Like Chickens for Elephantiasis

I offer a service. I can help people learn how to organize an essay, use a semicolon, and avoid pronoun-antecedent disagreement. 

Interested?

Bob is. He decides my service is worthwhile and useful as part of a larger goal of getting a college degree. So Bob decides to trade currency in the form of banknotes that have a value determined by general agreement for my service. Now, Bob doesn't give me his currency. He gives it to an institution who holds it for him until another institution, one that has agreed that the services I offer are useful to people like Bob, requests that currency. At which point Bob changes some numbers and currency shifts from the first institution to the second.

The second institution and I agree to cooperate. I provide my mad English skills and the people and structures within the institution act as intermediaries between me and Bob. Still tracking?

An English teacher who also washes cars

Now, on the weekend I decide I need to get my car washed because, you know, it’s about that time of year. I don’t want to do it myself, so I drive my car to a local car wash that has other people who have made agreement with the owners of the car wash to provide me a service I desire: doing their best to make my dented 2004 Civic presentable.

I hand one of these people a card that belongs to another institution who has promised a short-term loan for currency I have been promised in exchange for teaching Bob how to parse complex texts, and the car wash owners have some people soap up my ride while I sit on the patio and enjoy a coffee.

We take this admittedly simplified series of transactions for granted. Everyday we buy stuff and get other people to do things for us in exchange for money. We are, by proxy, offering our goods and services for their goods and services. It is very rare that people in the developed world trade services or goods directly.  I doubt that Julie at Green Valley Car Wash would wipe down my car in exchange for a quick lesson on compound sentence structure. Simplifying this system to eliminate proxy exchanges of goods and services through the use of currency is impossible in any culture more advanced than a Stone Age extended family. True, there are instances of straight barter in our lives. For instance, I traded my neighbor a piece of scrap lumber for a handshake and a bit of goodwill. My father traded permission to stay in one of his rental units for a few paint jobs on other units to a tenant who was unable to produce money. But this simplistic form of direct exchange does not keep a civilization based on specialization running. The reason I have hauled you, if you are still here, through my half-assed economics lesson is because I sometimes think people forget the necessary complexity of a modern economy. I keep running into people who seem to hold a view of economics borne of hyper-nostalgia and a romantic notion of rugged individualism based on simple transactions. They view the economy as an exchange of mutually beneficial contracts between equals: I make things, you can choose to buy them. I will provide a service in exchange for a service you provide. The problem is that love for this sort of modern economic fairy tale permeates some political circles and strongly informs the public debate on health care in America.

A few years ago there was a kerfuffle around Sue Lowden, a Nevadan with a penchant for the public eye and periodically successful runs for public office, who said, “Before we all started having health care, in the olden days our grandparents, they would bring a chicken to the doctor, they would say I'll paint your house."
She stood by her comment, and not only as figurative language. She implied that health care should be part of the marketplace and subject to negotiations of contracts between equals and, by extension, those who have something worth exchanging for say, a colonoscopy. If you couldn’t come to an agreement, maybe the doc wanted a cow instead of a chicken and you didn’t have one,  you were SOL. Or maybe you could trade some chickens to the rancher. But then we’re starting to get complicated. This implication by Lowden and many others that health care should be wholly part of the marketplace is something with which we have yet to really decide, even though we have made this decision with regard to many other services. We decided that the education of our children through the age of 18 is an essential service and something important enough to provide to all our citizens. We decided the same thing for fire protection, judicial services, major transportation infrastructure, and enforcement of safety norms. Sure, my Libertarian, homeschooler, and organic-veggie-for-hemp-sandals-bartering friends would argue that some of these services would be better managed by individual families at the kitchen table and with garden hoses, firearms, 4WD and a strong sense of caveat emptor. But wherever you stand philosophically, we live in a republic where the social hierarchy is built around individuals we elect through a system of mass expression to stand at the top and make decisions for the group. At this point, it is clearly decided that in general it is worth funding schools as well as fire stations, highways, courthouses, and the FDA. While there are some, like those Libertarian friends, who crow their disgust at many of these institutions, most people I know really just want to get on with their everyday lives, while throwing out an occasional Facebook rant or slapping on a bumper sticker. In poll after poll, most citizens are willing to gripe about some aspect of the services we as a society have decided to support, but are unable to decide which of those services they personally would like to do without. It seems crazy to me that one of the major services we seem to have been unable to address philosophically is health care. We can’t decide whether healthcare is like getting your car washed or like educating your children. We haven’t decided if keeping everybody as healthy as possible is beneficial enough to fund in the same way we do the other services we’ve deemed critical, or if health care is an optional service that should be available only to those who have enough chickens (or produced enough chickens by proxy) to afford it. Look, health care is limited. It will always be rationed. There will never be enough to service everybody at the highest possible level.

Sorry, there's only one of me to go around

Do we ration it via the marketplace, just like we do Teslas and Coach purses and valet service and landscapers and painters? Or do we ration it the same way we ration education, another service without enough providers to go around? Making health care a service governed by the same business principles as grocery stores will mean that quality and access to care will be clearly defined by the marketplace. Limited supply will drive demand and prices will adjust accordingly. If you can’t afford it, you don’t get it. Making healthcare openly available, as have most Western democracies, might indeed dilute the quality of care some people receive and where we submit our currency will shift from private companies to public entities.  However, those with no access in the market-based system will get some level of basic care. Should the ability of our citizens to access medical care be as important as their ability to access K-12 education, safe drinking water, and legal defense? Or should the ability of our citizens to access to health care be as important as their ability to access a movie theater, get their cars washed, and have their yard mowed? So, before we get derailed arguing about someone taking our money to give to somebody else, which is what happens in all modern economies, we need to answer this question: Is access to health care for all our citizens fundamentally important to the strength of our nation? Pass your answer up the chain. It may help us get past this mess.