A View from a Purple State

Monday October 09, 2006

Much of the passion around the health debate is fueled by an unspoken but critical question: What is health care, really? An entitlement? Or just another commodity in a market-based economy?

Those who care most about this issue split up fairly predictably along red-state, blue-state lines. The Blue crowd here in North Carolina wants to amend the state constitution to make health care a “right.” And of course, since health care costs something, what’s implied is a right to a specific dollar benefit, or some form of guaranteed and/or subsidized insurance.

The Red folks, including most business people, are predictably leery of this approach, knowing that they’ll undoubtedly get the big and ever-growing bill that such an entitlement will require. They tend to favor the incremental reforms that get most people, but hardly all, under the health access tent. Like any other private sector commodity, though, some get what they need and some don’t.

I’m profoundly uncomfortable with either extreme. Amending the constitution to make health care a right? Constitutions are created to keep governments from trampling on natural rights, not to promise goods and services, even ones as necessary as health care. The government must allow the free pursuit of happiness, but it can’t promise to catch it for you. Yes, I get what they’re trying to do: raise awareness of the problem and shame state legislators into finding funds to fix it. But laws are passed every day without adequate funding to carry them out. That dog just won’t hunt, as they say down at the capitol.

I’m also concerned about the immense waste our health care system could generate if its current low level of efficiency and ever-rising demand were permanently attached to the national Treasury, the mother of all financial teats. I really believe it would irreparably damage the U.S. economy.

But I’m no more comfortable with saying health care is just another market-based commodity. As a state legislator told me one day, health care’s just…different.

Perhaps this is because I come from a blue collar background that makes me very aware of how all this plays out for the average guy. My Depression-era dad knew too many good guys — honest, hard-working family men — who lost everything when they got sick or hurt. Sad thing is, that’s still happening today.

So I’ve got another idea. Maybe health care is neither an entitlement nor a market commodity. Maybe it should be a compact, or if you’ll let me get a little biblical, a covenant: a pact between citizens and government in which both have responsibilities. Individuals would have to own their lifestyles and have their real costs tied to the individual choices they make for health care services. Government would regulate markets to ensure that consumers have access to useful information on cost and quality, and create a real financial safety net that never, ever drops anyone.

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