Last week, Joe Carter praised The Atlantic’s forthcoming (mammoth) article on health care as “one of the most sensible and pragmatic articles on the health care debate you’re likely to ever read.” I couldn’t agree more. Goldhill’s analysis is even-handed and thorough.
But what struck me most was his solution: Goldhill suggests that people finance noncatostrophic health care the way they finance cars, through saving and (if necessary) borrowing. Goldhill wants to restore the consumer to the center of the health care system, which he persuasively argues would reduce costs and increase the possibility of coverage for everyone.
All this I tentatively agree with. But Goldhill’s solution includes government contributions to health savings accounts for those who are incapable of making their own contributions. Yet what happens if such individuals use those funds for lifestyle, for things outside of health care? Goldhill’s answer is that they would pay for health care costs with credit, borrowing against future contributions to their health savings accounts.
This answer is limited by the dissolution of social structures surrounding the family and the church. The inability to pay for health care by some can, and doubtlessly would, be offset by contributions and donations from churches and extended family. Such contributions, for those who are willing to receive them, would presumably be more efficient at eliminating poverty than increasing the debt of America’s poorest class.
It is also limited by its ultimate dependence upon the concept of rights. The assistance of the poor and disadvantaged by the church and by extended communities is a pre-political solution to health care reform, a solution that situates our health in the complex web of human relationships. And as such, it is a solution that can not be implemented as long as the language of rights remains the dominant framework for our discourse about health care. Despite its long Christian heritage, the notion of rights has been stripped of its pre-political meanings and has been reduced to signify that which exists only in a political context. For this reason, the question of whether health care is a right can only be answered in terms of the government’s involvement or lack of involvement in it.
Goldhill’s imaginative vision, then, is constrained on the one hand by his consumerism—which understands health care as something to be bought and sold—and on the other by his implicit understanding that health care is a right. Whether real health care reform can be built on this foundation is an open question. While I am more sympathetic to Goldhill’s proposals than those being discussed in our halls of government, I remain duly wary.
See also: Eric Chevlen’s article today on “Confessions of a Health Care Rationer.”