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What are Our First Principles of Health Care?
In the study of law there is a Latin term, ab initio, which means “from the beginning,” used in reference to the legality of contracts or actions dating back to their origins. A woman suing for alimony during a divorce, for example, could find the entire marriage ruled invalid if her husband was previously married, thereby nullifying her marriage contract.
The current health care debate has focused, to a great extent, on the details of this or that plan with very little attention paid to the ab initio philosophy underlying the concept of health care.
What are, as Marcus Aurelius might ask, the first principles of health care delivery? What is our philosophy, as a nation and a people, about how we care for the sick and injured?
To illustrate the importance of first principles allow me to use an example from American history.
In the late 19th century, as the wars against the Native American population were coming to an end, the U.S. Senate turned its attention to assimilating these conquered peoples. Their solution was the Dawes Act, which allotted 160 acres to every Indian male head of household. The Dawes Act was predicated upon a European-American capitalist system in which men and individual families competed for limited resources, one against another. Those who worked the land most effectively reaped the greatest rewards for their labors. By providing farm land for each Indian head of household the Dawes Act hoped to turn the Indian tribes into a series of farm families, assimilated into the general American population.
It proved a dismal failure.
During the nearly 50 years of the Dawes Act two-thirds of Indian lands were lost to European-American speculators. The explanation for this was apparent - the Indian people had some personal or moral failing which resulted in their impoverishment. After all, there were countless examples of this same system of competition and reward working within the European-American community.
Obviously, the Indians were either lazy or unfit to succeed in American society.
However, if we examine the Dawes Act ab initio we see that it was predicated on a fundamental misunderstanding of Indian culture. Native American societies were not set up as a series of individuals in competition with one another, as was European-American society, but rather as communities which co-operated to harvest limited resources. Trying to turn these tribal groups into separate little-house-on-the-prairie farmers was doomed to failure because it failed to understand the first principles of Indian life, which focused on co-operation over competition.
The fault lay, not in some moral failing of the Native American population, but rather in a clash of philosophic principles.
So, what are the first principles of our current system for delivering health care?
We still are operating under the European-American capitalist system, in which the game is set up for winners and losers in the competition for limited resources. When applied to health care this means that those who have the most wealth, get the best health care. And who are the most successful players in this game? As a demographic group they are going to be the oldest members of our society, who have had a lifetime to accumulate wealth. Because the health delivery system is a for-profit system, those who deliver health care services are going to chase limited dollars by going to where they are most plentiful - the elderly.
What does this mean in a practical sense? Those with the dollars are going to get the meds and those without, will not. What is the most expensive year of life? The last year. So, because this is where the money is, hospitals, doctors, drug companies, and everyone who hopes to earn a profit from health care is going to focus time, talent, and resources on those who offer the greatest return on their investment - old, dying people.
Yet, Marcus Aurelius tells us that what is not good for the hive, is not good for the bee. Is it in the best interest of our society to focus our resources on those who have already contributed the most they have to give to that society, while at the same time limiting resources invested to those whose potential for bettering society is still ahead of them?
Every system rations health care. In a world of limited resources there is no other choice. The question is, how (and to whom) will we ration those resources? Does it really make sense that pharmaceutical companies have invested so much money into developing a pill for older men to maintain an erection, while the United States has an infant mortality rate that is an embarrassment to the industrialized world? What does it say about our values that we are 42nd in life expectancy or that 100,000 people die every year because of a lack of medical care? We talk about health care rationing and death panels, yet 27% of health care spending in this nation goes toward only 1% of the population.
Competition or cooperation?
What are the first principles in which we believe when it comes to providing care for the sick and injured? When a member of our family is sick, do we make a choice based on his or her personal wealth? If not, then why do otherwise for the greater community?
What is not good for the hive is not good for the bee.
The ab initio question we must ask ourselves is, do we want a health care system that is designed first to make a profit and which serves the community only as an ancillary benefit or do we expect our health care system to provide for the health of the nation as its first principle?
_________________
"Go out and run 'em."
- Lindy Ruff, 23 Feb. 2007
Last edited by Godzilla1960 on Thu Dec 24, 2009 12:39 pm, edited 1 time in total.
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