[img]7|left|||no_popup[/img]Democracy Now had a headline blurb (http://www.democracynow.org/2009/6/12/headlines#4) explaining that Sen. Max Baucus, chair of the Senate Finance Committee, would oppose public healthcare in any form. “It’s not going to be public,” he said.  “We won’t call it public, but it will be tough enough to keep insurance companies’ feet to the fire.” It sounds like a Republican talking point – oppose any option other than private, corporate, for-profit healthcare – but it really begs the question: since when has “public” become a dirty word?

The anecdotal, simplified version of the argument against public medicine — that is, taxpayer-funded healthcare — boils down to why the money we earned ourselves should pay for someone else’s medical bills. It would be interesting to compare this question to why we should bother saving a drowning man. Philosophically, it’s the question as to when moral obligations switch from the negative (why NOT to do something) to the positive (the moral duty to DO something). But we don’t have to get quite so technical, because paying for someone’s else healthcare with one’s own money isn’t quite what’s going on with public healthcare.

The first thing to consider, of course, is that medical care isn’t free. It doesn’t fall from the sky or grow on trees. There’s a cost, and someone has to pay it. By pooling resources in an insurance model, what can be ridiculously, impossibly expensive for one individual can be made affordable to a group of individuals. When we pay into an insurance system, it’s not the case of one individual paying for another individual’s care — it’s a case of everyone paying for everyone’s care. In other words, everyone puts in to hedge against the event of illness or injury, and everyone has the same chance to take out when needed. What the allergic reaction to the word “public” neglects, however, is that this is true regardless of whether people put into the system via taxes or whether they (or their employer) pay monthly premiums. Public or private, we as individuals ultimately have to dole out our own money one way or another to fund the healthcare insurance system.

Next is the end goal. Ideally, the healthcare system works in that when you want to see a doctor, you can see a doctor – and the one you want. If you need emergency care, you get it. If you need to see a specialist, you and your GP make the decision. It’s fairly straightforward and…also the goal of a publicly financed system.

Give the Public a Chance

So if public healthcare follows the same essential insurance model of the private care system and it doesn’t result in any less individual freedom in how and when we get healthcare, then why is “public” such a dirty word? In fact, the two advantages that come with a public system –—no ties between healthcare and employment, no conflict of interest between the drive to make profit and the need to provide care — are mitigated in a public system.

But wait. Countries with public healthcare like Canada and the U.K. have all sorts of problems. This is true. But there is a difference between administrative problems, which are relatively easy to resolve with a bit of political will and effort, and philosophical ones. Clearly, the U.S. is not Canada or the U.K. in many respects. It may be that a universal public system is not workable in practice. Or maybe a two-tier system is needed and room can be made, as President Obama has suggested, for a public competitor to private healthcare. Or maybe, just maybe, a public universal healthcare system is feasible. The only way to have an honest discussion about the state of healthcare in this country is for Republicans, and their Democratic enablers, to recognize that what is public is not necessarily coercive and what is communal does not necessarily erase the individual.

Frédérik Sisa invites you to visit www.inkandashes.net.