Shalom, not economics, should inspire health care

Dr. Jonathan Yonan’s recent argument in the Sept. 16 issue of The Waltonian, that wrong questions lead to poor answers is refreshing and true.  Unfortunately, his rejection of the question of whether “comprehensive health insurance” is a civil right is mistaken.

Dr. Yonan worries that “rights” language in the debate over health care reform gives government-centered policies an advantage by “sidestepping central economic questions.”

He seems to believe also that “comprehensive health insurance” is not a right because it isn’t part of the “natural realities of human persons.” He prefers that legislators determine health care policy by using “contextual, prudential judgments” grounded in economics.

“Economic prudence” and “contextual, prudential judgments” are necessary even when governments recognize a right to health care. Recognizing this as a right means citizens deserve health care and government must ensure access to it.  It doesn’t mean government must deliver or run health care. 

There are several different kinds of health care systems among other rich countries—all of which are more successful than ours and all of which recognize health care as a right—and their health care policies inspire much internal debate about government’s role.

There is obviously a lot of opportunity for prudential judgments about how to deliver what citizens deserve by right.  Attentive Canadians will tell you they enjoy their right to health care but tire of the fiercely competitive politics about how it is provided.

Dr. Yonan trusts markets to deliver essential health care, but competitive markets sometimes fail to distribute even essential goods justly.  Just ask the 47 million uninsured.
U.S. health care is expensive, and costs are running ahead of inflation primarily because of expensive prescription drugs, advanced technology, increasing rates of chronic disease, fee-for-service, and living longer, not because Medicare distorts the market, as Dr. Yonan argues. Even if the U.S. completely privatized health care, tens of millions would still be unable to afford it.

Finally, I especially can’t accept Dr. Yonan’s fundamental assertion that “economics should be at the center of the health care debate.”

At the center?  Really?  I sincerely wonder what question he asked himself to evoke this bald claim.  Economics feels more like the answer to a modern question (like,”what is practical?” or “what works?”) rather than one derived from the biblical story. 

In the spirit of trying to craft the right question, I ask:  What health care reform policies are likely to create conditions that engender human flourishing, which the biblical authors call shalom? 

Of course, human flourishing requires just economic policies.  But we severely stifle our imagination if we start with the assumptions, principles, methods and language of an academic discipline.

Alternatively, the biblical prophets and Jesus taught out of a vision in which humans flourish.  They believed God created human beings to thrive, and the Psalmist, among other biblical writers, believed the king (or government) is responsible to ensure justice for those who aren’t flourishing (see Psalm 72).

Health is critical to human flourishing; it is part of the natural realities of human persons. Health care, of course, is first the responsibility of the individual and her family, but, if they are unable to afford the health care necessary to flourish, the wider community must step in to help. 

Threats to human flourishing inspired the laws of jubilee and sabbatical release that required the Hebrews to restore human dignity to persons buffeted by the whims of personal and social life and to give them the real opportunity to participate fully in community life. 

Likewise, a contemporary society may require government to ensure the health care of the medical underclass.  The government may make “contextual, prudential judgments” to exercise its public authority on behalf of the society to arrange market incentives and disincentives, collect revenues and otherwise pass laws that enable it and/or non-governmental health care providers to deliver essential care.

Ironically, Dr. Yonan and I could come to some agreement similar to what he proposes at the end of his essay—that is, to “subject routine medical goods and services to the forces of the market…while leaving catastrophic events and the safety net for the poor to some revised version of a health insurance system—even one that’s government run.” However, I’m open to this solution not primarily out of economic prudence but on the basis of shalom.

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