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February 4, 2006

Health Care and the Commons

Access to health care should be proclaimed an inalienable human right.

There’s ample reason to worry about the 45 million Americans who don’t have health insurance. The uninsured postpone dealing with health problems until they are serious, which means until they are the most difficult and most expensive to treat. Treating the uninsured often takes place in emergency room settings, which is the most expensive way of providing health care.

We all pay when people don’t have health insurance. In the narrowest sense, we all pay because treating the uninsured that way shifts the costs to the insured, thus driving up everyone else’s costs. But we all pay in broad, social ways. People without health insurance tend to be sicker and less productive citizens, which reduces society’s overall economic well-being. And to the extent that children grow up without access to vaccinations, treatments for minor infections and routine monitoring of their development, the cost of the uninsured is passed along to future generations.

I don’t know anyone from either side of America’s ideological divide who would argue that the nation wouldn’t be better off – physically, economically, and spiritually – if everyone had health insurance that provided access to the health care they need. Indeed, I think it fair to say there is a consensus that the universal provision of health care, like education, employment and housing, is wholly beneficial.

Indeed, it is their universality – or at least our desire that they be made universal – that makes health care, employment, housing and education as much a part of our social commons as our desire to preserve clean air, fresh water and a sustainable natural environment.

Yet unlike housing or employment, there has never been a law proclaiming universal health care as a goal. During the Carter administration, the nation declared it federal policy to promote full employment. This commitment has been largely ignored during the tenures of the last two Federal Reserve Board chairmen, Paul Volker and Alan Greenspan. But it exists and any close reading of the semi-annual presentations Fed chairmen make to Congress (the Humphrey-Hawkins Full Employment Act requires those presentations) shows they honor that commitment by discussing inflation and economic growth in terms of generating full employment. (An aside: In the wake of Friday’s announcement that unemployment had fallen to a four-year low of 4.7 percent – remember the 3.9 percent unemployment rate at the end of the Clinton years? — it will be interesting to see how “straight-shooter” Ben Bernanke handles the jobs question when he testifies before Congress on February 15th.)

If you live in a city with homeless people roaming the streets or have seen some of the sprawling trailer park slums outside some of our Sunbelt metropolises (and not just the ones filled with New Orleans evacuees), you might wonder about America’s commitment to adequate housing. But it’s there in law: the 1949 Housing Act. While that law was responsible for many of the nation’s most poorly designed public housing projects, it opened by declaring that it is U.S. policy to promote decent housing for all its citizens.

Education has never been a federal obligation. But every state constitution – I believe it is universal but someone can correct me if I’m wrong on this one – includes a clause making it the duty of the state to provide an equal and adequate education for all its citizens. These clauses, in place for over a century, have been the basis for numerous public school financing lawsuits where the plaintiffs in property-poor school districts demand equal opportunities compared to those in property-rich districts.

But health care? A year ago, Rep. Pete Stark (D-CA) and Rep. Jesse Jackson, Jr. (D-IL) proposed amending the U.S. Constitution to guarantee health care as a right for every American. It drew just 27 co-sponsors and no attention. But as Stark said in introducing the bill, which he explained as promoting a “common interest”: “Until we can guarantee that all people have the right to equal, high-quality health care through the Constitution, the interests of the people will continue to play second fiddle to the corporate bottom-line.”

I was really hoping President Bush would tout his plan for individual health savings accounts (HSAs) during his State of the Union address last week. Last year’s failed campaign to privatize Social Security did a pretty good job educating Americans about the nature of social insurance and how there are some things in life that we must do together as a society – like providing for a secure income in old age and not leaving that up to the whims of the market.

A loud campaign promoting HSAs would have provided a similar teachable moment for health care. As the public learned more about individualized health care insurance and how that would make the current health care crisis worse, they would be well-primed for embracing the only reasonable alternative: a national health care system that provides universal access to adequate health care.

Alas, President Bush ran away from his own advisers’ HSA proposals. I suspect it didn’t poll well. By week’s end, he was donning wonk robes to tout high technology and science education.

But the health care financing crisis hasn’t gone away. And as the Baby Boomers age, it will only grow worse. The national discussion about how to provide this common good is once again heading to the top of the nation’s domestic agenda.