I rarely get political on this blog.  I think I can count two posts that might be seen as having political overtones.  And this will be the third, though for me, it has nothing to do with being a democrat or a republican, a liberal or a progressive or a conservative or right-wing extremist.  It has to do with health care, and what our goals should be.

It seems to me that most discussions between the two sides of our very polarized country break down because we start with different premises.  Case in point:  the second amendment.  There is a legitimate debate about exactly what the “founding fathers” meant when they stated:  “A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.”  Most gun proponents look at the second part — “the right of people to keep and bear Arms, shall not be infringed.”  They therefore assume that they have the RIGHT to own any type of weapon that is manufactured, as long as it can be classified as “Arms.”  Others look at the first part of that quote — “A well regulated Militia, being necessary to the security of a free State…” — and see that right to bear arms as being limited to their participation in a militia, say, the National Guard.  Still others look at the quote, written over 240 years ago, and believe that if the founders had an inkling of what would develop in weaponry — things like assault rifles and grenade launchers and ammo that could punch through the thick metal bodies of tanks (which were also unimaginable to them, certainly, in present form), they would have wisely incorporated some limits.

The point isn’t what is right or wrong about the second amendment, it’s that when we start with different premises, we will never agree.

So the trick is to find a common premise and that may indeed be a difficult trick.  So let’s start with this.  Is health care a right?  If so, at what level?  And if not, how do we deal with the health issues of those who can’t afford to pay for their care?

For example, I start with the premise that some basic level of health care should be accessible to all Americans.  I see that access to affordable health care at some level as a right.  Others do not.  I’d love to hear their reasoning.

I also see it as a reasonable penalty to pay some relatively small amount as a penalty for someone’s choice to not pay for coverage, because if that person ends up in the hospital, be it because of disease or accident, they’re not going to pay for it — the rest of us are, in indirect ways like higher hospital costs and higher insurance premiums.  Others see that as an infringement on their own right to not buy health insurance.  Where does their right end?  Does it end when that choice ends up costing the rest of us a lot more money in terms of health care?

Can we agree that an accident or a disease should not bankrupt a person or a family in order to pay for their health care costs?  That seems like a pretty low standard.

If we can agree that the above is a reasonable thing, then we have to decide how to achieve it.  I can tell you that lowering providers’ reimbursement will not work.  Sure, some physicians might be making inordinate amounts of money compared to an Amazon warehouse worker.  But who gets to decide how much money physicians, who have one of the most important jobs in the world, should be paid?  How much is enough?  I think it should be substantial.  I won’t go into all the reasons here, but I do know that if I’m having surgery, I want the best trained and smartest person available doing that surgery, and so do you.

So if providers’ fees aren’t going to be cut, where’s this savings going to come from?  Everyone has different ideas.  Sometimes those ideas get put together into health care legislation, and an attempt is made to solve some of the problems.  But the people who were getting rich off of other people’s misfortune might not like those solutions because some of them might cut into their profits.  And sometimes the goals of the people purchasing the insurance (employers and individuals) are at odds with the goals of those selling it (the insurance companies).  So nothing is ever going to be perfect.

In a perfect world, we’d all be able to go to the doctor when we were sick and not have to worry about not being able to afford the care we need.  And isn’t that what we should be striving for?  A perfect world?  We’ll never get there, of course, but it should be a goal.  The goals of American society should include affordable and accessible health care for every American, whether they are rich or poor, sick or healthy.  When you need health care, you need health care.  There’s no getting around it.

Can we all agree on that premise?  It seems so logical to me, but perhaps that’s because of my perspective as a family man, as a health care provider, and as a businessman who has employees.  Perhaps others have a different perspective on that premise.  Maybe there are those out there who don’t see that goal as being part of a perfect society.  I’d love to know why if that’s the case.  Please feel free to comment, anonymously, if you’d like.  (Just don’t get abusive or disrespectful.)

Because if we CAN agree on that premise, then we should see this new republican plan for what it is:  a BIG step in the wrong direction.

*****