At a 11 May 2011 hearing held by the Senate Health, Education, Labor and Pensions (HELP) subcommittee on Primary Health and Aging, a short debate over healthcare delivery took place between Senator Bernie Sanders of Vermont and Senator Rand Paul of Kentucky. Sanders, who is chair of the subcommittee, is one of the Senate’s few independents and is a socialist at heart. Paul, who is an MD (an ophthalmologist), is a "Tea Party" Republican and a libertarian at heart.
The subcommittee meeting was held to investigate the use of emergency rooms as primary care centers by the poor and uninsured. Many people in the United States, who find themselves without access to proper health care facilities, end up using hospital emergency rooms for their everyday health needs. This turns out to be very expensive. It creates a financial hardship for the hospitals which must either supply uncompensated services or turn sick folks away. If such patients could be redirected to less expensive facilities it could result in savings of $6 and 40 billion a year according to the Government Accountability Office (GAO). Sanders, who has taken the position that access to health care is a "fundamental right," believes the answer to this problem is to expand the use of government subsidized community health centers, which would cost much less in the long run and supply just the sort of broad spectrum primary care people need. Indeed, a program in his own state of Vermont has demonstrated that he is correct.
Rand Paul, however, has a sharp ideological objection to this solution. Here is some of what the Senator from Kentucky said:
1. "With regard to the idea whether or not you have a right to health care you have to realize what that implies. I am a physician. You have the right to come to my house and conscript me."
Now that is a bit of a leap. But Paul persisted,
2. "It means you believe in slavery. You are going to enslave not only me but the janitor at my hospital, the person who cleans my office, the assistants, the nurses...You are basically saying you believe in slavery."
From this we can draw many conclusions. An immediate one is that being a trained ophthalmologist is no guarantee against seeing the world in an exaggerated and illogical way. No one was saying that Paul, or his hospital’s janitor, must work in a community clinic. As importantly, this ideologically driven interpretation of access to health care demonstrates that Rand Paul is one of about 18% of adults in the United States who place more value on a near anarchistic (and, in practice, quite impossible) level of personal "freedom" than on the notion of common sense responsibility between citizen and society. To put it another way, Paul has gotten it into his head that his personal freedom as a doctor will somehow be infringed if any government program offers the poor decent healthcare. The government will come and "conscript" him–force him to provide this service. This assertion is completely unfounded but nonetheless he is staking out his position that his individual freedom is the paramount value here. To defend that position Paul appeals to the alleged intent of the nation’s founders. Thus, he goes on,
3. "Our founding documents said you have a right to pursue happiness, but there is no guarantee about physical comfort. When you say you have a ‘right’ to something there is an implication of force..."
Actually, I am pretty sure that the majority of the "founding fathers" would agree that "the pursuit of happiness" entails the pursuit of a modicum of "physical comfort." As far as I know none of them were among the relative few who derive happiness from of the pursuit of uncomfortable activities (other than making revolution). Of course, the founding documents of the country don’t spell it out explicitly for Senator Paul. In fact, they say nothing substantive about health care, but that does not mean much.. The resources and the technology having to do with medicine were very limited at the end of the 18th century. Making decent health care available to everyone was therefore an issue that did simply did not come up. However, let’s take an analogous situation. In 1787, when the US Constitution was drafted, the resources necessary to provide public education to all citizens was not there either, and no where in the Constitution does it say publically subsidized education is a basic right. Yet, by the end of the 19th century the resources were becoming available and education was deemed economically and socially necessary to the US’s position as a strong and competitive nation. Pretty soon education was not only a right, but, as Paul laments, children were being coerced into school (that is where the profession of Truant Officer came from). Now it is quite possible that, if he had the power to do so, Rand Paul would do away with compulsory public education. Such an act would certainly be consistent with his ideology. But what would that do to the United States? Quite frankly, you could kiss national strength and competitiveness goodbye. So, whether it entails the "implication of force" or not, the right (to be forced) to be educated by the state is here to stay.
You can make the case for health care the same way. You want the USA to be strong and competitive? You better keep people healthy. And health is not necessarily something that is just individual. There is a field called public health and it works from the premise that people living in close quarters have an influence on each other’s state of physical well being. You say that you should be free to decide whether or not to vaccinate your children. Well, deciding not to runs the risk of promoting diseases that can impact the rest of society. Thus the government can, and in some places in the US does, compel you to vaccinate. Certainly, at the first sign of the return of something like polio, one’s individual freedom from vaccination will be rapidly replaced with your right (to be forced) to be disease free. So you see, health care for all can be seen as both a right and as a social necessity–like education.
Where does all of this leave Rand Paul and his "freedom" loving 18% of the population? It leaves them in the position of a bunch of radicals out of touch with reality. It would seem that the man and his supporters have foresworn a core concept of community. If you live in a community, in society, you cannot have freedom without responsibility. That sort of freedom is enjoyed only by hermits. Responsibility, in turn, implies a minimum level of coercion. You have a responsibility to go to school for a certain minimum number of years. You have the responsibility to pay taxes. And, now (perhaps, in part, as an extension of the paying of taxes) we are moving in the direction of having a responsibility to provide health care to all. Maybe Paul is really worrying about the enslavement of his tax dollars to the cause of healthcare. Too bad. I have been protesting the enslavement of my tax dollars to foolish wars for years. The IRS is unsympathetic. If Rand Paul wants to escape this sort of "coercion" let him go live in what little is left of our deep woods. Otherwise, he should accept the importance of responsibility to social life.
People have a right to decent health care if for no other reason than a) with the proper prioritizing of resources, it is possible for them to have it and b) it makes possible both stronger and happier individuals and communities. In other words, at this point in our national history, if we have the right to "pursue happiness" we should have the right to see a doctor. But what about Senator Paul’s insistence that his personal freedom is more important than the health of either individual citizens or the community as a whole? Perhaps he should consider the opinion of the 19th century Swiss philosopher Henri Frederic Amiel who said, "In health there is freedom. Health is the first of all liberties."
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