The Essential Aims of the Just Society

[Originally written on 12 April 2007]

The three preeminent objectives of a democratic society must be justice, prosperity and longevity. The hope of attaining these central objectives is the basis upon which all policy decisions affecting a nation and its people should rest.A just society concerns itself with measures vital to the public welfare. It is through this concern that parity of opportunity and prosperity are achieved. Long ago the objectives of American society, and the proper functions of its government, were decided. Today, though the challenges which arise may differ from those of that time, the goal remains the same. It is our aim to create a just society, enabling all people to pursue their desired goals, fully utilize their potential and realize their maximum capacity as citizens. To achieve this, equality of opportunity is essential. Economic prosperity is indispensable. Only when government, as the collective agent of the people, commits itself to doing all that is necessary to achieve these goals can their achievement be assured.

A society plagued by ignorance is neither just nor capable of the prosperity necessary to ensure longevity. Government should and has undertaken the responsibility, in an admittedly sometimes ineffectual manner, to afford parity of educational opportunity to all of its citizens. The difficulty of this task by no means justifies an abdication of our responsibility to achieve it. In a multitude of other areas, from transportation to development assistance to public safety, government has assumed the responsibility necessary to achieve society’s desired objectives. In one crucial area, however, action has been long delayed: health.

As with education, it is difficult to refute that the vitality and progress of a society is inextricably linked to its health. Just as an ill-educated society cannot prosper, a society in ill health cannot endure. If American prosperity is to be obtained and sustained, access to medical care must be guaranteed. No nation can expect for long to reap the benefits of abundance if it denies the benefits of quality medical care to a large segment of its population. The economic health of a nation can be no greater than the health of its people.

The necessity for action is not at all difficult to ascertain; a thoughtful examination of the relevant facts is all that is required. The current American health care system is broken. There are few who would deny the classification of the current state of health care as that of a crisis, both because of the hardship the system imposes upon the nation’s economy and the needless suffering it inflicts upon its people. Paradoxically, as costs rise exponentially, the percentage of Americans able to acquire medical insurance, which is the only plausible means for paying for most medical services, continues to decline. According to the National Coalition on Health Care, a non-partisan policy analysis entity, health care costs are rising at a more rapid pace than at any time in the nation’s history. In 2005, the nation’s total expenditures for health exceeded $2 trillion. This figure is projected to double by 2015 (“Facts”). The economically unsustainable nature of this alarming rate of increase is evident, and its impact on individual families and the overall population is extraordinary.

First, nearly forty-seven million Americans are uninsured, a staggering sixteen percent of the population (“Income”). This is the reality despite the fact that the United States spends, per capita, more than any other industrialized nation on health care. The United States remains the only industrialized nation which does not guarantee coverage to its entire population. According to NCHC, eight in ten of those lacking insurance in 2005 were working Americans. The percentage of working Americans lacking insurance rose from 18.5% to 20.5% in just one year and now stands at a higher rate than the uninsured rate for the overall population (“Number”). It is indisputable that the nation’s workers contribute immensely to its economic vitality and fully demonstrable that the health of a worker factors greatly into his productivity. This increase is a clear indication that the health care crisis is rapidly worsening. The gravity of this crisis commands immediate and bold action. Its impact on families is too tragic, on businesses too detrimental, to permit continued delay.

The nation’s small businesses are especially impacted by the current crisis. Small businesses employ nearly one-third of the workforce, and in recent years have been responsible for a high percentage of new jobs created in this country (Gunderson). It was in recognition of the importance of healthy workers that employers, when costs were stable, elected to assume shared responsibility for the health insurance costs of their employees. For nearly four decades, this employer-employee cost-sharing system had been the foundation of the American health care system. Over the last two decades, however, small businesses have found it increasingly difficult to cope with rising costs. In 2006 alone, health premiums for employer-based plans rose 10 percent. Since 2000, the percentage of small firms offering health coverage has declined from 66 to 60 percent. (“Economic”). These cutbacks come despite a consensus in the business community that covering workers is not only essential for economic purposes but morally right. According to the NCHC, small businesses offering medical benefits report high recruitment, retention, employee attitude and performance, employee health status and high worker productivity. By contrast, firms unable to provide benefits report opposite conditions (“Economic”).

American prosperity will be needlessly jeopardized if existing trends continue into the future. It is illogical to expect to maintain a competitive edge in this competitive global economy if the health care crisis is not addressed; if we do not, as every one of our competitors has managed to do, develop a system to cover everyone. Productivity will suffer. Job growth will be stifled. Wage increases will be suppressed. Personal debt will continue to rise. Consumer prices will rise due to reduced worker productivity and increased hiring costs for producers. The creation of a system of universal coverage will put the United States on equal footing with its global competitors, helping to establish an economic climate more conducive to sustained economic growth. It is in the interest of all major players in the economic realm-- business, labor and consumer—to make universal health care a reality, for it will improve worker productivity, enhance the overall quality of life and reduce consumer costs.

