Health care and the rugged individual

DAVE COLAVITO
Posted 5/31/17

When William Bradford and his companions disembarked the Mayflower, they did so from a culture in full swing for centuries. Nevertheless, besieged by scurvy after many weeks at sea, they incurred …

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Health care and the rugged individual

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When William Bradford and his companions disembarked the Mayflower, they did so from a culture in full swing for centuries. Nevertheless, besieged by scurvy after many weeks at sea, they incurred heavy losses. Furthering matters, the New England winter granted no quarter. Help wasn’t far, however, and it could be said that dead Indians came to their aid—the Pilgrims, we are told, proved adept at pilfering corn from Wampanoag graves.

Eventually, prosperity’s roots extended from 60% of world-trade cotton in the pre-Civil War South. As is often, good fortune came at a price, then, a nation torn over slavery. And while Lincoln’s judgment has been called into question, slavery’s role isn’t open to doubt—the backbreaking work of American progress was forced upon backs considered worth breaking.

Throughout much of that same century, European settlement moved ever westward, fortified by U.S. Army protection. Yet that reality, too, proved a poor match against fanciful notions—in that instance, of how the “West was won” through independent spirit and superior intellect. Ultimately, it was the swarming mass of encroaching humanity that overwhelmed a continent’s indigenous inhabitants.

Given the options, it’s understandable that imaginations took comfort in that uniquely American ethos of the rugged individual—truth be told, rugged individuals there certainly were; surviving the wrong end of that ethos required nothing less. But the mystique of the rugged individual lives on today.

We know of other nations that have managed to finance health care for all their citizens. But for many Americans, the thought of single-payer healthcare financing is unsettling for, so far as I can tell, primarily four beliefs: we are not Communists; it would provide fewer choices, lower quality and delays; it would be too expensive; and we shouldn’t pay for the freeloaders.

I can’t speak with authority on the number of Communists in the U.S., but I take it on faith that it must be very small. So agreed; we are not Communists—whatever that means.

I’m sure we also agree that no health care system will be entirely satisfactory to every American. Yet it’s difficult envisioning one more inefficient and expensive than the current maze of private insurers and policies doctors and patients contend with. Think: a doctor providing the same service to many patients at different prices that often aren’t revealed, even to the doctor, until after the service is rendered. Then think: many doctors, many services. For that and other reasons, our current fee-for-service model is doomed to lower quality at higher cost. The excesses baked into that cake should be clear to any advocate of fiscal responsibility; there is no rational basis for understanding why they are not.

Finally, fully two thirds of Medicaid spending assists children, the disabled and the elderly. The adult poor—often working—are beneficiary to the remaining third. Studies also show that over 80% of people without any insurance comprise low-income families with at least one full-time worker. Presumably one or more of these groups “freeload” on rugged individuals. Conflict in the ethos, however, finds no rest here. Objections to paying for freeloaders ignore the fact that rugged individuals already do—often at greater costs for hospital emergency care. Yet the ruggedness to advocate, publicly, that we should refuse necessary medical care to these freeloaders appears to exceed its supply.

Every ethos has its issues; surely the rugged and unrugged can support each other on that common patch of ground. Single-payer financing doesn’t mean “one size” health care for all Americans. And honestly assessing it against our current mess needn’t be threatening to anyone’s ethos.

[Dave Colavito is a resident of Rock Hill, NY.]

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