Healthcare – No Man is an Island

Universal healthcare – it is common knowledge that anyone who calls himself or herself a conservative it totally against this concept. No one in their right mind would want the government controlling that aspect of their life. In this article Robert Freer approaches this subject as a human and a conservative.

Robert E. Freer, Jr, President of The Free Enterprise Foundation

"All mankind is of one author, and is one volume; when one man dies, one chapter is not torn out of the book, but translated into a better language; and every chapter must be so translated...As therefore the bell that rings to a sermon, calls not upon the preacher only, but upon the congregation to come: so this bell calls us all: but how much more me, who am brought so near the door by this sickness....No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee."

The acceptance by philosophers and other learned thinkers during the Renaissance that man has a responsibility not just for his brother but all mankind is one of the most ennobling of our spirit to spring from that era. As noted in this meditation by John Donne, we are all connected through our humanity to each other. We live as individuals, but we progress as part of all humanity. In the last two articles, I have written much about principles of prudent fiscal management. I continue to believe that government is an inefficient “non” solution for much which our better nature aspires for the character of our Republic. That is not to say we should not pursue these goals our better nature tells us we should.

Through the energy of past centuries and our own, marshaled by soul and freedom of thought, man has hurtled through time and space and is beckoned to undreamed of opportunity that lies in our future. While the darkness that threatens all society in the form of tyrannical Islamic jihad stands as a barrier, it is a sign of the maturity of our society that almost in one voice, we are seriously contending with the moral dilemma of healthcare delivery for all levels of our society. Truly, we are all diminished by those who suffer from inadequate care. We must solve this problem for all or we solve it for none.

All mankind is afflicted with old age and death. It stares at us as we look forward. It stares at us from the eyes of our families and colleagues when they suffer. No part of our society is free from the consequence of our own mortality. Since 1935 when social security became available, science and free enterprise have succeeded in expanding our expected lifespan by almost a third. The scourge of polio and other diseases has been eliminated. Our knowledge of our bodily systems and how to extend their vitality has been greatly expanded but unevenly made available. Our insurance system and social safety net has often resulted in strange outcomes that appear a variance with our professed support for those who work the hardest.

As a human being and an American, I accept my responsibility to be part of “the solution” for the affordable healthcare of all Americans. As a conservative, I believe in the ability of the private enterprise system to provide cost effective solutions and am suspicious of government delivered one size fits all solutions. The cost of the present system to which we have committed ourselves legislatively is both too expensive and ineffective in providing a universal solution. I do, however, accept that government has a role in wielding carrot and stick to energize those parts of society that must work together to get this done now, not 20 years in the future. We have to solve this problem together, and we have to do it with respect for differing views of our diverse population. This is decidedly not a time for politics as usual.

Massachusetts with its universal coverage plan beginning implementation and California headed toward adoption of its own statewide plan proves that there is still a vital role for our states to play as laboratories for the nation. From the seriousness of these efforts, we can say the country is poised to make real progress toward a national consensus on a solution. As the state programs are implemented, we will be able to see how both work and the “tweaking” required to make them ready for the prime time of national consideration.

To be a solution the adopted plan requires two elements. One is universal coverage from cradle to grave. The second is the constant discipline of the free market to encourage efficiency and cost containment. We need also to break down the divisions between medical disciplines that have layered costs and provided inconvenient and costly healthcare solutions. While healthcare in the U.S. will continue to be relatively costly so long as we wish whiz bang technology, we can do a lot better.

Generalized "cost containment" is made up of thousands of individual actions that combine to lessen and focus the demands on our system. First personal health education must be strengthened so that all Americans are aware of what it takes to keep themselves fit and are encouraged to adopt a lifetime fitness regime early in life that becomes ingrained. (And let’s put back mandatory “recess” in school so our kids get some fresh air and opportunity to run.) Patient education thus becomes the entry point for all our citizens.

Focused care becomes another element of emphasis. Nurse practitioners should be the in-take point for the delivery of routine care. Medical education should also encourage team interaction among all parts of the healthcare delivery team. The current tendency to develop single care clinics can most economically be managed by someone like a nurse practitioner or physician’s assistant who is part of family practitioners' staff serving as the referral point. Physician, pharmacist, nurse, radiologist and nutritionist should more routinely consult together on patient treatment.

Private enterprise should continue to play an important role in assuring that the benefits of competition work to keep costs low. For the insurance industry, however, Commissioners of Insurance nationally must insist that all providers provide broad coverage and base their rates on the whole community. From youngest to oldest and healthiest to sickest, all must be included in the rate pool to avoid relegating those most in need to a high risk pool. All of us ultimately end up there, and while we are healthy, we should lend our "health" for the affordability by all. Without this requirement, I doubt that universal healthcare is possible. The pool is simply not large enough to make the cost bearable. The insurance providers must be required to reflect that reality in their rates and in their practices. Broad community rating will also impact on the cost of healthcare by eliminating the reasons and the incumbent costs of claim denials and its frustrating appeal process. It would be a not inconsequential side benefit that it will strengthen our communities’ sense of wholeness and shared risk

Copyright © 2007 by Robert E. Freer, Jr. All rights reserved

About the author: Robert E. Freer, Jr. is President of the The Free Enterprise Foundation. He is a Visiting Professor, at The Citadel and elected in 2005 to be their first John S. Grinalds Leader in Residence. A regular contributor to the Mercury, He can be reached by E-mail at The Citadel . Copies of his earlier columns can be found The Free Enterprise Foundation.

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