The current health care system is, ironically, one that invites higher costs and restricted access. The current system renders preventative care inaccessible to uninsured individuals, permitting illnesses which are easily preventable or treatable in their earliest stages to pervade and evolve into much more serious health matters which, of course, entail a much higher cost to address. The uninsured are at least 30 percent more likely to be hospitalized for a preventable condition than those with insurance. For the treatment of these various preventable illnesses, often in the emergency room, the United States spends nearly $100 billion each year. Of this amount, nearly $34 billion is never recouped, instead being passed on to the insured consumer in the form of higher premiums (“Facts”). The inability of so many to obtain preventative care perpetuates the very system which robbed them of that opportunity to begin with, and keeps costs on the rise while coverage continues to decline. It is a vicious cycle that must cease.

The economic detriments facilitated by the existing system are compelling, but they only tell a part of the story. The economic costs the current system entails are far less important than the human suffering it inflicts. The economic costs are great, but the human costs are so much greater. Lives are wasted, and indeed sometimes lost; potential is sapped. An estimated 18,000 Americans die each year because they are unable to obtain medical care (“Number”). Countless more are forced to live with crippling and debilitating illness which could have very easily been prevented had they obtained medical attention earlier. This suffering is not only depressing, but entirely unnecessary. Other nations have recognized this and acted to solve the problem. The United States can and should do the same. Universal coverage is not merely an economic necessity, but a moral imperative. Condemning so many to ill health solely because they cannot afford medical care is inconsistent with both the values and goals of a just society. The denial of adequate medical care to eight-and-a-half million children is especially unjust and unwise. A just society can ill afford to leave so many of its people behind. The United States is capable of extending the benefits of modern medicine to all its people—and it is both advantageous and just to do so. Universal availability of medical care is essential to American competitiveness, prosperity and longevity. Health must become the new freedom, for if this nation and its people are to realize their full potential, prompt and indiscriminate access to medical care is indispensable.

Problem identification is not sufficient, however. Solutions are needed, not rhetoric. The creation of a system of universal coverage does not require the institution of socialized medicine, for such a system would be both woefully inefficient and repugnant to the highest principles of American society. It does not require draconian tax increases that will inhibit rather than enable economic growth. All that is needed is a responsible reform of the method through which health care is financed, shifting from the current premium-based system to a payroll tax system in which the tax is set as a percentage of an individuals income. Health care premiums for many individuals and families comprise one-third or sometimes one-half of their total incomes. This is unreasonable and unsustainable. It perpetuates poverty and despair. The creation of a payroll tax-financed system will enable all Americans to acquire coverage at an affordable price. No American will receive something for nothing under this new system, nor should any expect to. Rather, all will pay according to their ability and none will be denied coverage.

Long ago it was decided that a great part of the American covenant was shared responsibility in those areas which are of the greatest importance to the national welfare. It was in allegiance to this covenant that public education was established to guarantee every child the opportunity to fully develop their mental capacity and make the most of their lives. It was in the spirit of national community that Social Security, Medicare, Medicaid, job training programs, et cetera were created. These programs, derided by some as part of a larger “condescending agenda of welfare liberalism,” are today an essential part of the American social safety net. To be sure, they are subject to abuse. They are, in some areas, plagued by inefficiency and waste. However, at their core they represent an abiding faith in the American community, both contributing to the national welfare and serving the national interest. The occasional difficulty of maintaining them in no way diminishes the necessity of their existence. Their existence confirms this nation’s commitment to the greater good, a just society and the fulfillment of its oldest aspirations. But by no means is the job done. Until every American, regardless of their station in life, is guaranteed access to medical care at an affordable price, the great American covenant will be unfulfilled, the conscience of this just society will be unsatisfied and its most timeless aims will go unachieved. Reform is possible. The economic realities of today demand it. The moral conscience of a nation commands it. A just and innovative nation can achieve universal coverage, if it will.

Works Cited

“Economic Effects of the Uninsured.” National Coalition on Health Care. 2007. 12 April 2007 < http://www.nchc.org/facts/economic.shtml>.

“Facts About Health Care.” National Coalition on Health Care. 2006. 12 April 2007 <http://www.nchc.org/facts/coverage.shtml>.

Gunderson, Linda. “Number of Uninsured Continues to Rise.” Annals of Internal Medicine. 15 September 1998. 12 April 2005 <http://www.annals.org/cgi/content/full/129/6/513>.

“Income, Poverty and Health Insurance in the United States in the United States.” The United States Census Bureau. 2006. 12 April 2007 <http://www.census.gov/prod/2006pubs/p60- 231.pdf>.

“Number of Americans Without Health Insurance Reaches Highest Level on Record.” Center on Budget Policies and Priorities. 27 August 2004. 12 April 2007 <http://www.cbpp.org/8-26-04health.htm>.