What do we value?

Why do we owe people health care?

With no certainty about what lies on the other side of death, we all must place the greatest value on our continued existence. Yet there are limits to what people spend to preserve themselves. Most of us have finite funds, so at some point we exhaust our individual capacity for buying continued life in any increment. We value our family's survival, and most of us reach a point where we won't beggar our family for additional life. This is particularly true, since when we have reached that point in our illness, the additional life that can be purchased has little value. Sometimes life can be bought through another person's suffering. Again, most people are unwilling to pay this price if the cost is obvious.

Conversely, people will sometimes sacrifice themselves for others. Parents face danger for their children, soldiers for their comrades, firemen or police officers for civilians.

The point is there are limits to what a typical (mentally healthy) person is willing to spend on his continued existence. Given that the person most interested has limits, it must be acceptable for society to accept limits as well.

Your family also places a value on your life. Some people contribute to the support of the family, so they have true economic value. Courts consider this when determining liability in a wrongful death lawsuit. Family members have tremendous emotional value (again typically) to the rest of the family. Anecdotally, it appears that family emotional attachment leads to more extreme efforts to preserve a life than a person would expend on themselves. I would guess that the value a family puts on an individual's life is the largest any concerned party would assign.

Employers also have an economic interest in your health. Most likely, a company has some contractual obligation to insure your health. This obligation is strictly limited, since both your employer and its insurer are interested in maintaining profitability. In addition, your contribution to the company has economic value which would be disrupted by illness or death. Even when you are easily replaceable, your absence will disrupt the company's smooth operation. Loss of someone with unique skills will be correspondingly more devastating.

Your health also concerns your community. At a minimum, you are a source of tax revenue and consumption. To the extent that you volunteer, beautify your home, or participate in politics you enhance your city's quality of life, desirability, and stability. Your death or illness decreases the city's well-being.

There is a more tenuous connection between your life and health and the nation. I half-remember the idea of the social contract, where the nation provides benefits to me, which includes protecting my health and welfare to some extent and in turn, I perform my duty as a citizen by voting, paying taxes, and defending the nation if called upon.

It seems reasonable that the nation acts as insurance for my family and myself. Catastrophic health issues are relatively rare, so together, we should be able to afford some level of health coverage for all people.

There must be an explicit limit to the care that the nation is willing to provide. At some point additional care would require too much money. These limitations seem reasonable to me. Our current system has implicit limits to care that largely fall on anyone who is unfortunate enough to suffer some catastrophic illness. It seems that our system only offers choice and quality care to people who don't yet need it.

This has been a long, rambling, and delayed post. I am trying to develop the notion that the more distant a connection between you and any other person in the US, the less reason they have to support you during illness. However, there are more and more people as you get further from a direct connection, so adequate protection from illness should only require a small commitment from them. I have yet to address how much the nation owes you or provided an proof that such a debt exists. I have not yet addressed how much faith we can put in our existing valuation of life and health. I hope to write more cogently and often about these questions in the future.