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.”
August 28th, 2009 | 12:00 pm
[...] how the article begins, which you can read at First Things, where I am honored to be an occasional contributor to their blog First Thoughts. Also, [...]
August 28th, 2009 | 1:26 pm
EXCELLENT! – makes an important distinction:
“…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.”
August 31st, 2009 | 2:28 pm
A technical point: Goldhill’s proposal allows the spending of those funds that exceed the government-required level for a person’s age group on whatever but that would not be a problem for those poor enough to receive government funds, who could never actually pass the ceiling amount if they are unable to contribute.
Maybe I overlooked it but where exactly does charity come into play in Goldhill’s proposal? If ‘the poor’ are not able to spend the government money in their HSA’s, why would they be more likely to need charitable contributions from family and the church? So many people are bankrupted by medical expenses already.
If health is considered a right, would not the designation of it as a ‘human right’ be pre-political?
The guarantee of a certain amount of funds to spend on health care is not the same as ensuring a certain standard of health care so it conflicts with the idea that it is a right. A consumer-centric approach to health care reform is marred by the assymetry of information that exists between the providers and consumers of modern specialized medicine.
August 31st, 2009 | 4:37 pm
“This answer is limited by the dissolution of social structures surrounding the family and the church.”
Yes, and what is possible in the here and now is also limited by the dissolution of such structures. And given that politics is the art of the possible, etc.
September 1st, 2009 | 12:51 pm
As much as anything, the emphasis on the individual (instead of the community) has weakened these social structures. The stress on individual responsibility is a conservative value that has contributed to this erosion of family/social/community that limits our ability to collectively address a social problem.
The bottom line is that we’re not in this together. We are atomistic consumers who only care about our own welfare and those we know, provided they are not living perfidious, irresponsible lives. Goldhill’s solution makes sense in the absence of a widely-shared sense of the General Welfare but a collective response to a collective problem would be better.
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