The über-reliable Sean Safford has a longish post on orgtheory.net today about the shift in health care debate from fairness and equity to sustainability:
Sustainability is related to the notion of conservation in the sense that it is interested, primarily, in the preservation of the social system. But it shifts the nature of that argument significantly. Rather than focusing on the maintenance of order and stability through systematization, sustainability focuses on interdependence. Its origins are in the environmentalist movement, but I would suggest that statements like Leonhardt’s and even Ken Lewis’s suggest that is has spread to form an ideological basis for government action outside of concerns about the environment.
The argument goes something like this: We live in a highly interconnected society which operates within a series of interconnected systems. Resources (physical, material, social, and political) are not only scarce, they are extinguishable. The system is in place, not so much to keep social order, but to ensure the reproduction of the resources needed to reproduce society over time. Undermining any of the systems on which society depends threatens to have ripple effects on others. But importantly, the biggest threat to the system comes not from external threats, but from individuals acting in their own self interest in ways that could undermine the delicate balance on which interdependencies of the system depends. Government action is needed, not to ensure fairness, but in order to save us from ourselves.
His points on org theory and social movements are especially insightful, albeit brief.
As an example of the ripple effect mentioned above, think about the uninsured using hospital emergency rooms as primary care facilities. The uninsured wait until the situation is dire enough to merit going to the hospital rather than using preventive care or early treatment. The severity of health problems is likely to be more advanced than those of people who have coverage and regular check-ups. Treatment in the hospital emergency room–already expensive–becomes more so as advanced illness is treated. Cost soars. Unable to pay bills, the uninsured go bankrupt. Hospitals or insurance companies eat the losses and pass on the cost to consumers in the form of higher premiums. The now-bankrupt uninsured take advantage of government services, which increases the burden on tax revenues.
It would take more time than I have at the moment to dig out studies supporting the above scenario, but most of it should be fairly intuitive. If people who are uninsured get health care and cannot pay for it, the costs have to be absorbed somewhere. To a degree, a somewhat socialized health care system already exists, and it is a truly inefficient one.
If arguments for fundamental fairness in the most powerful country in the world aren’t enough, the economic case–including the current burden to individuals–should be more than clear.
[Note: chart above from AHIP.]