There is a lot of buzz lately over government's role in health care. As usual, it seems to me that the arguments align predictably with ideology. Some feel health care is a right, others that it is a business and any effort for government intervention is tantamount to socialized medicine.
Physician executives and other health care executives are caught in the classic "Catch-22" of an obligation to provide care where it is necessary (morally, legally and ethically) while struggling to justify the radical expectation that they should actually be paid for services provided.
The conclusions are a natural consequence of the assumptions with which people approach the argument. The arguments are always logical and internally consistent, but logic is useless without constant attention to assumptions, so I'd like to see how they stand up. The first two statements below are polar opposites of the next two and are among assumptions that are typical of the right and the left.
Health care is not a right
Medicine is not a calling
Health care is not a business
Medicine is not about improving one's own living status
I suspect most readers would either agree or disagree with each of these four statements, some will even react violently. The reader might also wonder why they are written in the negative. My point is that's the only way for all four statements to be true... read on.
Health care and medicine are an unusual sector of the ECONOMY where a social good coexists with a business activity.
The health care sector is responsible for one seventh of the country's economic output but recipients of health care may see other economic consequences. I believe there are economic benefits of access to good health care, including future economic production. However, the closest I ever got to seeing the proof was a reference to an ancient pilot study that purported to show an improvement in income following the introduction of improved Medicaid services. Well, I never found the original study and I bet it was fraught with problems. I suspect economic benefits of health care access is an extremely difficult point to prove, which is why it is simply not part of the debate.
The relationship between economic productivity, health status and poverty are clear, but the effects of intervention (i.e. improved access to health care) are certainly not adequately fleshed out. Moreover, is there any reason to believe that the researchers would not bring their ideological biases to any such investigation?
Other social activities bear a similar burden of dual roles (social good and economic engine), like road construction and education. Free markets and competition sometimes exist in these sectors, but only by virtue of the type of regulation that levels the playing field and defines areas of potential abuse and profiteering. The same can occur in health care.
Medicine IS a business AND a calling. Health care is a right AND an economic engine. Only after acknowledging this will the rhetoric cool and pragmatic intelligence drive a pragmatic capitalist solution to social needs.