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What Health Care is Like: Seeking Supreme Analogies

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Health care is NOT like cell phones. Hold that thought.

Apparently, during the already infamously harsh second day for health care reform before the Supreme Court, one of the justices posed this question: If the government can force us all to buy health care, what can't the government do?

The justice then went on to suggest that the government could force us all to buy cell phones.

Why? Because health care is something we might all need some day in an emergency. A cell phone is also something we might need some day in an emergency. If the government can force us to buy insurance we might need some day to address an emergency that hasn't happened yet, it stands to reason they could force us to buy the cell phone we will need to call 911 to get the emergency response.

And if that analogy holds up, clearly we are on the slippery slope that leads to the government taking over our lives and telling us when to tie our shoes and wipe our... Well, you get the idea.

But this is about the worst analogy I've ever heard. If it's the best the justices can do, grasping at straws would be trading up.

Health care is something that every last one of us SHOULD get (i.e., in the form of preventive services) and virtually every one of us DOES get at some point, if not many points in our lives. People can make it through their whole life without a cell phone, and many do. Every prior generation did -- although they, too, had health care.

Health care is something you get without asking for it when you happen to be hemorrhaging, seizing, drowning, or unconscious. When you've been chewed on by a shark, hit by a train, or shot. The situations in which someone forces you to use a cell phone you don't want are -- well, few and far between at best. I suppose it might occur during a ransom negotiation if you are the kidnapping victim. But even then, you don't have to buy the cell phone!

If you don't buy a cell phone, the body politic does not automatically absorb the cost of cell phone use you need but for which you didn't pay. That is exactly what happens with health insurance. You will get health care in an emergency whether you can pay or not -- and the costs are passed along to those who can pay, without our will or consent. To my knowledge, I have never borne the costs of anyone else's unpurchased cell phone. But I do have health insurance. If you do, too, we have both borne the disease care costs of those who do not -- and nobody asked our permission.

Routine use of health care as recommended by expert bodies can save lives and money. I am aware of no such evidence regarding cell phones. In fact, if anything, there is some evidence that routine cell phone use may be causing potentially serious health problems -- but that's a topic for another day.

I could go on, but it's pointless -- because the point is self-evident. Health care is nothing like cell phones, or any of the other things that "might" come in handy during some future emergency: a bulletproof vest, a car, a ladder, a fire extinguisher, a helicopter, a Hazmat suit, a gas mask, a tank, etc. Truly, about the worst analogy I've ever heard.

So, what is health care like?

It's a lot like the police. We all pay for police protection which we might need some day.

It's rather like (non-volunteer) fire departments. Ditto.

It's something like the TSA. We all pay the costs of the TSA -- even those who don't fly! Is that fair? The question may be moot, since we're already doing it. But the events of 9/11 suggest it is fair, since victims of lapses in air travel security could be minding their business in an office building.

It's rather like the military, for which we all pay. We share in the costs of defending the body politic. Sharing in the costs of defending our bodies would be much like that.

To my knowledge, there is neither a Democratic nor a Republican uprising to eliminate the nation's police, or the military.

Health insurance is also like Social Security, and... a lot like health insurance, in the form of Medicare. We are all required to support Medicare.

It's true, some on the far right have called to have Medicare dismantled. But the program is so popular among seniors that one of the more effective attacks on health care reform was the suggestion that it would undermine Medicare. The bottom line is, we are all "forced" to pay for health insurance already -- and those of us who don't live past 65 will never benefit from it. But it's a done deal, and not going away.

One of the arguments against my analogies might be that some of the services -- such as police and fire -- are provided by state or local government, not the feds. Much is made of that distinction. Far too much, in my opinion.

For one thing, I am an American. I was born in California, and have lived in Massachusetts, New York, New Hampshire, and Connecticut. I have never lived in another country, and never seriously considered it. I have been an American, and proud of it, every step of the way.

For another, I cross state lines all the time. I was in Maryland and Pennsylvania last week, and will be in North Carolina tomorrow. I don't want to review a tome of fine print to know what fundamental rights and protections are left behind at every border.

We also wind up with a potential problem of inequity if health care access changes at state borders. If New York requires coverage and New Jersey does not, what happens if an uncovered person from New Jersey gets into a bad car crash in New York? I don't think anyone -- Supreme Court included -- is suggesting they be left to bleed in the street. But when they do receive emergency care in a New York hospital they can't afford, who pays? Presumably, the citizens of New York -- who now pay a "tax" of sorts on behalf of their neighbors from New Jersey.

Whatever one thinks about state autonomy, we are Americans -- and some benefits and burdens work best when shared. I take comfort in the fact, for instance, that Maryland, Pennsylvania, and North Carolina have police and TSA as we do here in Connecticut -- and that all are under the same protective umbrella of the U.S. Military. Hurrah to that.

And regarding that military, by the way: It is the very epitome of a socialist institution. Socialism has been the rallying cry of opposition to health care reform and almost every other initiative of the current administration. But this and every president is commander-in-chief of a socialist military.

And while we're at it, the Catholic church, and every other major organized religion, is also pretty socialist. What, exactly, did we think organized religion was "organizing"?

So here we have it. Not an attempt at Constitutional scholarship -- I readily acknowledge I'm not qualified. Just an effort to identify some supreme analogies. Or, at least, analogies that make a bit of sense.

Maybe if the heavy hand of a government run to socialism can require us to purchase health insurance, they could ALSO require us to pay for police forces, fire departments, the TSA, Medicare, and our military.

Oh, wait -- they already do. And yet still, I tie my shoes and wipe my... nose when I decide.

That was a close one! But apparently, I won't be forced to buy a cell phone any time soon.

Can somebody lend me one? I'd like to call the Supreme Court to let them know.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

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