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Healthcare - who owns it?

Shortly after East Texas State University merged with the Texas A&M University System and became Texas A&M University-Commerce, President Jerry Morris appointed me to represent the University in several System-wide initiatives. One of the first was to explore ways for System institutions to play more active roles in community development and in enhancing the quality of life of communities in which System institutions were located. At the time, I was Assistant to the President.

As he had done with other representatives from other System Universities, the Assistant to the Chancellor for Community Development (Daniel Hernandez) met with me to plan a community development conference in Commerce. With input from various constituent groups, we agreed that the focus of the Commerce conference would be Health Care, specifically how Texas A&M University and the Texas A&M University System could help improve healthcare in Hunt County.

At the conference, I was tasked with moderating a panel discussion on the topic of the status of healthcare in Commerce and Hunt County. Panelists included a member of the Hunt County Memorial Hospital District, a locally elected official, a hospital administrator, and a physician. After I introduced the panel, I asked each of them to respond to a series of questions that I had been on my mind ever since the failed attempt by the Clinton Administration to address healthcare. The questions went something like this: Is healthcare a right or is it a commodity? Is healthcare something to which everyone is entitled and deserves, or is it a commodity that is purchased only by those who can afford it? Should healthcare be rationed, based on one’s ability to purchase it? Is healthcare strictly market driven or is there a role for the government? As I recall, the consensus among the panelists was that it was both because someone eventually must pay for healthcare. Someone on the panel pointed out that emergency rooms had become substitutes for primary care for most indigent patients. Thus, hospitals have ended up absorbing the costs of treating uninsured and indigent patients, or passing the cost on to insured patients or those with means. But there was more support among the panelists for the position that healthcare should be driven by market forces, and that those forces could be trusted to determine the winners and losers and to regulate, objectively, the costs and availability of both basic and specialized healthcare.

As I listen to the current debate on healthcare, nearly 20 years later, I find that those and other questions are being asked, and the same answers are being proffered. If healthcare is regarded as a commodity that is purchased by those who can afford it, what happens to the overall quality of physical and mental health of our nation? Will emergency rooms continue to bear the burden of treating uninsured, poor, sick people? Will poor, uninsured, sick people simply ignore their health concerns and experience increased morbidity because they can’t afford to pay? Ultimately, who pays for healthcare? Should everyone be required to purchase health insurance, as they are for auto insurance? What about a single-payer system? What about Medicare for all? Should Medicaid be expanded in order to supplement insurance coverage for the poor? Should there be a health insurance system in which older, sick people are placed in one pool; and younger, healthier people in another? Should birth control be a mandatory provision of any insurance policy?

If healthcare is a right and the government is charged with protecting that right, where does the money come from? Some say the wealthy should pay through higher taxes. Others say that the cost can be covered by re-examining spending priorities.

As I ponder the question of whether healthcare is a right or a commodity, I also ponder the question of whether education is a right or a commodity. Are there similarities and differences in the debate over healthcare and education? Can the same arguments be made on both sides about healthcare and education?

My next blog will focus on those and other questions: Should public tax money be used to fund private schools? Should decisions about public education be driven by market forces? Is competition from private schools beneficial or detrimental to public education?

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