The usual thing.  A party.  Neighbor asks what I do.  The usual discussion.  Universal healthcare.  Neighbor asks, “But why should my tax dollars support healthcare for, say, people who smoke, or who made themselves obese and then can’t seem to control their diabetes, people who never exercise, or who drink and drive?”

There are, of course, plenty of assumptions to be noted and subtle philosophical arguments to be made here, including:

  • Whether “Love your neighbor” has a codicil that says “if they deserve it.”
  • How absolutely voluntary lifestyle choices are that seem to correlate so tightly with socioeconomic status and ethnic group?
  • How certain we can be that such problems as obesity and diabetes are due to current lifestyle choices, rather than genetics, environmental factors, what you were fed as an infant, or even what your mother ate before you were born
  • How, exactly, we could determine which people “deserve” access to healthcare, and which don’t

But there is one factor that overrides all others and makes any answer moot, and renders the question a mere Scholastic exercise, a philosophical brain-twister, and it is this:  We already pay to treat these “undeserving” people.  One way or another, through higher taxes or higher healthcare costs, we pay to treat them in emergency rooms when they come in suffering from diabetic shock, or emphysema, or whatever acute phase their problem has brought them to.  We pay for their care in the most intensive and expensive environment possible, when their disease has reached the most intractable state.

If we converted to a universal healthcare system, and if that system encouraged strong outreach, with rich preventive, educational, home, and chronic care components, the cost might well be negative.

Furthermore, our current system carries the burden of significant distortions caused by our cultural denial of the fact that we are giving the uninsured billions of dollars of free care – hidden in the budgets, mostly, of hospitals, many of them on the brink of failure.  Covering everyone would allow for structural changes that would bring greater efficiencies to all of healthcare.

If we are unmoved by arguments from charity and equity, we should extend coverage to all Americans out of sheer selfishness – it will lower the costs of healthcare for all Americans, not just the uninsured.