Sailing on the good, but sinking, ship ‘Healthcare’


David Crisp

Nothing summarizes the emptiness of Montana’s special election for the U.S. House better than the candidates’ stances on what may be the second-most important issue to come before Congress in the next two years: healthcare.

Those 30-second TV ads leave little time to flesh out plans for reforming healthcare. But the candidates’ websites, with virtually unlimited and cheap space, aren’t much better.

Greg Gianforte’s campaign website devotes three sentences and 57 words to healthcare. The first sentence says that Obamacare isn’t working for Montanans, without sacrificing the internet space it would take to point out that Obamacare is working extremely well for certain Montanans. The second sentence tells us that Gianforte would like for healthcare to be better, cheaper and more accessible, without suggesting any way he might achieve that.

The third sentence has no discernible meaning in English, so I used Google Translate to turn it into Urdu, which rendered the sentence this way: “نہ حکومت بیوروکریٹس – – صحت کی دیکھ بھال مساوات کا مرکز بننے کے لئے اس Montanans لئے وقت ہے.” Somewhere in there is the magic phrase “government bureaucrats,” which tells us everything we need to know.

Rob Quist’s healthcare position is even more terse: 53 words in two sentences. Setting platitudes aside, it could be summarized in two words: preserve Obamacare. But since even Obamacare’s most ardent supporters agree that changes in the law are needed, this tells us little about what Quist would actually do.

Libertarian Mark Wicks uses just 47 words to convey the simplest message of all: repeal Obamacare.

In fairness to the candidates, healthcare reform is tough to explain even with unlimited space. Even the president of the United States has now become the 300 millionth American to realize that healthcare is complicated.

So let’s turn for guidance to my brother Joe, whose special knacks, in addition to belching on cue, include finding ways to explain complicated things in simple ways. He also has been a hospital chaplain for a good many years, so he has thought about these issues more than most of us have had to.

In a couple of long emails, Joe explained that Americans think about healthcare all wrong. We tend to see healthcare as a consumer product, something we can shop for and purchase as needed in a free market. But he argues that healthcare is nothing like that.

He points out that one of the earliest forms of insurance developed in the 17th century in the shipping industry, which was a high-risk, high-reward business at the time. Merchants knew that some of their ships would sink; they just didn’t know which ones, or when. Lloyd’s of London became one of the first insurers to charge shippers a fee to build a fund that would cover the cost of lost ships. No matter how tragic the loss of a single ship might be to the sailors on board, the ship’s owners could stay in business as long as most ships made it safely to port.

The model worked, Joe argues, for three reasons: The insurance was purchased only by property owners wealthy enough to afford it, losses were reasonably predictable, and only enough insurance was needed to cover the value of the property.

None of that applies to health insurance, which covers not property but the intangible value of “health.” “Health is the physical and mental state of the body that enables one to acquire and enjoy property,” Joe says, “but neither health nor the body can be considered property. Embodiment is a condition of human personhood, something that is not obtained like property, but rather is conferred freely on everyone. Just as everyone has a body, so also, everyone has an interest in maintaining the health and life of the body, because the body is the fundamental interest by which or in which one pursues whatever other interests one might have.”

In other words, all that talk in the Declaration of Independence about “life, liberty and the pursuit of happiness” is meaningless drivel without at least a certain degree of health. But having a body does not necessarily mean one has money. Moreover, nearly all of us will need expensive healthcare at some point. We are the sailors on board the sinking ship, not the ship owners sipping brandy in London.

Perhaps one example will make the case. When my daughter gave birth in October, there were complications that just a few decades ago could have meant the loss of mother, or son, or both. How much would I have been willing to pay to prevent that from happening? This much: all that I have, all that I have ever had, all that I ever will have. Not a great bargaining position for even the savviest of consumers.

As it happened, thanks to medical technology, my grandson came into the world knowing as much about health insurance as Donald Trump apparently does, but young Arthur King was naked, penniless and ineligible to vote. Fortunately, my daughter had good health insurance (thanks, Lee Enterprises!)  and we never had to risk everything on this particular ship making it to harbor.

Joe also points out that healthcare is a product that few of us actually want to buy. Just because I have insurance that covers the cost of a triple bypass doesn’t mean I want to get one. Most of us wait to get healthcare until we really need it, which puts us at a huge disadvantage in a competitive market.

As Joe points out, we don’t refer to people who go into hospitals as “consumers” or “customers.” We call them “patients,” a centuries-old word that originally meant “one who suffers.” Merriam-Webster’s first definition of “patient” as an adjective is “bearing pains or trials calmly or without complaint.”

That’s pretty much the situation most of us are in when we seek medical help. We don’t bargain; we don’t argue; we don’t ask for bids or a test drive. We just say, “Make me better.”

Joe concludes, “Instead of a consumer good, healthcare should be thought of as a remedy for the inevitable illnesses and accidents of life. Our system for providing and funding healthcare should not be based on market models, but rather on a communal effort to share the risks of the common misfortunes of life.”

Too bad no Montana politician has put it that clearly.


Comments are closed.