Dear Socrates cafe-goers,
Based on the results of our recent online poll regarding possible topics, we will devote our next Meetup to the question: Should healthcare (basic or more extensive) be a legal entitlement in the U.S.?
Though healthcare, and its rising costs, has been a subject of debate in the past decades of the United States, the debate has risen to national attention with the introduction of the Patient Protection and Affordable Care Act (usually shortened to “ACA,” and often referred to as “Obamacare”). The ACA has brought with it a mandate for individuals living in the U.S. to purchase health insurance, which is a fundamental change to U.S. healthcare policy. This policy change brought not only legal, legislative, and administrative changes, but also questions as to what our rights as U.S. citizens are, and what level of participation we are required both to give and to accept from our government. Though the new law did not create a true legal entitlement, it has ushered in a new zeitgeist in that its proponents used the legal entitlement argument as part of the platform for the passage of the new legislation. As a result of the ACA, we as a country have begun to examine healthcare reform not only in terms of costs, but in terms of rights.
Those who oppose healthcare as a legal entitlement have basically two routes of argument, as do its proponents: Some oppose it on principle, others on pragmatics. Those who do so on principle usually cast such a legal entitlement as an infringement of the freedom and individualism that the United States has long been built upon. Our patriotic narratives often entail standing against the intrusion of government, fighting for our liberation from tyranny, and praising the pioneers who made their way into the unchartered wilderness, acting out their “Manifest Destiny.” Principled opponents of healthcare as a legal entitlement often invoke a libertarian conception of economic justice: it is not just for the government to give to one person what it takes from another person without the other person’s consent; nor is it just for the government to force an individual to spends her resources, even on herself, in a way she does not choose. Those who oppose a healthcare entitlement on pragmatic grounds usually take the stance that it is economically infeasible. For example, the argument that “Obamacare is a train wreck” often seems to flow from a conviction that, whatever the merits of universal health insurance in principle, government involvement in the provision of healthcare is bound to do more harm than good.
The proponents of healthcare as a legal entitlement also have principled and pragmatic arguments. Those who support it on principle make the case that social equality demands healthcare equality. As part of a society, we are part of a collection of people, and we cannot exist as a collection of people operating as separate individuals. We have a tacit social contract that requires that we each take an active role in the outcome of our nation, and operate with an understanding that a nation of separateness cannot stand in unity. Proponents of the principle assert that the “American Dream,” built on the principle of democracy, can only fully function when each person has true, unfettered upward mobility; without that, we are a system of classes or castes. True democracy, as well as the upward mobility we are purported to have, only exist when those who are part of it have equal access to its benefits and equal access in its participation. Healthcare is a necessary extension of our ability to participate in our own democracy. Those who support a legal entitlement to healthcare on pragmatic grounds lay claim to the fact that (according to The World Bank) the U.S. has the highest health expenditure as a percentage of GDP of any industrialized country. As cited by Wikipedia, according to the United Nations Department of Economic and Social Affairs, the Life Expectancy Prospects for 2010 have the U.S. ranked 40th in life expectancy, while the World Health Organization had the U.S. 33rd in life expectancy for 2011, well below the level of Western European countries, as well as lower than several “less developed” countries such as Slovenia and Kuwait. It appears that we have some of the highest health expenditures in the world, yet one of the lower life expectancies. Countries with some sort of universal health insurance, such as most European countries, seem to be faring better in both categories. Proponents from this camp would also point to the other major US entitlements, such as Social Security and worker’s compensation, noting that not only are these programs hugely popular, but they are also economically necessary in order to make the country more economically stable.
I anticipate another lively and interesting discussion. Hope to see you there!
Yours in Socrates,
P.S. Many thanks to Danielle Hathcock for her contribution to this introduction!