Health care over easy, with fries on the side

People sure are funny.

Take the response to last week’s column on how Karl Marx’s philosophy is slowly but surely taking over the United States. A number of readers wrote to let me know they appreciated my willingness to challenge the “entitlement mentality” that has pervaded our country, but a few others wrote to call me names.

I enjoy nothing more than a well-reasoned argument, but being called an “egotistical, arrogant jerk” has its charms, too.

Almost everyone who wrote to complain about my column focused on the paragraph that talked about health care. I compared the example of two hypothetical families, one which tries to pay its own way and one which feels that “health care” is a right and thus should be available to everyone, with or without the ability to pay.

Put aside the notable lack of reference to “health care” in the Constitution of the United States. Forget about the fact that the Declaration of Independence does not mention the right of the people to commandeer medical services whenever necessary. The Declaration does say that people have an unalienable right to life, and apparently some people think that includes the extended service warranty with full checkups until death and unlimited repairs at no cost.

Except, of course, there is a cost.

When someone gets free medical service, it means someone else paid for it — the doctor, the hospital, the insuror, the taxpayer. Someone, somewhere is shelling out the dollars. You can take that to the bank.

In the old days, before the New Deal, most of the largesse that helped the less fortunate pay their medical bills came in the form of what is now quaintly called “charity.” It was the idea of individuals helping each other, or in a grander sense, the idea of institutions such as the Catholic Church helping those in need. Thus, it was common in many communities to have a Charity Hospital, where the poor and indigent could count on service thanks to the kindness of their fellow man.

Somewhere along the way charity got twisted into “welfare” — the difference being extreme. Charity is an act of giving. Welfare is an act of taking — namely the forced taking of money from one set of citizens for the betterment of another.

This is not to condemn people on welfare. They have no choice in the matter. This is the only option society has given them, and that should be the point which you take away from a study of entitlements. Once you create them, it is inevitable that people will take advantage of them. Poor people are no different than rich people when it comes to opportunism. If you create a loophole in the tax code, then rich people are going to take advantage of it. Why shouldn’t they?

By the same token, poor people are going to take advantage of anything given to them for free. Why shouldn’t they?

So we should not be surprised by the fact that as soon as private charity became institutionalized as public welfare, it also inevitably mutated into an entitlement. Instead of receiving help with gratitude, people with an “entitlement mentality” receive it with certainty that they deserved it all along. And to be honest, once an entitlement is granted in a democracy, it is virtually indestructible. That’s because entitlements eventually translate into voting blocs — also known as special interests — and politicians for obvious reasons are beholden to the voters who vote for the politicians who granted the voters the entitlement in the first place. It’s called a vicious cycle.

Of course, the issue of public health care is a complicated one, which cannot be reduced simply to a discussion of entitlements. One underlying cause of almost any problem in our society today is the lack of an extended family such as existed for millennia before technology allowed us all to become mobile. When you lived in a small town with your mother and father and five to 10 brothers and sisters and your rich Uncle Allan and your great-grandmother Rose and you all knew each other and got together for holidays, then if you got sick, it wasn’t going to be the problem of Uncle Sam; it was going to be the problem of Uncle Allan and whoever else in the family had some money to help.

Today, it is much more likely that you live in a town where you have no relatives other than the immediate nuclear family. That means there is no private support structure — which is why more and more people turn to the government for more and more help.

Then, of course, you have to factor in the wonderful achievements of modern medicine. The average life expectancy increased by 50 percent during the 20th century. Over the course of about 160 years, life expectancy has increased by as much as 40 years. That is quite remarkable, and it means that health care costs for society as a whole have increased exponentially. You also have to kick in the value of all those high-tech gadgets and gizmos that diagnose us and cure us. Or if you want cheaper health care, you can just go to a hospital that doesn’t use MRIs, miracle drugs, computer-assisted surgery — you know, the kind of hospital they had 100 years ago.

But that isn’t going to happen, is it? Because everyone wants the very best medical care they can get — for obvious reasons. And because we are a caring people, American society tries to give it to them, but let’s be realistic about what that means — not just to the individual but also to the society.

It is nice that we live in a society where individual well-being is highly valued, but before we declare “quality” health care a human right, let’s remember that every time we “declare” a new right, it costs society money. The way that rights have been piling up lately, we may well be on our way to a bankrupt society. Perhaps that will come when we declare that everyone has a right to free food. After all, you need it to live, so why should you have to pay for it. Just back your truck up to the grocery store and take what you want.

Then we will have to change the old slogan to “There ain’t no such thing as a free lunch, but I’ll take mine with mustard on it.”

(Original publication date: April 16, 2006.)