Why I am here

I am here because, for too long I have stood on the sidelines of the debate about an issue I care about, talking to whoever would listen, but not doing enough. Will blogging be enough? Probably not. It's more, however, than I have been doing. I represent myself as an idealist. That term, however, immediately takes most of us toward a picture of pie in the sky unreality. I am an idealist. I am not, however, a Utopian. Nor am I particularly a believer in the fundamental goodness of human beings. In short, my ideals are not those most commonly associate with the term idealist. I have some thoughts and ideas about health care in the United States. About where it should go and how we should change it. About why many who are currently engaged in the public discourse on the topic either (1) are actually fighting a different war on this battlefield, or (2) are simply arguing from such a place of unreality that we should ignore them. It's important, though, that if I am going to ask you to read what I have to say on the topic, that I establish my bona fides and also reveal the ideals that I do hold, and hope to serve in a practical way. Bona Fides: I am an attorney. I work for a large technology company and have for many years. I have a degree in Human Biology from Stanford University. It was health care policy, as well as biological and medical ethics, that led me to go to law school. While in law school, I studied and wrote extensively on those topics. As will happen, though, the vagaries of practical economics, competing interests and chance took me in other directions in my working life. I have always maintained an interest and currency, however, in health and bioethics issues. I am then, an amateur, but a trained and well informed one. Ideals:

• Rationality. This is my foremost ideal. I believe that we, collectively in society and as individuals, will do better, be healthier, succeed more readily, live longer, precisely in proportion to our ability and willingness to (1) establish the facts of a situation as best we can and (2) apply logic to those facts to derive a way forward. Most of my other ideals flow from and are thus subsidiary to this prime ideal.
• We are responsible for ourselves -- the universe does not owe us anything. Many people search through life and are dissatisfied, often despondent, because they are unable to find "meaning" in life. I find this to be immensely counterproductive and narcissistic. We are alive. We have capacities to perceive, to think, to love, to feel, to create and procreate. When and why did it become necessary to discover some different, deeper, "better" meaning than that? And whence came the notion that we were entitled to such things? Which brings me to my next ideal:
• There is no such thing as a fundamental human right. The notion of inalienable rights is a convenient rhetorical device with no basis in reality. The rights we have exist because of a social compact. Human beings decided what rights to accord each other, and can decide collectively to take them away. Looking at this in any other way leads into a morass of belief structures and teleological arguments that inevitably distract from and degrade the quality of debate and conclusion on the topic.
• If we are to survive, let alone thrive, we must turn our attention and effort to those goals. The power of human ingenuity and collective action is truly breathtaking. Unfortunately, the vast lion's share of innovation and effort are expended in ways that either do not advance the utility and survival of the species and the civilization it has built, or actually actively take away from them. I believe we can find a way forward, fix what is broken, improve and expand what is not. But we must DO those things. Nobody else is going to.

Back to health care:

A few of the things I believe about where our health care system must go are probably now clear. Others flow less directly from the above ideals.

1. Health care is not a "basic human right," and such a label does not advance the discussion. Even if there were such things as basic human rights, how could health care, which is, at root, a service that human beings provide to other human beings be such a right? Are we seriously saying that the providers of health care are enslaved to the recipients? That we all have the right to demand service from others regardless of the scarcity of resources or the consequences to those who are bound to provide those services? Clearly, we are not, but labeling health care as a basic right leads inevitably to that conclusion.
2. Health care is a service that requires the expenditure of limited resources. Regardless of how much we would like to believe otherwise, we do not have infinite resources. If we are to provide a service, we must pay for it, in terms of the time of the people and the use of technology, innovation and things. Any resource we direct to health care cannot be used elsewhere.
3. The system that we use to apportion limited health care resources is very sensitive to which goals we chose to optimize for. This one seems obvious, but seems almost completely lost in the history and emotions tied up in the current debate. Are we optimizing for maximum healthiness across the entire population? Maximum quality of life? Maximum survival of every individual person? Maximum choice and availability of services? Maximum opportunity for profit by doctors and drug companies? Untangling this question and answering it is of paramount importance.