On Point: The tao of health care

Stephen B. Young, The Daily Record Newswire

Two recent decisions should cause us to rethink how best to provide health care.

The practical need to do this is to contain the growing costs of health care, which, given the use of principles of subsidy and insurance coverage to transfer the costs of individual remediation to the rest of us, are becoming more and more a private concern and a public issue.

The ironic consequence, therefore, of looking upon health care as a right of individuals to get treatment is to give everyone else a stake in each individual’s expenditures as others are called upon to pay for the exercise of our right.

The first decision about health care that caught my attention was that of the American Medical Association to declare that obesity is a disease. This disease now affects one-third of all Americans.
If obesity is a disease, what is the best treatment?

The second decision was the now infamous one of July 3, 2013 — announced by a deputy assistant secretary in the Treasury Department — to delay for one year enforcement of the Affordable Care Act’s mandate for employers with more than 50 employees to provide health insurance or pay a fine.

This decision calls into question having employers pay for individual health insurance instead of letting individuals have their own personal health insurance policies, paid for out of their salaries. The cost to employers of paying for health insurance would be transferred to increased salaries paid to individuals.

This second decision has sparked a worthy national debate on whether we have a government of laws or just a government by executive prerogative in derogation of a constitutional tradition running back to Magna Carta.

My last column coincidently spoke to the point of a system of rule by law taking over from the revolutionary ideal of the “rule of law.” How sad actually that my worry was made very real at the moment I was writing my commentary by a very important regulatory act by the current presidential administration to ignore a law of Congress.

Failure to execute the law is an impeachable offense under the Constitution. Consider the articles of impeachment of Richard M. Nixon:

“Using the powers of the office of President of the United States, Richard M. Nixon, in violation of his constitutional oath faithfully to execute the office of President of the United States and, to the best of his ability, preserve, protect, and defend the Constitution of the United States, and in disregard of his constitutional duty to take care that the laws be faithfully executed, has repeatedly engaged in conduct violating the constitutional rights of citizens, impairing the due and proper administration of justice and the conduct of lawful inquiries, or contravening the laws governing agencies of the executive branch and the purposed of these agencies.

“In all of this, Richard M. Nixon has acted in a manner contrary to his trust as President and subversive of constitutional government, to the great prejudice of the cause of law and justice and to the manifest injury of the people of the United States.”

In 2013, restoring the health of our constitutional system and our politics is a conundrum for many other minds to ponder.

Today I want to suggest solutions to another equally baffling conundrum: how best to pay for health care in a free and democratic society living under the rule of law.

Both of the above decisions point to a way forward: Health care is more than an individual right; it is a personal responsibility.

We each have a moral obligation to others to minimize placing the burdens of our lives on them, unless they consent to the imposition. This policy builds on the ancient laws of negligence in all societies; we are each responsible for the external consequences of our actions. It may have been John Stuart Mill in his famous essay on Liberty who said that “my freedom to swing my arm ends where your nose begins.”

My doctor has told me that I am now a borderline type 2 diabetes quasi-invalid. And I thought I had been living prudently and responsibly in my diet and exercise. No matter; nature takes its course with me regardless of my desires and best efforts.

The point is that the best treatment for me is personal discipline in what I eat and when and how much I exercise. Improving my condition is first and foremost my responsibility, not my doctor’s and certainly not yours and all my fellow Americans.

The same moral truth applies to our newly declared disease of obesity: The best treatment for this disease is individual responsibility. Obesity is a condition that results very much from lifestyles. Change lifestyles and the disease abates. Who is responsible, then, for our lifestyles: them or us?

Of course, given the causes of obesity, those who provide us with food and drink also have a responsibility to be prudent in what they manufacture and sell.

But is it unfair to look upon health as a matter of personal responsibility first and foremost? I find comfort in shifting our moral perspective on health care from right to personal responsibility in both Buddhism and Taoism.

Buddhism does away with seeing ourselves as victims by putting each of us individually at the center of solving our challenges in life. The Buddhist Noble Eightfold Way of right thinking, speaking and acting is a process of continuous improvement in which we go inward to maximize our potential for living well in this not-always-so-happy world. Original, Theravada Buddhism, or the similar Buddhism as taught by the Dalai Lama, does not put the primary responsibility for our lives on others to make us happy.

Much of Chinese Taoism, and Chinese approaches to health care using yin and yang analysis of natural forces, also put the locus of good health on the individual person, not so much on the attending medical professional. The patient is looked to first and foremost to live a balanced life and to eat and drink properly so that Ch’i, or life-sustaining encouragement, flows abundantly and in the right channels. Of course, individual mental discipline — self-awareness, control over emotions, and following the Tao — is also tasked with the responsibility of not upsetting our internal equilibria.

In these traditions, health is seen to be mostly self-maintenance and less external intervention by outsiders.

As the Tao Te Ching says, a journey of ten thousand miles starts from where we are. To enjoy good health, therefore we should start with ourselves.

Now, to a similar conclusion, if the Obama Administration finds that enforcement of employer payments for health care is too complex and intractable, this may be a sign that the entire approach should be reconsidered.

After all, we backed into employee provided health care by accident during World War II. It was then accepted by the federal government as a benefit for workers on the home front that would not violate wage and price controls aimed at preventing war-time inflation.

But as a jerry-rigged expedient, it created unexpected consequences when employees changed employers (risk of adding adverse pre-existing conditions to the new insurance pool) and in imposing locked-in, fixed costs on employers facing adverse market pricing for their products or services.

Making health care a personal responsibility would eliminate those two problems, providing more security for individuals in having access to health insurance and flexibility for companies.

To move our payment system for health care in that direction, employers would pay more in wages so as to offset health care insurance premiums, and taxes on the economy (as we have now in Medicaid and Medicare) would provide subsidies directly to individuals in need.

Being responsible for our own health would be a kind of national service, the proud duty of thoughtful and resolute citizens.