The CNN/Tea Party Republican debate (September 12, 2011) provided a chilling vision of health care in a world of rugged individualism and unbridled liberty. The moderator, Wolf Blitzer, posed a hypothetical question to Ron Paul, the only physician among the Republican presidential hopefuls. In the scenario, which was meant to ascertain who was responsible for medical bills, Blitzer describes a young man without health insurance who slips into a coma. Dancing around the original question of who should pay for that persons health care, Paul lambasted the welfare state and those who expect government to pick up the tab. On redirection, Blitzer bluntly asked, But congressman, are you saying that society should just let him die? While Paul quickly answered no, voices from the audience screamed out to the contrary.
In what will largely be remembered as the defining moment of a political debate devoid of discussion on health care (except for Michele Bachmann mentioning Obamacare a total of 10 times), the let him die enthusiasm of the Tea Party audience requires us to pause and reflect whether America is simply a collection of individuals content to protect their own interests or if America is in fact out of many, one society.
That concept of E pluribus unum is mirrored by the social solidarity that permeates the culture of most Western industrialized democracies. Countries such as the United Kingdom, , , and have explicitly determined that when it comes to health, members of a society should bear one anothers burden. The United States has yet to make this commitment; members of the Tea Party imply that individual freedom in America is anathema to the principle of social solidarity.
Just as certain as we could agree that it is not societys responsibility to provide breast implants or Viagra for everyone; could we not agree that when someone suffers a tragedy such as a violent car wreck or a massive stroke (either of which could put that person in a coma) that society should help defray the expense? Yes, it would be ideal if everyone voluntarily went out and purchased a major medical insurance plan. But as its stands today nearly 50 million Americans still go without health insurance.
Some counter that government should not be the vehicle upon which to balance risk. Instead, they state that in the hands of charities and churches the risk for catastrophic health care could be pooled.
In life there is always death; amid health there is often sickness. Because it remains impossible to predict with absolute certainty who and when catastrophe will strike, we must rely on insurance. That means that we must rely on pooling risk.
To prevent bankrupting any one American, any one family, or any one community, the risk pool must be large enough to buffer the consequences of the catastrophic illness. But how large?
Returning to the question: should society…just let him die? Once we can agree that the answer is a firm No! then we can discuss the best way to cover every American.
Valuing every Americans life – regardless of his or her economic value – does not equate to socialism or support of a specific financing structure. However, our society must intelligently come up with a way to secure health care coverage for all Americans. Only when every American has access to health care can our society truly state that we dont want to let our fellow Americans die.
A society should not be content to witness its members dying or becoming financially ruined because of something as unpredictable as a catastrophic illness or injury. Yet, the reprehensible response of some Tea Party members in a recent Republican Presidential debate implies that some Americans are willing to let nearly 50 million others die simply because of an ideologic assertion that health is not a public good.
Universal coverage is the most important issue in health care today. Health care today is too expensive and too important to be deemed a marketable commodity. While some aspects of health care – e.g. Lasik surgery – are appropriate for the market, the vast majority of this life saving, $2 trillion sector of the economy belong (just like the police, the military, and interstate highways) as public goods.
Cedric Dark, MD, MPH