The limits of freedom

I had a revealing set of conversations recently on Twitter that brought home the reality of the American political scene today. The specific topic was the failure of Republicans to act on their promise to repeal and replace Obamacare, but the attitudes swirling around this exposes the ethos of our culture that explains how we got here.

The definitive tweet for me was a declaration by someone whom I won’t embarrass by naming here that she’d rather die than sacrifice freedom by accepting government-controlled healthcare.

Now it’s easy to mock a statement like that. But there is an important truth that people on the left need to understand.

Feeling smug is easy because in the conversations I had, the opponents of a single-payer healthcare system didn’t actually realize what such a program involves. Right-wing politicians have presented such a system as requiring authoritarianism, a takeover, a case of micromanagement, a determination by the government of who lives and who dies. Except that’s not what single-payer is.

In fact, single-payer is exactly what the name says — and I realize how odd that is in politics. In a single-payer system, doctors, hospitals, pharmacies, and other providers run their own businesses, compete with others in the field, and decide what services they choose to offer. Patients decide which providers they go to. Cost controls come from the fact that the single-payer negotiates fees paid to providers. And everyone is covered.

But what about the Canadians who have to wait for care or who cross the border to seek it out in the United States? It turns out that very few do that. And while the wait times can be higher in Canada, unlike the United States, people aren’t being denied care. Elderly people get hip replacements, for example. The health outcomes of people in the Canadian system are the same or better than in the United States, according to multiple studies, and the per capita spending on healthcare by our neighbors to the north is about half of what we pay.

The comparative costs answers the complaint that many here have over having to pay for services they’ll never use. No, I as a man don’t need any treatments or tests done to female reproductive anatomy. Should I have to pay for those? Yes. I may need prostate care in the decades to come, and if I’m willing to share the costs for women’s healthcare, I can ask them to share my costs. And if selfishness is my central motivation, I still have to be sensible about it, recognizing that I’ll pay less in a cooperative system.

Supporters of a single-payer healthcare system get accused of being lazy or of making bad decisions about our lives that lead to disease, but the reality is that unless you chose your parents wisely or have managed to turn yourself into a millionaire, there are conditions that occur due to no fault of the person suffering them, and even routine care for many will be outside the financial resources of most Americans.

Another objection to healthcare paid for by taxes is that the Constitution doesn’t allow the federal government to do that. The point of contention is Article 1 Section 8. Therein is found the powers and duties of Congress, and included in that is the power to tax for the purpose of providing for the general welfare. It takes a particular commitment to opposing government to say that healthcare isn’t a part of the welfare of the people. Now healthcare isn’t specifically named as something that the government should have a role in, but while doctors in 1789 could do some basic trauma surgery, the extent of their treatments for diseases that couldn’t be cut out were leeches and emetics. Things are more complex today, and the framers gave us the flexibility to deal with that.

Is promoting the general welfare a loss of freedom? In a strict sense, yes. We have to pay taxes. As a result, we have a far more interesting society than would be possible if we didn’t cooperate with each other. We also have a great deal more freedom, since opportunities are greater. And with a rational healthcare system, we don’t have to die or endure reduced ability to function from diseases that can be treated.

If I were a member of Congress, I’d likely get a high rating from the NRA. Freedom and basic rights are something that I value. And if someone chooses to reject medical treatment, I’ll respect that decision. But the U.S. Constitution limits what government can do to us, not for us. I’m not talking about being the stereotype of the user of social programs, someone who supposedly won’t work, while demanding benefits and freebies. I mean that the Constitution doesn’t prevent us from choosing together to provide an essential service that we all need at some point and that can make our lives better for lower costs.

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