November, 2005

Since a friend's husband asked me that a few years ago, I've given it a lot of thought. I believe there are different answers on different levels.

On the top level, it's a moral question. I believe that human beings are entitled to the basic necessities of life -- what is required to keep them alive. Health care is one of those necessities. To not provide it to everyone is immoral. Is, in fact, evil. An estimated 18,000 Americans die each year for lack of medical insurance.

The second level is social -- what is required to make a society work, to keep it from flying apart. The cohesive factor, the glue that holds us together, makes us work for the common good.

I'm not a socialist or communist, but I'm not a pure capitalist either. Capitalism, if taken to its logical extreme, is a completely predatory system, and it destroys societies, because it gives people no reason to work together. Pure socialism, on the other hand, would destroy individual initiative. So I believe in a mixed capitalist-socialist economy, where we get the best of both systems.

Which system to use would depend on the nature of the goods or services produced. I don't want to buy a computer from the government (although I would buy it from a worker-owned factory), and I don't want to buy medical insurance from a corporation. We've tried that, and it doesn't work. It has given us the most expensive health care in the world, with measurable outcomes (life expectancy, infant mortality, etc.) below those of other industrialized countries.

Viable societies have to take care of their citizens, one way or the other. Societies which get greedy and don't take care of their citizens decline and fail. They gradually come apart, because there is no mutual support. The U.S. is already far down that road. We pay for it with a loss of prosperity -- as a growing minority of the population cannot buy goods and services -- and with a steady gnawing of the nerves which we all feel, whether we're willing to admit it or not. Rising alienation teaches us all that we cannot trust or depend on each other, and leads to a breakdown of marriage, family and other relationships. If you refuse to pay the necessary taxes to support a just society, get used to being lonely. What goes around comes around.

On a third, more personal level, my friend's husband is retired and his health insurance is provided by the taxpayers of San Francisco. Why should they do that? It is no longer the norm for American employers to provide health insurance to retirees. That system, under unregulated capitalism, is rapidly disappearing. Just in terms of self-interest, he had better stomp on the brakes.

The bottom line is, if you're not going to take care of others, don't expect them to take care of you. Most of us are living on the edge.