Wednesday, January 20, 2010

Defining Health Care

I will start writing in this blog today as if the debate were just reset.

The 2009 Health Care Debate was a poisonous affair in which the political elite threw before the people a political power grab without any effort made to discuss the nature of health care or to explain why a power grab by a centralized authority would approve health care.

A reset debate should start with the fundamentals. It should start with a discussion of the nature of health care and what is in place to help us care for health.

In the current debate, we hear absurd statements about millions of people without "health care." Yet, when we look at the system, we find these people living lives, seeing doctors, and engaged in all sorts of activities to care for their health.

Clearly, this debate is disingenuous. The political class has equated not having a particular type of insurance with not having health care.

Such equivocation does not form a solid basis of debate.

An authentic approach to the health care debate starts by examining the nature of "health."

Health is an attribute of an object. A healthy object is one that is in good working order. An ill object is one that that is not.

I used the term "object" in the above sentence to emphasize that the term can apply to all sorts of things. We can apply it to plants, animals, and inanimate objects. For example, one might say, a healthy economy is one with plenty of jobs, and steady growth. Environmentalists love applying the term health to an ecosystem. Environmentalists often see the actions of people as a disease in the ecosystem.

There is not a universal state of good health. There are complex interrelations in health. For example, having a healthy, robust colony of worms in your intestine would be considered a disease.

When discussing health, one must be attentive to the object to which we apply the term health.

When we talk about health care, are we talking about the health of individual, or the health of the group?

The health of an individual and the health of a group are not the same thing.

As a quick exercise: Think of a healthy group. In all likelihood, you are imagining a group of active young vibrant people. Think of an unhealthy people. A hospice full of terminally ill patients is an unhealthy group.

Now, think of your individual health. If you had a large cancerous growth on your forehead; you would want it cut off.

If the health of the group was our concern, the solution to health care is simple. If you cut off the dying parts, you would have a healthier population.

This is the way nature works. Wolves tend to the health of the herd of deer by killing off the unhealthy parts.

Sadly, in human history, there have been numerous societies that accepted the natural model for maintaining the health of the group by letting the old an infirm die.

In a communitarian society, such as feudalism, one would see a worker staying home to attend a sick parent as an act of greed. By attending to a dying parent, the greedy peasant is denied the benefit of his labor to the group.

Because we live in a nation rooted in Christian values, most of us automatically think that the term "health care" applies to the health of individuals. Yet, when one jumps into discussions of public policy, one must be attentive to the dimensions of the debate. Is the public policy about the health of individuals in the society or about the health of the group?

The health of the individual, the health of the group and the health of the environment are not necessarily in harmony. For this reason, one has to be attentive to the way they define the term.

As we reset the debate on health care, I think we need to think about fundamentals including the definition of health along with serious thoughts about conflicts between the health of the individual and the health of the group.

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