very seductive. And on the surface, very appealing. Then I remembered what it was like, to spend time in France, and work with French people. The infrastructure there makes New York look like utopia, the government bureaucracy makes you nostalgic for the California DMV, and getting anywhere is a nightmare because almost every day some group is on strike or demonstrating for more time off or more money for doing less. The unemployment rate is sky high, productivity is low, and the slums outside Paris are continually at a flashpoint.
Every form of social organization has its tradeoffs. The question we are facing now is what tradeoffs are we, as Americans, willing to live with? In our system, there are clear winners and losers; mostly determined by choices within their control; sometimes, unfortunately, by forces outside their control. In other societies (third world countries), there are winners and losers, mostly determined by forces outside of most people’s control. And then there are cultures (like the Scandinavian countries) where equalizing outcome has so leveled the society that winning and achieving is a moot issue. I believe, by the way, that losing, in our culture, is a unique opportunity to learn, grow, and develop.
Finally, on a practical level, there is no doubt in my mind that our health care and insurance systems need some changing. There is also no doubt in my mind that the changes can best be made through lessening regulation and controls, not by increasing them. We need, for example, to completely sever the ties between employment and health insurance; we need to remove geographical restraints on writing insurance coverage; we need a loser pay reform of our tort system; and we need to dramatically expand the health care services that can be provided by non-M.D.’s, which would have the most profound impact on primary care of anything that has been done for the last fifty years.
But, before we do anything practical, we need to decide what kind of society we want to live in for the foreseeable future. That’s what the big debate ought to be about.
I covered up these deficits with a pretty good story; even taught it as a strategy to make busy professionals more efficient and effective. Why would I waste my time in front of a computer, slaving away at a keyboard, when I had assistants that I paid handsomely to relieve me of the details of life? So, I persisted in writing out my outlines, power points, etc., in longhand, on notepaper, and faxing them to my executive assistant. I even had my assistant read all my emails and fax the legit ones to me, so that I could write out my responses and fax it back to her. At least, I reasoned, I was using some technology. (It just took me five minutes to figure out how to underline “was” and “some.” I wish I could think like the people who design computers.) I have been ashamed to admit the latter to many people, until I had dinner a few weeks ago with a former client and member of my generation, who confessed to the same modus operandi. (The italics only took me a couple of minutes.) We had a good laugh. It was like two adolescent boys mutually discovering that they kept the same magazine under their mattress. This lead to a great discussion of how our grown children have shamed us into “texting.” (My youngest son won’t answer his cell phone and has no landline.)
I grew up in an upper middle class professional home. My father was a dentist and my mother was a college educated manager in an upscale retail chain. They were the first in their generation to leave the ghetto and homestead the suburbs of Chicago. Making it, in their peer group, meant doing nothing around the house. In my household, extreme manual labor was watering the lawn. And a screwdriver was a high tech instrument. There was always great angst about who would drag the garbage can the fifty feet to the alley. We had a lawn service and anything that required maintenance around the house, was fixed by one of my father’s patients. My job, growing up, was to do well in school, and to learn how to argue.
It has been very hard for me to admit that a lot of technology scares the hell out of me. And even harder to admit, that as smart as I am, I have been convinced, until very recently, that I could not figure out how to use a computer (or plumb the depths of my cell phone). When I finally did come to terms with that reality, I started doing what I have taught people to do for years. I faced my fears and took some risks. Two days ago, in preparation for a phone conference, I developed a talking points document, saved it in my computer, emailed the client, and (to my utter amazement) attached the document, hit “send,” and had a great meeting. It worked! I can’t tell you how good it felt, and how proud of myself I was. It was right up there with re-setting the clock in my car, last spring.
In addition to all this being a great personal triumph, I now have a new, profound respect for people who struggle with change. I definitely “feel their pain.” And I can, in good conscience, recommended facing your fears, “fessing up,” and taking those risks.
Tell us what you think – click here to send us an e-mail with your feedback.