The health system in the United States is a product of the nation’s economic, political and cultural evolution. Economic freedom is considered by many a bedrock of this nation’s foundation, a right as integral to the liberties guaranteed under the Constitution of the United States as those protecting speech and religious practice. The Fourteenth Amendment to the Constitution, in particular, is often cited as protecting the freedom of U.S. citizens to earn a living and engage in trade:
“No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”
The Tenth Amendment, which imposed limitations on the federal government in all matters not specifically proscribed under the terms of the Constitution, is also occasionally cited as reaffirming the right to economic freedom.
The purpose of these references to the Constitution, and to the issue of economic freedom, is to place in the proper legal context the evolution of what is typically called “the health care system.” That system, such as it is, has been developed and operated principally by the private sector, with the budgetary implications that implies. For-profit medical care facilities must function as commercial entities if they are to survive, and capitalism, for better or worse, inevitable entails winners and losers. The problem, obviously, is that “losers” in the context of health care suffer and die from ailments that the more financially-endowed stand a better chance of surviving given the higher quality of health care they can afford.
Because the capitalist economic system that produced the U.S. health care system – a system, it should be noted, that has saved innumerable lives and improved the quality of life of hundreds of millions of people – invariably produced “losers,” the government stepped in. In 1965, President Lyndon Johnson, as part of his Great Society reforms, signed into law the establishment of Medicare and Medicaid, the two government-sponsored health insurance programs that were to ensure that the elderly and disadvantaged would receive health care irrespective of their abilities to pay. That’s all well and good, of course, as any civilized society should seek to protect the interests of its most unfortunate citizens. A problem, though, lies in the fact that the government does not have a good track record of managing health care systems. Concerns about the insolvency of Medicare and Medicaid, good intentions aside, remain, with some estimates that these programs will go broke any minute now, although just as many economists and health-care experts argue that these programs’ solvency is unquestioned [see for this latter perspective the Center for Medicare and Medicaid Services website]. Whatever the actual situation, everyone agrees that government expenditures for health care are high and will continue to grow over the following decades both as percentages of gross domestic product and of federal spending.
Now, all of this may seem like a diversion from the question, ‘how did the predominant beliefs and values in the United States drive the development of the health care system.’ That system, as noted, evolved over many decades as a direct reflection of the free market emphasis in the U.S. and the value many Americans placed on the provision of welfare for the poor and elderly. Budgetary debates continue because costs have to be considered and taxes paid to fund these programs. The social welfare agenda clashes with the free market beliefs that dominated the country’s history. The United States, more so than most of the rest of the developed world, was imbued from the start with a strong sense of economic freedom that both drove the country’s growth and sacrificed those who were unable and/or unwilling to keep up. The 1965 Great Society reforms were an attempt to bridge that gap.
The beliefs and values that played a part in opposition to health care reform – and opposition to reform is a misstatement given the breadth of opinions across the political spectrum that substantial room for improvement does exist, even if President Obama’s keystone Affordable Care Act remains a divisive series of laws because of the way those laws go about their objective – stem in no small part from the belief that economic liberty extends to the medical profession, and that physicians and insurance companies are competent to set rates and make determinations that many other people argue have been fundamentally unjust. This belief in economic freedom as it relates to health care incorporates a strongly-held belief in the eminent fallibility of government to provide a solution. Conservatives tend to view government as an obstacle to progress; liberals tend to view government as the requisite solution to problems that plague society. This is a large, politically-divided nation. Do the math, and you get the somewhat dysfunctional system that exists today, one with technologically-advanced capabilities and highly-trained physicians and nurses that produce health care at costs well in excess of what citizens of other technologically- and economically-advanced societies pay for equivalent procedures and medications.
To the extent that insurance companies are a part of the problem, and they no doubt are, then many, mostly on the political left, argue for development of a so-called “single-payer” system in which a government agency or government-sponsored entity assumes the role currently played by numerous privately-owned and operated insurance companies. How well such a system would work is, of course, uncertain, with conservatives skeptical of the government’s ability to operate a complex, nation-wide all-consuming insurance program and liberals arguing that meaningful reform means eliminating the existing admittedly convoluted system of such companies dominating how health care is provided in this country. In any event, the country is politically divided on a lot of issues, and health care is one of those issues. The compromise arrangement, if it arrives, will be interesting to observe and experience.
