The Hard Questions

I've become convinced that our elected politicians have only two goals.

1. Get re-elected
2. Get their friends elected and re-elected

Everything they do seems to be aimed at these two goals.  Gone is the day of the "gentleman farmer" who goes to Washington to serve the nation for a few years, then returns home.

The net result is that the hard issues are glossed over, and the hard questions are never asked.

Let's take health care as a specific example.  What's the hard question?

Should full access to health-care be a guaranteed American privilege?

Forget about money for a minute.  If you're an American, do you have an intrinsic right to the best health care?  That's the first question that needs to be asked.

The answer appears to be "yes", because anyone can walk into a hospital to receive health care, whether they have money, insurance, or a job.  The hospital won't turn them away, even if there's no chance the patient can pay for the services provided.

This leads us to the second hard question.

Who pays for health care services provided to the indigent and uninsured?

Right now, the real answer is "everyone else".  The cost of these free (unpaid, uncollectable) services is bult into the cost that everyone else pays.  And, since the uninsured can't usually afford basic preventative medicine, these "gratis" services are often rather expensive.  These expenses are spread out over all the bills that everyone else pays.

If the answer to the first question is "yes", then we have a limited number of possible answers to the second question.

1. Socialize medicine and make it a government service, paid by taxes, with equal access to all citizens.
2. Force everyone to buy insurance, with the government providing insurance to the poor.
3. Soak the rich and hope they don't leave the country in response.
4. Leave the current system and spread the cost over all the middle-class citizens who have insurance.
5. Create a caste system with private hospitals for insured patients and government services for the uninsured.

None of these options are ideal, given human nature.  Any option is probably workable.  Some are not acceptable to the American population.  Nobody wants to pay for freeloaders, but we have a long history of social conscience - taking care of the poor and indigent.

We don't have the guts (or callousness) to say, "No insurance, no service!"

So, any health care solution is going to stink.  It's the nature of the beast.  If we provide health care to everybody, someone has to pay for those services.

We just have to figure out who gets the bill.