Recently, over breakfast, a friendly argument on the state of national healthcare came to a head with the standard refrain;

“…it’s people like you who make my health insurance so expensive.”

This sort of statement always takes me aback; I of course rebel at being characterized as a class of people who are the cause of undue cost,

but the fact remains, Am I?

I am reminded of a favorite sci-fi thriller, in which the evil flunky of a corrupt empire confronting the plucky decorated civil war rebel hero- pauses mid-fight, while he clearly has the upper hand, he explains away each of these well established roles as unrealistic, calmly asking: “what do you think is going to happen here captain?”  The villains’ superiority is never in question, yet, of course, after much excitement, in the end, the rebel prevails, his motivation is palpable, the system the villain embodies? Not so much. Statements do not equal facts, and even firm belief can be trumped by reality. The fact is, I am the only me there is, and my resistance to a purchase does not increase costs.  It is the dysfunctional system that is responsible for any undue cost, and the insurance industry that makes that insurance so expensive.

The fact is; I don’t cost anybody anything as yet. The state of my health has relied only very, very slightly on the medical establishment, and not at all on the insurance industry. As I pass the early part of my 5th decade, I am reasonably healthy, rely on no pharmaceuticals, prescribed, or otherwise, and have thus far avoided injury or disease. While accepting my ultimate mortality, I hope to continue this trend into the future. Another fact is that my lifestyle is technically well below the poverty level, my income is low, to non-existent. I pay no income tax, because I have hardly any income, and to do so would be as much a fiscal hardship as purchasing health insurance. But too, I rely on no government services, other than the roads; and general law and order, contributed to by a tax on my fuel, land tax, and sales tax.

Shouldn’t I get some credit for staying off the dole? I find that in issues like this, I am more anarchist than socialist. Perhaps this is one reason why pure socialism has yet to exist. Its creation relies on averages and masses, a statistical view of an aggregate humanity that denies the individual particulars of a given situation. The enlightened anarchists view must take into account the particular facts of individual day-to-day reality.

Of course accidents do happen. On paper I am not required to purchase insurance, I am clearly eligible for state assistance. If I need care, I am confident I will receive it, and in the worst case scenario, if I cannot afford to pay for the service I require, as the law now stands, the cost of my care would one day be recoverable from my estate when both my wife and I are no longer alive. I find myself without any heirs and so it may be appropriate, I suppose, “to be fair” to keep the accruing value of our real estate, in reserve for that purpose, but I wish there was a better way.

Aside from the fact that I cannot afford insurance, I resist paying for health insurance for a variety of reasons, I find flaws in a government empowered by a flawed constitution, but I do take constitutional restrictions as perfectly valid. I strongly believe that government has no right to demand the purchase or enrollment in anything. This is not why government is established, and requiring payment for service from a for-profit corporation, because your income is at a certain level is not the way government should operate, or healthcare should be reformed.

I would have no problem paying into a system that reformed the way healthcare is delivered. The so-called single payer alternative would mean that all care delivered to anyone is paid for by a single, non-profit agency, and lower cost would be an instant side effect. Perhaps an incentive for health could include reduced fees as credit for health promoting practices, and penalties for risky behavior. Universal coverage for basic health repair and maintenance would make participation automatic, and the lower costs would be paid out of the general fund of the U.S. automatically, fulfilling the constitutional purpose, of promoting the general welfare of citizens. That would be a decent place to start. How could this possibly ever happen? Oh yeah, I remember, we could consult with most every other civilized country on the planet. But there is more that can be done.

I heard former Governor of Vermont, Dr. Howard Dean interviewed by a conservative business news network, the final question was: “So, what are the problems with health care reform, what would you do differently?” From the kind of comments the host was making, I imagine she was fishing for the single payer answer, to fulfill her agenda of exposing another liberal non-starter. No doubt, Dr. Dean knowing he had no time to adequately address this question, side stepped any criticism of the current reform act. As the end-of-show theme music began, he went much further with a pithy, one sentence sound bite, he said what we really need to control spiraling cost;

“We need to get rid of fee for service healthcare.”

This would mean that becoming a doctor would not equal winning a career lottery, and that health promoting specialized equipment and supplies are not more valuable than their actual cost of production. It could create a new class of healthcare professional, those that are called to serve, and heal. Part of this would require paying to train the doctors, and other practitioners we need to have a healthy society. Perhaps education in exchange for public service could create a new opportunity for public service. Encouraging and rewarding ongoing education, successful innovation and research in all disciplines could actually move our society towards health.

Paying actual costs for materials and supplies, while providing stable equitable salaries and job security for civil servant providers could mean healthcare is operated as a non-profit public service, not exploited as a business opportunity, benefiting us all.

Well, we are all in this together. Maybe I am a socialist after all?