Monday, January 11, 2010

What Would Jefferson Think of the Healthcare Debate?

Thomas Jefferson would have been rather stunned by the debate on the future of America's healthcare system currently unfolding in Congress. As a man of the late 18th and early 19th centuries, the very concept of a healthcare system would have been alien to him, and it would have taken him some time to adjust to it. Jefferson would certainly have been delighted and amazed by the astonishing progress that has been made in medical science since his time, and would certainly want its fruits to be available to all citizens. Indeed, it could be argued that access to proper healthcare is part of a person's inalienable right to life. But how to ensure it?

After familiarizing himself with the debate, Jefferson would have first pointed out that personal responsibility is the most important aspect to this question, and he would have been dismayed by its near-total lack of mention in the debate. Americans, he would quickly say, would do more for their own health if they simply took a thirty minute walk every day than if they created the best healthcare system in the world. But aside from this, what manner of public policy would Jefferson call for in the healthcare debate?

One of the key sticking points in the healthcare bill that is to emerge from negotiations between the House and the Senate is whether it should include the so-called Public Option, a program to be offered by the federal government to compete with private insurance plans. The House bill includes it, while the Senate bill excludes it. Its proponents say it is the only way to ensure proper coverage for a large segment of the American populace, while its detractors say it would lead to a collapse of the private healthcare system altogether.

Jefferson would almost certainly oppose the Public Option, because he opposed virtually any measure that increased the power of the central government. He clearly saw that every increase in the power of the central goverment made the people less free, and enacting the public option would certainly be a massive accumulation of goverment power. Even if the federal government had the very best of intentions, it would be a blow to the self-reliance of the people and, therefore, to their freedom.

But Jefferson equally understood that the government was not the only threat to the liberty of the people, and he would have opposed private health insurance companies when they sought to rob Americans of their right to healthcare. The image of private companies denying coverage to citizens because of their past medical history would have struck Jefferson as immoral and unacceptable. He saw the government as the protector of the rights of the citizens, so it seems clear that he would have supported those provisions of the bill which prohibit private health insurance companies from discriminating against citizens based on their past medical history.

In short, Jefferson would have opposed the government becoming a provider of healthcare itself, but he would have supported reasonable government regulation of private healthcare companies to ensure that they couldn't deny Americans their right to health insurance. He would be rational enough to recognize that there had to be some government involvement in the healthcare system, but he would have striven to make sure that this was limited as much as possible to local and state governments, and that federal involvement was kept to an absolute minimum.

Both the House and the Senate versions of the bill prohibit taxpayer money from being used to pay for abortions, and Jefferson would have approved of this. While it's impossible to know what Jefferson would have thought about abortion in general, he certainly would have opposed a person being compelled to pay taxes to support a practice he or she found morally repugnant.

Jefferson, as a rational man, would also ask us to look at the multitude of examples provided by the experiences of other nations and see what miht be emulated in an American environment. What does the healthcare of France do well, which we might do as well? Or Germany? Or Japan? The all-too-common American practice of ignoring what works well in other countries would have dismayed Jefferson, especially on such an important matter as this.

And finally, Jefferson would have been kept up at night by the thought of how much the final bill that emerges from Congress was going to cost. While always in favor of low taxes, he would have approved of the measures in both versions of the bill to pay for the expense through increased tax on higher-income earners, because he firmly believed that deficit spending was a greater evil than taxation. Still, he would call on us to do everything in power to minimize the cost to taxpayers, while still ensuring the provision of affordable healthcare to every American.

Between the House and Senate versions of the healthcare bill, it's rather clear that Jefferson would consider the Senate verson to be superior. But he would still consider it too expensive and call for additional revisions to reduce cost and curtail the involvement of the federal government. To the greatest extent possible, Jefferson would want decisions regarding healthcare to be kept local and personal.

This does not mean that Jefferson would want to maintain the status quo on healthcare. Believing as he would that access to the fruits of medical science is an inalienable human right, he would recognize that the current system allow private companies to deny this right to Americans and that this wrong needed to be righted.

No comments: