Enlightened self interest and the healthcare debate

In a Twitter discussion recently (@gregcampnc), I was presented the right-wing position on healthcare: I take care of myself, and you should do the same. I owe you nothing. One participant told me that he would prefer to die if he developed cancer, rather than have the government help him survive the disease. Another insisted that health savings accounts would be enough to deal with chronic illnesses, though she expressed her contempt for everyone with such conditions, since, in her view, they are responsible for their sufferings.

Not so long ago, this would have sounded like Ayn Rand fan fiction. But in the era of Trump, colossal selfishness has been made an official virtue, and old notions of social responsibility are no longer held in common.

Addressing that lack of empathy is a subject for another time. Even if we cannot convince someone to care about others, we should be able to agree that if selfishness is one’s core philosophy, it is best to be intelligently selfish. We have to check our beliefs against reality now and then, and the consequences of our favored policy choices have to be taken into account.

Take worker productivity as one illustration of this. Workers with chronic health conditions result in lost time or reduced efficiency, and while it would be easy to say that workers ought to manage their weight and blood pressure, doing so without the advice of medical professionals is not so simple. It is true to say that many illnesses are the result of bad choices, but many are not, and the costs in any case will be paid by society.

Even if we were somehow able to revise human nature to such an extent that no one ever smoked or ate too many cheeseburgers, diseases will still happen. No one, for example, expected the Spanish influenza, but the result was millions of deaths, and that epidemic appears to have contributed to the recession that we experienced following World War I. The presence of many infectious diseases is the result of human agriculture, so in the merciless philosophy of the right wing, we are to blame, though that same agriculture allows the population numbers that we currently have. But until we are willing to return to the lives of hunter-gatherers, we are going to be subject to a variety of viruses that can be treated by modern medicine, and guaranteeing access to such treatment reduces the cost to society of lots of sick people who cannot work, while retaining the ability to spread the illness.

Assuming that we accept the benefit of productive workers and of restrained infections, what is the best way to achieve those goals? A comparison among the healthcare costs per capita in developed nations gives us a good direction for policy. It is true to say that many Americans make bad choices that affect our health, things are not quite so simple. In the United States, 33.70% of the population is obese, but Canada comes in at 28.00%, the U.K. at 28.10%, and Australia at 28.60%. Smoking prevalence shows similar results, since 19.5% of Americans smoke, while in Canada, 17.7% do, and the U.K (19.9) and Australia (16.7) are again close to our figures.

The differences in these totals are not enough to account for the fact that we spend over twice as much in this country as those three others. I am repeatedly told that while we spend a lot more, our outcomes are better, but once again, this is false. The reality is that no system is perfect, but that does not excuse our failures.

The reality is that we pay for prevention, pay for treatment, or pay for losses in productivity. If we set self-interest as the highest value, an enlightened understanding of that, even without any acceptance of social responsibility, directs us to a universal healthcare system.

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