we must all cultivate our gardens

As it turns out, the federal government is heavily involved in managing/subsidizing crop insurance for producers. "Under the Federal crop insurance program, private-sector insurance companies sell and service the policies, and USDA’s Risk Management Agency develops and/or approves the premium rate, administers premium and expense subsidies, approves and supports products, and reinsures the companies."

It's easy to see why the federal government has stepped in to play a role in this. After all, if our farmers go out of business, and there is a famine because there are no farmers to grow our food, people will die. We certainly want to prevent starvation. Well, I do. Maybe some will extend the free market even this far, but I personally will draw the line well before famine as a market correction tool.

As I understand how the crop insurance program is administered, we don't spend a lot of time worrying about whether the farmers are bad farmers. We don't moralize about their poor crop choices. We just insure them, because a harm to the farmers is a harm to the public if there is not adequate food.

If you agree that the federal government has a legitimate role in providing crop insurance, but does not have a legitimate role in providing health insurance, please explain how you view the goals of these two programs as differing. Because it seems to me that although people die more quickly from lack of food than lack of health care, they do die from both. Although I suppose you have to offset the number of people who die from botched health care annually.

In the case of both food and medical care, insurance provides the safety net for our economy as currently structured. If you're okay with one, why not the other?


suppose it's an obligation, and not a right?

Suppose we frame the current health insurance* debate in a different way?

*It is about insurance. "Health insurance"=/="health care," although the former should lead to the latter.

Rather than arguing whether American individuals have a right to health care (beyond what you can already find in EMTALA, and please God let's not consider repealing that), because people get very huffy about this concept, can we ask a different question?

Should we Americans collectively assume an obligation to "promote the general Welfare" by providing everyone access to basic health services, in the way that we have obliged ourselves to provide all children with access to a free public education (largely from each state's constitution, with the exception of protections for disabled children)?

Consider this: we have already agreed, by enacting EMTALA in 1986, that as a society we don't want to see people die because an ER turns them away if they can't pay. We have already assumed that obligation. But waiting until people are very nearly dead before we assume any obligation for their care is extremely expensive, and in the case of many ailments, just cruel. Think heart disease. Think diabetes. Think cancer.

We have already agreed, by enacting mandatory vaccination laws (although we have wobbled a little on this one with exemptions), that we have an obligation to protect the herd by requiring this simple public health measure. We also have quarantine laws to fulfill our obligation.

We have already agreed that we have an obligation to provide safe water to all (coughs Flint coughs), also pretty basic for health.

We have also agreed, via our Supreme Court, that it is a violation of the Eighth Amendment prohibition against cruel and unusual punishment to deprive prisoners of necessary medical care in Estelle v. Gamble, 429 U.S. 97 (1976). Let me repeat that. People in prison have a right to medical care (although even they can be charged co-pays).

It does not seem like that far a reach to propose that we have an obligation (collectively) to provide people who are not incarcerated access to health care before they show up at the ER, if for no other reason than to reduce the expensive ER visits that we are already obligated to fund.

Given the way our system is currently set up, rather than nationalizing the health care system, which sounds like quite the disaster, or providing everyone with a government doctor (which also sounds like a disaster, given how the VA has been struggling), making sure everyone has health insurance coverage seems the least disruptive path. Although nationalizing the insurance companies has a brutal appeal to me, and eliminating the middlemen in the long run through gentler measures will probably be helpful.

So for those of you who don't want to grant other people individual rights in this area, ask whether you might be shirking the societal responsibility that you have already undertaken. And see also this interesting analysis of the free rider problem in this area.

Not your brother's keeper, you say? Can we have a talk about the corporal works of mercy?