Talking about health

While everyone wants to talk about health care, no one seems to be willing to talk about health. The assumption seems to be that we all know what health is and that it is something that all Americans want, need and have a right to expect. After all, what could be more fundamental to “life, liberty and the pursuit of happiness” than one’s physical well-being? Nonetheless, if we are going to make rational policy decisions that have any chance of successful execution, we have to carefully and dispassionately examine logical premises and the outcomes we hope to achieve. Here are just a few of the questions we need to answer.
Why is health important? Do we think it leads to happiness, life satisfaction?    
What interest does the state have in my health and happiness?
How is health/happiness defined/measured? Who does the defining/measuring?
Is health/happiness an entitlement owed to me by my fellow citizens?
What is the level of health/happiness to which I am entitled?  What constitutes a deficiency?
Are the defined health minimums the same for me at 10, 30 and 70 years of age?
Are some health factors in my personal control, unrelated to medical treatment?  
Which health factors outside my control (e.g. genetics) can be improved via public policy?
What is the current/future cost of healthcare for those with healthy and unhealthy lifestyles?
Are the marginal benefits worth the marginal costs?
These questions are neither “loaded” nor trivial. Even the controversial question of “death panels” has genuine merit – for all of us. All medical insurance programs, private and public, already have “panels” that decide whether the policy will cover a particular treatment for a particular individual with a particular health deficiency. I have observed with interest (and concern) as one close friend was told that her private insurance would not cover a potentially life-saving cancer treatment, and as another was told that her public insurance would not cover a life-extending treatment. These decisions were made by “panels” who had to judge whether the treatments were (to be blunt) cost effective.  
True to all heated debates among Americans, this one includes perceptions and values about entitlements, personal responsibility, social freedom and, of course, money. But let us not mistake this for a new debate. We are revisiting of the role of the central government in American democracy. Indeed, it is remarkably similar to discussions held in the First Continental Congress between those who wanted a dominant central governmental and those who wanted to restrict government control over states, enterprises and individuals.  
When we skip the fundamental issues and jump directly to the correction of what some see as societal deficiencies, we are left with no basis for policy, no measurable objectives, no way to determine success or failure. Words like “better, more affordable, more accessible” may sound attractive, but they say nothing specific about the goals, are not measurable and provide no basis for budgeting.  
Because of the failure to answer difficult questions and the lack of specificity in the various proposals, the current debate about healthcare has quite naturally become philosophical, political, partisan, divisive, self-serving and understandably passionate. “That’s a prevarication!” comes from all corners of the body politic, with everyone accusing everyone else of being uncivil, uncompromising, unethical, disingenuous, racist and just plain ignorant. From where I sit, everyone is right about that.
It is hard work to devise public policy with measurable objectives, well-defined costs and identifiable sources of revenue.  And of course it is politically risky. When clear statements are made about who will get certain benefits and who will not, what benefits are included and what benefits are not, how much things will cost, and who will pay for what, each of those targets becomes… well, a target. The choices are to step up to the plate and do the hard work or to pontificate with phrases that have no meaning and argue that the problem is so urgent that doing anything, no matter how open-ended and poorly defined, is better than doing nothing. We have to do better.

Editor’s Note: This guest editorial is offerd by John Cragin. He is a member of The Shawnee News-Star Guest Editorial Advisory Board The views expressed by our guest editorialists and guest columnists are theirs, and do not necessarily reflect the views of the News-Star’s management.