Why I Care About Health Care

Nowadays it seems like anyone with a political opinion feels the need to express it meanly, loudly, and unapologetically. Such folks tend to yell (or cry) a lot, and to the extent that they ever attempt to justify their position, it’s done primarily by caricaturing the opposing side. The ultra-conservative movement is particularly guilty of this: the tea partiers, the town hall protesters, and the so-called “birthers” all insist that you’re either with them or you’re a socialist, a globalist, a radical, an illegal alien-lover, or worse. Indeed, it seems that the prevailing sentiments on the Right are the fears and prejudices of–and I quote a Politico story here–a vocal subset of “cranks” who “make you cringe” with the “pettiness of their vitriol.”

Well, I’m sick of the cranks, and I don’t want to play their game. So how about I step back from the political mudslinging and explain why I support health care reform without vilifying the opposition–or even pressing the urgency of my policy case? How about I discuss the case for health care reform from a conceptual, apolitical standpoint?

Since this is my blog, I don’t have to wait for your answer (don’t like it? Get your own blog, buddy).

First order of business: I am a capitalist. It’s true! Sure, capitalism is an undeniably ugly system–let’s face it, the whole shebang is built on a faith in human selfishness and greed. But the way I see it, any viable economic system has to have these vices built into its infrastructure, otherwise it ignores the basic reality of human nature. Consider: in communist ideology, the working class and the state were assumed to have a sort of fundamental virtuousness; both were idealized well beyond practicality. As a result, the Soviet Union fell apart when corruption, repression, and general stagnation took hold. There were no institutional mechanisms to control for and thus adapt to human failings.

Put another way, the ideology could not account for the fact that people are jerks; instead, it assumed that it was only the bourgeois who were the douchebags. In contrast, capitalism–and in fact, the whole U.S. democratic system–is premised on the notion that everyone’s a potential douchebag–that people are power-hungry and selfish, and that it’s more productive to pit these instincts against each other within a bounded system than to ignore them (consider, for example, the checks and balances system in our government).

This market logic makes sense to me for a whole lot of things–but not for health care. You can’t leave health care to the market–because it’s a different good than the usual commodities that are more appropriately produced, distributed, and consumed within markets.

Put simply, you can’t shop for you health–not really. Sure, there’s information out there that can help me live well, prevent diseases, and generally stay healthier–and of course this information should be sought out and made broadly available. But you never know what might happen: when you’ll get sick, what diseases are programmed into your genes, or when you’ll have an accident. You can’t plan your health with absolute certainty and, just as importantly, you can’t objectively assess your health. My health depends on my family history, my emotions, my psychology, my experiences, my environment, chance encounters, catastrophes–many, many things beyond my capacity to make rational decisions.

Thus one of the key properties of a functioning market–the individual, rational decision-maker armed with perfect knowledge of all relevant components of his or her health, at all times–just doesn’t apply. None of us are really able to predict  when or how we’ll get sick, nor can we predict smaller things like how our body weight will hinder our ability to respond to physical therapy, for example. In health care, our capacity to be level-headed, all-knowing consumers is severely limited because the consumer is the product. You can’t separate out consumer and consumption, subject and object. Our health is not interchangeable for another product. It’s not for trade.

This fact is really what drives my perspective on health care. I don’t think the government should run everything, or even most things. I’m no socialist. But I do understand that when you take markets on their own terms, it’s pretty clear that they are not a good fit for health care. The key features of markets–perfectly rational individuals with perfect knowledge about the nature, costs, and benefits of their transactions–have little application to our health, and thus to health care as a system. As a result, I support building a system that recognizes this fact, and attempts to optimize insurance coverage and health care delivery. That is, I support a system that understands how and why health care is a unique good, even in the context of capitalism.

‘Cause it is.

Photo by Jacob Bøtter