smoke signals
Fire Burns Away the Fog of Ideology: Can Humane Health Care Reform Rise from the Ashes?
by Michael MillensonAs wildfires sweep Southern California, I have been surprised that homeowners in some of the most affluent and staunchly Republican enclaves in the state have not protested the widespread deployment of government workers bearing fire hoses and driving ambulances. The pain of watching one's life possessions burn to a crisp must almost be matched by the pain of watching tax dollars wasted on a task that private, for-profit firefighters could surely perform more cheaply and more effectively. Yet not even the richest of the fire-torn refugees has expressed regret over government intervention in their rescue.
It's important to remember that wildfires in California are a foreseeable event, just like hurricanes in the Southeast, blizzards in the Upper Midwest or - to switch from the cosmic to the quotidian - illness or accidents befalling individuals. In bumper sticker terms, stuff happens. If one believes in the marketplace, then it should be up to individuals knowingly facing risk, not the government, to either take prudent steps to protect themselves or face the consequences.
If, after all, one believes that Medicare should be privatized, then one also implicitly believes that the old, frail and infirm should be left to their fate if they chose a health plan adequate to finance the flu but with coverage too meager for multiple myeloma. Economists call this a "market signal," meaning that it's supposed to scare everyone else into acting like Rational Economic Man rather than like actual human beings. Similarly, if your health savings account is exhausted before your medical needs, that should teach the guy in the next cubicle to quit wasting money on a big mortgage and sock away something for a possible stroke.
Given the Republican allegiance to the marketplace, should not California taxpayers send fire engines to rescue only those whose home insurance covers full replacement cost - Rational Economic Man -- and the "deserving poor" who, clutching tax returns in hand, can prove they couldn't afford the premiums? The question answers itself.
Firmly held convictions about the importance of individual responsibility seem to melt away when the flames approach our house, the winds howl outside our window, the snow drifts trap our car or disease strikes our family. The marketplace does some things very well, but responding swiftly to rescue those who cannot rescue themselves is not one of them.Fire, wind, rain, snow and illness can strike any of us, regardless of political beliefs. Paying taxes to protect the vulnerable from devastation is not a step down the slippery slope of socialism but a reaffirmation of a basic human commitment. As our nation tries to build a consensus for sweeping health care reform, perhaps the California fires can reignite a recognition that Rational Economic Man is a straw figure and that community and compassion are the values that truly define us.
Michael Millenson (mm@healthqualityadvisors.com) is the President of Health Quality Advisors LLC in Highland Park, IL.