Virtually all conversations about health care with my friends leaning Republican break down along the issue of personal vs social responsibility for an individual maintenance of health. In my opinion, while each of us should strive to to make smart and healthy choices for ourselves individually, we also make choices as a society that improve us as individuals. For example, we as a society decided to subject our children to vaccinations. Our Constitution does not mention vaccinations. And yet everyone can get them. With exception of some fringe individuals and groups, majority seems to agree that there is indisputable evidence that vaccines save lives. While it is an individual responsibility of parents to physically bring a child for shots (although house calls certainly work just as well), it was us as a whole society that made that choice to invest in vaccination programs, manufacturing, distribution, and education. If there were early doubters of this social responsibility, and I am sure there were those who screamed socialism and usurpation of individual rights, vaccines worked and saved lots of lives, not to mention money. And now Republican children also get vaccinated. For free and not feeling as if they are giving up their individual rights. To receive a vaccination became both a social and personal responsibility.
Perhaps even better an example is our commitment to education. As a society we decided to provide K12 education for free. We could have left it fully in the realm of personal responsibility of well-heeled parents. But no, we decided that education, even though not a Constitution-charted right is a right nonetheless for everyone. Who can argue that by doing so our society became prosperous, with obvious benefits to ourselves, our economy, our lives. We, as a society made a choice to invest in firefighters rather than leaving firefighting an individual responsibility. We probably saved lots of lives and money this way. Did anybody question this idea by arguing that have one's property saved by firefighters is not outlined in Bill of Rights?
All these choices are examples of social insurance that effectively spread risks among all of us. Those who refuse vaccines also get a benefit from herd immunity, a phenomenon that describes protection from disease by virtue of lack of disease due to many vaccinated individual around the one who is not. Those who are vaccinated do not carry pathogens and therefore cannot transmit them to anybody including those who are not vaccinated. A risk of not being educated was spread through the entire population. We decided that education is worth it.
So why is health care so different? Take for example a recent ban on soda in New York City by the mayor Michael Bloomberg (which has been just struck down.) He argued, and not without good evidence, that consuming supersized amounts of sugary beverages cannot be good for one's health. And there seem to be an agreement on this even among advocates of individual rights. Of course, this is because metabolism has no regard for one's position on individual rights. It's all about calories in and calories out, and obesity affects Democrats and Republicans soda-gulpers equally badly. The divide is clearly along the individual freedom to enjoy all 32 ounces of it without a bureaucrat saying that you cannot have it.
And this is a juncture where my understanding of my Republican friends' positions tapers off. They argue that personal responsibility should kick in right before one gulps all 32 ounces of sugary fluid and the society should not intervene. The premise my Republican friends base their argument is two-fold. They argue that these 32 ounces can only hurt the person who gulped them, and as long as that person is aware of consequences (which is of course a gulper's responsibility to find them out), gulp away. The second common problem cited with such "broccoli laws" is their boundaries: people in power could start banning everything they perceive harmful, and this is a shortcut to a totalitarian state.
It is easy to see how someone gulping 32 ounces of soda raises health care costs for all of us, in some part because all we, and insurance companies, know the consequences. And insurance companies are in the business of risk assessment, and the one who drinks lot of soda has a higher risk for diseases associated with indiscriminate diets. Insurance companies of course can jack this indiscriminate dieter's insurance premium. But the most important problem is that this gulper's health costs will most certainly be higher over his life time than if he was not such an indiscriminate dieter. And since the goal of insurance is to spread risks over large number of people, the cost translates to all of us. So as a society, wouldn't it be smart to lower our costs by making it a little harder to be an indiscriminate dieter? How much harder? Just get two 16-ounce gulps instead of one 32-ounce drink. We have sacrificed more important civil liberties than this one without much peep.
Perhaps even better an example is our commitment to education. As a society we decided to provide K12 education for free. We could have left it fully in the realm of personal responsibility of well-heeled parents. But no, we decided that education, even though not a Constitution-charted right is a right nonetheless for everyone. Who can argue that by doing so our society became prosperous, with obvious benefits to ourselves, our economy, our lives. We, as a society made a choice to invest in firefighters rather than leaving firefighting an individual responsibility. We probably saved lots of lives and money this way. Did anybody question this idea by arguing that have one's property saved by firefighters is not outlined in Bill of Rights?
All these choices are examples of social insurance that effectively spread risks among all of us. Those who refuse vaccines also get a benefit from herd immunity, a phenomenon that describes protection from disease by virtue of lack of disease due to many vaccinated individual around the one who is not. Those who are vaccinated do not carry pathogens and therefore cannot transmit them to anybody including those who are not vaccinated. A risk of not being educated was spread through the entire population. We decided that education is worth it.
So why is health care so different? Take for example a recent ban on soda in New York City by the mayor Michael Bloomberg (which has been just struck down.) He argued, and not without good evidence, that consuming supersized amounts of sugary beverages cannot be good for one's health. And there seem to be an agreement on this even among advocates of individual rights. Of course, this is because metabolism has no regard for one's position on individual rights. It's all about calories in and calories out, and obesity affects Democrats and Republicans soda-gulpers equally badly. The divide is clearly along the individual freedom to enjoy all 32 ounces of it without a bureaucrat saying that you cannot have it.
And this is a juncture where my understanding of my Republican friends' positions tapers off. They argue that personal responsibility should kick in right before one gulps all 32 ounces of sugary fluid and the society should not intervene. The premise my Republican friends base their argument is two-fold. They argue that these 32 ounces can only hurt the person who gulped them, and as long as that person is aware of consequences (which is of course a gulper's responsibility to find them out), gulp away. The second common problem cited with such "broccoli laws" is their boundaries: people in power could start banning everything they perceive harmful, and this is a shortcut to a totalitarian state.
It is easy to see how someone gulping 32 ounces of soda raises health care costs for all of us, in some part because all we, and insurance companies, know the consequences. And insurance companies are in the business of risk assessment, and the one who drinks lot of soda has a higher risk for diseases associated with indiscriminate diets. Insurance companies of course can jack this indiscriminate dieter's insurance premium. But the most important problem is that this gulper's health costs will most certainly be higher over his life time than if he was not such an indiscriminate dieter. And since the goal of insurance is to spread risks over large number of people, the cost translates to all of us. So as a society, wouldn't it be smart to lower our costs by making it a little harder to be an indiscriminate dieter? How much harder? Just get two 16-ounce gulps instead of one 32-ounce drink. We have sacrificed more important civil liberties than this one without much peep.
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