By George Bohmfalk, M.D.
The Aspen (Colo.) Times, September 6, 2018
(Part 1 of 6. Read parts 2, 3, 4, 5 and 6.)
Is health care is a right or a privilege? Discussions about health care commonly break down over this moral disagreement.
In a series of articles over the next six weeks in The Aspen Times, I will explore many aspects of the U.S. health care system and how it might be improved. I will not express an opinion on the right-versus-privilege dilemma, because it is a false argument. We each have our own moral systems, and mine may conflict with yours. Just like religions, I can’t claim that my moral pillars are any more valid than yours.
As social psychologist Jonathan Haidt described in his book, “The Righteous Mind,” conservatives and liberals feel differently about several moral values, and those values affect almost every decision we make. Liberals feel very strongly about fairness and caring, as seen in their traditional support for civil rights for the poor and the disenfranchised. They certainly also value loyalty, liberty, sanctity and authority, but fairness and caring take precedence. Conservatives hold all of these values in about equal regard, such that questions of fairness and caring may at times take a back seat if an issue of authority or liberty arises. Most conservatives are comfortable that a few innocent prisoners may have been held in Guantanamo, as they regard national security as being morally more important than fairness to certain individuals. Given our differing moral systems, it’s no wonder that we often find it difficult to discuss politics and religion.
Many conservatives feel that it’s unfair to ask them to pay for anything that will benefit someone else. They believe everyone who is capable should be self-sufficient and not depend on the government. I don’t know any liberals who are opposed to self-sufficiency, but liberals tend to be more empathetic to those who, for any number of reasons, need help. Let’s look at one industry that everyone supports: fire departments.
Until the mid-1800s, most fire departments were formed and run by property insurance companies. Insured buildings were marked by plaques, just as we erect signage of our home security companies. An insurer’s fire brigade would only extinguish fires in buildings carrying their sign. This system was very profitable for the companies.
As you might imagine, terrible things happened, as unattended fires from uninsured buildings spread to insured ones. Public demand prompted cities to form their own fire departments as a community service. Insurance company fire brigades disappeared, many merging into municipal fire departments. Fire departments were fully socialized, with governments owning and operating all aspects. We all pay for them in taxes and hope never to have to use them. As a nation, we decided that for-profit fire departments were not a good idea, and that universal protection, for everyone, simply made more practical sense.
What moral values led to that decision? Perhaps the main one is group loyalty — we’re all better off putting out fires as a community than as individuals. Another is authority — putting someone in charge of the overall situation, rather than responsibility being spread around a myriad of companies. Sanctity and liberty also play roles — we protect our sacred homes and enjoy some freedom from worry and loss. Municipal fire departments are fair — everyone gets the same protection, regardless of ability to pay. Fire departments care for their communities. Accordingly, fire departments enjoy broad bipartisan support. But in the end, tax-supported municipal fire departments are just a good, common sense solution, immune from any contentious moral debate.
Similarly, providing health care to everyone is a good, common-sense community service. It also would satisfy both conservative and liberal moral values. Insurance companies should not be motivated to withhold care in order to make profits, like the old fire brigade companies. Health care protects individuals and families and strengthens the entire nation. Universal health care brings everyone together, under clear public, not-for-profit leadership. In helping all Americans, and providing liberty from financial ruin, universal health care would be patriotic and fair.
So, is health care a right or a privilege? It doesn’t matter. As I hope to demonstrate in this series, providing health care to everyone is simply the common-sense, correct thing to do, regardless of your moral pillars.
Dr. George Bohmfalk practiced neurosurgery in Texas before retiring to spend half of each year in the Roaring Fork Valley. He is active in Physicians for a National Health Program, a physician-driven group advocating for a single-payer health care system.
