Healthcare: The illusion of choice

At first glance, the strongest argument advanced by opponents of universal healthcare is the need to protect personal freedom.

Part of this has to do with Americans' preference for free markets. When we shop, we like to have plenty of choice, whether the commodity is breakfast cereal, automobiles or healthcare. We're afraid that, if we adopt universal healthcare, our healthcare choices will be restricted.

At a deeper level, most of us instinctively reject anything that smacks of the government's telling us how to manage our lives. We don't want Uncle Sam telling us when, or whether, we can have that chronic back pain tended to.

The weakness of the first part of this argument is that freedom of choice in the marketplace is always limited by means. If a consumer has slim resources, then his choices will be restricted to what he can afford, which will often be the cheapest available alternative.

In this sense, then, freedom of choice in the marketplace is generally illusory, because this kind of freedom is available only to those who have the means to exercise it. The rest of us may believe that we have freedom of choice, since we can see the more expensive options before our eyes on the shelf or in the showroom. But because those options are out of our reach, they're not really options at all.

Now, one great advantage of the free market system is that, with many commodities, a few producers and distributors normally recognize the viability of ultra-low-cost retailing and fill the gap with everything from low-end retail chains like Dollar General, where people shop who find Wal-Mart's prices too high, to genuine factory outlets that sell seconds and discontinued items. There's an entire segment of the U.S. economy that inhabits this sphere. These folks also frequent flea markets, garage sales, Salvation Army stores and day-old bakeries.

Of course, a lot of customers at flea markets and day-old bakeries are there by choice; they can afford better, but they'd rather not pay for it. My father, it can now be revealed, preferred to buy “pre-owned” suits at the local thrift shop even when his earning power was at its highest. Who doesn't enjoy getting a bargain?

You could make a case for resenting people, like my dad, who are exercising real economic choice when they choose to purchase low-end products or frequent ultra-low-cost stores like thrift shops or dollar stores; you could argue that they're buying up the inexpensive goods that should go to the genuinely needy. Just as likely, though, these bargain-hunters contribute to the viability of the low end of the market.

However, when it comes to healthcare, that most expensive commodity, our ever-innovative, ever-serviceable free market isn't performing so well. The price of even rudimentary healthcare often puts it nearly on a level with luxury goods, well out of reach of practically all lower-income consumers and many middle-income folks, as well.

In other words, for most of us, freedom of choice, when it comes to healthcare, is actually an illusion.

With healthcare, you don't really have a panoply of options before you; you have only those which you can afford, or which may be — though by no means always are — offered as a job benefit. For the vast majority, healthcare options are minimal at best; for too many of us, the options are nonexistent.

So, one important question before our country now is this: Do we really want healthcare to be a luxury item?

Even the most Darwinian among us must acknowledge that inadequate medical care for any segment of our population hurts all of us. Consideration for human suffering aside, the lady who picks your tomatoes, takes your order at McDonald's or sweeps the floor at Dollar General needs to be healthy to do these jobs. And her first-grader needs to be in good health, too, else his mother won't make it to work.

This leads to a second question: If healthcare isn't to be a luxury item, then what has to be done to make it universally available?

What costs are we willing to pay — either monetarily, in our own insurance premiums or taxes, or socially, in the way our choices are structured — so that more people and their children can benefit from the advances in medical care that have come about in the recent decades?

However we resolve this critical problem, let's not pretend that we're opposed to trying new approaches because we don't want to put at risk our freedom of economic choice. For all the genuine freedoms we enjoy in the USA, truly free access to medical care has always been an illusion to all but a few.

Now on to the second part of the freedom-of-choice argument: Governments should not have the right to infringe on the way people manage their lives. This argument is harder to get a handle on, since it's so much a part of who we are as citizens of the United States of America.

In fact, though, we are all willing to permit government to infringe on our lifestyles under certain conditions. For example, most of us don't expect to have the freedom to drive while intoxicated, or to set up an outdoor strip-show in a suburban backyard, or to prevent our own kids from receiving a basic education. The exercise of our own freedoms must not infringe upon another's, as nearly any third-grader could tell you, in so many words.

And we're willing to accept greater levels of government involvement in our lives when there's a crisis. If there's a war, we'll accept conscription; if there's a natural disaster, we'll permit enforced evacuation; if there's a threat of terrorism, we'll wait in long lines at the airport and submit to electronic, and even bodily, searches. We don't necessarily embrace these things, but we acknowledge their necessity.

So it must be with healthcare. We all would prefer not to have to restrict our choices when it comes to they way we manage our own health. Still, should we not consider voluntarily limiting some of our own freedoms in order to end the exclusion of a sizeable percentage of our population from access to medical care? American soldiers of every generation have been willing to fight for those who can't — or won't — defend themselves. Shouldn't we take a hard look at whether we should sacrifice similarly when it comes to universal healthcare?

Talk to most Canadians or Brits, and they'll tell you — maybe somewhat grudgingly — that people can get used to being wait-listed for elective surgery if that's the cost of providing essential healthcare for all. Ask virtually any Frenchman, and he'll tell you that he possesses something that far more than compensates for the slice of his paycheck withheld as “social charges”: the absolute assurance that his children, his wife, his parents and he himself will always have the benefit of decent healthcare regardless of income level or employment status. “Pre-existing condition” can't even be translated into French. (OK, it can be, but in eight long years there, I never heard it!)

Give up our freedom of choice? Maybe a bit, yes. Either way, don't forget: When it comes to healthcare, your real choices are already limited by your own bank account.