The topic of universal health care has been brought up repeatedly recently due to the US’ new health care law, which improved and complemented the limited Medicaid health care to give all citizens health care. There was quite an uproar about whether this is good, or whether forced payment like this is an infringement of freedom.
In this post, I try to argue that, once you accept a specific premise, the question can not be whether universal health care should exist, but what it should cover.
When I use the term universal health care I refer to a concept within a society where the society as a whole guarantees that everyone within that society, no matter their personal finances, can afford a certain set of basic health care treatments.
In particular, it does not mean that all individual health-related expenses are paid for by the society as a whole.
Consider a specific situation. A poor person is involved in a car accident due to no fault of their own, and does not have any kind of health care plan. If they do not get treatment, they will die. Should society as a whole pay for his survival?
I find it difficult to say “no” here. It is possible to argue that not having a health care plan is a fault of their own and they have to deal with the consequences, and while I do understand the underlying sentiment, I do not agree that having to deal with the consequences would include death due to no fault of their own.
My premise for this article is that in a situation such as this, society as a whole should come up for the health care cost.
If you disagree with this, you disagree with the premise, and the remainder of this article will not affect you.
First Consequence: Basic Universal Health Care
The first consequence of this is that every person in a society has, by default, a very minimal health care plan: If your life is threatened due to no fault of your own, we the people will stand up and pay to save your life.
But if everyone in a society is covered by this health care, everyone in that society should also pay towards this health care, at least as far as their means go. Those who can afford more will have to pay a bit more so the society as a whole can cover even those with insufficient means.
Hence, if you accept the premise, you should accept the necessity of a basic universal health care paid for by everyone.
Second Consequence: The Problem of Delineation
The next step is about delineation. At which point is the life of a person threatened due to no fault of their own? Who is going to draw the line—usually on the spot—that this situation was the fault of this person, and hence we should let them die?
Even seemingly clear situations are not as clear as they might look like. Lung cancer can be caused by various causes. A person who never smoked could get it. In that case, it was likely no fault of their own, so society should help them get past that unlucky streak. But what if a smoker gets lung cancer? We do not know if it was “because of the smoking.” They might have gotten it also without smoking. Also, at what amount of smoking does it start to be their own fault? Five cigarettes daily? One? One a month? Once in your life? How about voluntarily going to a pub in which others smoke?
I do not think it is possible to draw a clear line here, and neither in other cases. And I would rather err on the side of caution than on the side of mistake. If this kind of behavior should be penalized, it would seem more sensible to charge fees for clearly unhealthy behavior (e.g. an extra tax on cigarettes to compensate for the medical damage caused).
I also think many people will find it difficult to let a person die even if the situation was their own fault. This is not nearly as clear as the original premise, though, and it can depend greatly on the circumstances. But even if this is not included, simply trying to decide when it is “sufficiently their fault” is unclear enough to say that it’s better to simply cover all cases.
Hence, it is sensible to simply cover (almost) any threat to life.
Third Consequence: Economical Rationality
Finally, treating mortally ill people is costly. It is usually much cheaper to prevent those situations than to treat them. So a society which will pay for the treatment of mortally ill people has a purely economic incentive to pay for check-ups and preventive treatment, as long as that makes economical sense. Anything else would be wasting the money of this society.
Hence, society should also cover certain preventive interventions, simply to safe money.
In this post, I have argued that, based on the premise that a society of people is not going to let a person die whose life is threatened due to no fault of their own, this society has a need for a limited, universal health care. As this health care is available to everyone in the society, it should also be funded by everyone within that society.
As it is difficult to delineate faults and causes for death, this health care should simply cover all cases where life is threatened. For purely economic reasons, it should also cover treatments that aim to prevent costly, life-threatening situations.
Hence, if you accept the premise of this post, the discussion about universal health care should not be about whether it should exist, but what it covers.
Based on this argument, the discussion can continue on the topic of which treatments are then to be covered by this inevitable health care. This will greatly be affected by the somewhat vague delineation argument.
The problem of delineation is the least clear point in this post. It is certainly possible to argue that there are extremes in which society as a whole should simply let a person die instead of covering immense costs, in particular but not restricted to situations in which they behaved clearly stupid and irresponsible. The nature of this shades of gray argument makes it difficult to defend in general, hence I included a limitation of it covering “most” situations. It might be interesting to develop this further to make the lines more clear. This would also greatly affect which treatments are covered by universal health care.
Also, it is possible to use a very similar line of argumentation to this post based on the premise of a society not allowing a person to suffer from strong pain. This is a much less universally compelling premise, though, and this makes the delineation argument even less clear. Nevertheless, it would be the basis of increasing the scope of the universal health care.