Counterpoint

241 years ago, the Founding Fathers wrote these words:

“When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.”

134 years ago, the poet Emma Lazarus wrote these words that are memorialized on a bronze plaque next to the Statue of Liberty:

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!”

The current debate over the Affordable Care Act, aka the ACA or Obamacare, and its potential replacements is both distressing to witness and embarrassing to this great country. Democrats and Republicans should be equally ashamed at the baldly political, cowardly and cynical way in which they have addressed healthcare policy since 2009.

In 2006, I approached the campaigns of then Representative Harold Ford, Jr. and now Senator Bob Corker with a proposal for a healthcare plan with these elements:

• Establishment of a H.S.A. account for every child born in America linked to their Social Security number;
• Government funding of $2,000 per year into every child’s H.S.A. account until the child turned 18;
• Government-funded insurance policy for each child for any catastrophic medical conditions or disease that developed between birth and the age of 18; and
• Optional conversion of the H.S.A. between ages of 18 and 21 into a 529 plan account.

Representatives of each campaign politely listened and then suggested that I would have the most impact by writing a check to the campaign. Three years later, the ACA became the law of the land.

I have read the ACA in its entirety. It is terrible in so many ways, as would be expected by legislation that was largely crafted by a group whose most consistent exposure to life outside the Beltway is attending the Virginia Gold Cup. Something that affects almost 20% of the economy and 100% of Americans should have been based on a “Great Compromise” derived from an open conversation with the American people, not naked political opportunism by fewer than 300 people with a limited understanding of healthcare policy and delivery.

The ACA is starkly different than the United Kingdom’s National Health Service (NHS), on which certain aspects of the ACA were modeled. Perhaps the most notable aspect of the NHS is the reverence with which it is held by its citizen beneficiaries. The reason? The British actually thought about whether access to healthcare services was a privilege or a fundamental right.

The NHS website sets forth the principles and values that guide the NHS:

The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles:

• that it meet the needs of everyone
• that it be free at the point of delivery
• that it be based on clinical need, not ability to pay 

These three principles have guided the development of the NHS over more than 60 years and remain at its core.

America has never had this “conversation”. Unfortunately for Americans, our politicians either don’t care what we think or believe they know better about the philosophical underpinnings of something that commands 20% of the economy.

So, in the absence of having that conversation with the American public, I have been considering my now 12-year old proposal against two documents that form the fabric of who we are as Americans.

First, given the inability or unwillingness of our elected officials to collaborate and act constructively on a vital and universal issue, I believe that Americans are entitled to “dissolve the political bands”, whether figuratively by sharing their thoughts through letters, emails, and town halls or practically by sending an entirely new team to Washington, D.C.

Second, out of “a decent respect to the opinions of mankind”, I believe Americans “should declare the causes which impel them to the separation” of the politicians from their offices by insisting that American citizens should have the controlling voice in the discussion about whether healthcare is a privilege or a right.

Third, holding “these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness”, it seems that the foundational principle for any national healthcare policy is that every citizen should be treated equally, whether poor or rich or terminally ill or vibrantly healthy. Logically, a policy that applies to all Americans at the exact same time in their life, i.e. their birth, is the only one that can be truly equal.

Fourth, and most compelling from a policy standpoint, providing a financial foundation from birth should reduce inequalities in care across gender, ethnicity, location and any other category, as each child would have the resources to pay for his or her care. In turn, health should improve and costs should decline, as primary care is readily available for people for the first 18 years of their life.

Such a result would “seem most likely to effect their Safety and Happiness.” And it would certainly enable America to serve our “tired…poor…huddled masses yearning to breathe free” more equitably and efficiently.