Wonks Anonymous has heard a great deal of talk about fairness in the debate over health policy. Often opponents of universal comprehensive coverage ask: Why should I, a healthy moral person, be expected to pay for health care for sick, possibly immoral, people?

And Wonks Anonymous answer here would be that life is not fair.

First, health is not just a matter of personal choice. Wonks Anonymous, for example, cannot consume alcohol without serious health problems. It took him some time to find this out and he required significant treatment to adjust to this reality. This adjustment was not made any easier by the fact that he was surrounded by people who could consume alcohol with no ill effects.

Most health problems are caused by our genes and can be made worse or better by our behavior and by medical interventions. Some are purely genetic - juvenile onset diabetes and cystic fibrosis. Others are genetic and behavioral - adult onset diabetes and alcoholism.

Illnesses with genetic and behavioral components can be treated with medical intervention and difficult personal transformation. Unless you have been there do not judge too quickly.

Now consider this scenario - developed by philosopher John Rawls -  suppose that you sit in some anteroom to the worlds, waiting to be born. You are told that you might be born into a body that will develop a serious illness or you might be born healthy. You do not know which it will be.

Your choice is this: Do you want to live in a world where each person bears the burden of caring for their illness alone? That would be a world where the sick are, almost inevitably poor. Or do you want to live in a world where everyone, sick or well, gives up some consumption, say a new wide screen television every year, and medical help is available to all at no additional cost?

In his extensive travels through the blogsphere Wonks Anonymous has heard the position that health care is a personal responsibility most often from people who know or believe that they are healthy and can point to some behavior that they consider causes their good health.

For these people Wonks Anonymous would like to paraphrase the old Greek saying: Consider no man healthy till he dies. You were not presented with the choice before birth and you may consider that everyone for himself is a pretty good plan, for you. You never know what genes or retroviruses lie sleeping in your body. You cannot foresee a sudden collision with a drunk driver.

Every day you are waiting to be born into an entirely new world where you may be healthy or you may be sick. Isn't it time to reconsider your choice?


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  • 1/2/2010 9:10 AM Lali wrote:
    Amen. Healthcare policy should be driven by medical ethics, not just pharisaic moral platitudes by free market cult members. And medical ethics are governed by the principles of equality and do not do harm through neglect or poor judgment.
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