Opinion – In a Perfect World

Universal health care is a noble idea. Not just from a humanitarian perspective, but economically – everyone who needs treatment becomes a burden on someone – their future earnings, through debt. Society, if they declare bankruptcy. Relatives, if they take responsibility, or the health care provider that took care of them, if their bills are never paid. Society pays in some way, whether it’s institutionalized or not. So why not institutionalize it? Health care is not like travel, or a new car, where a consumer can be told not to get it until they can afford it. Under pay-for-service models, which are certainly better in keeping with pure capitalist values, we risk becoming an inhumane society that can’t look itself in the eye. I think it’s the right thing to do in a just society.

I worry about treating it as a natural entitlement, however. The rights to life, liberty and the pursuit of property and/or happiness are considered inalienable in our commonly accepted Western philosophy. We’ve signed up for that by living in this country, through our collective social contract. Health insurance is not an inalienable right. It didn’t even exist until about 100 years ago, and it’s a modern construct designed to deal with economic factors that emerge as technology advances what is medically possible. It’s not a right, it’s a privilege – a challenge an enlightened society should try to take on.

As medical technology continues to advance, it will have many benefits – we’ll hopefully continue to expand the average length of life and of health, be able to cure more ailments and treat more illnesses. Yes, technology is also introducing new health challenges, through its impact on food and living conditions. Yes, big pharma and big medicine have some mixed motivations when it comes to actually curing diseases, instead of coming up with. But I expect the biggest challenges will be in resource allocation. There will be treatments that can’t be equitably dispersed – we’ve all read about worst-case scenarios, when someone is denied a potentially life-saving treatment because it’s extremely costly – usually also considered experimental. There will be a reality, however, when some life-extending measures exist, but are too costly to implement for everyone.

Given the progress in growing replacement organs, DNA therapies and man-made organ replacements, I don’t think it’s science fiction to predict that most of the things that kill us now will be surmountable by the time our grandchildren are in their dotage. But, at least at first, only at considerable cost.

If the reality for that generation becomes that they can live for hundreds of years, as long as they can afford to buy new parts and the treatments that go with them, how will society determine how to parcel out that technology? Whatever universal health care will have evolved into, it won’t be able to accommodate care that may cost more than most people will make in their lives. Compassion and finances will have to come to some kind of compromise. I don’t know what that will look like, but how we come to view health care today will become the foundation for those future decisions.