SKOWHEGAN — I have many right-wing friends and acquaintances who daily forward all sorts of email warnings about imminent collapse, plots by Barack Obama to take over the government and conspiracies by “liberals” to destroy the American dream. Usually they are filled with bold text, plenty of exclamation marks, dashes and rows of periods and end with a plea to forward the message through to all the people on my mailing list in the hope of saving America.

What none of them mentions in their discussion of impending disaster is the nearly 19 percent of the nation’s gross domestic product that is spent on health care.

Although good health care means a viable, productive population, when its cost reaches this proportion of our national productivity, it starts to become an end point in itself, an end point that does not provide for future growth. It becomes, in a sense, a debt that must be paid yearly and does not create anything for our economic future.

1986 law set up cost-shifting

Health care in America today is a badly wounded market. We have decided, as a society, that good health is a right owed to every citizen.

In 1986 Congress passed the Emergency Medical Treatment and Active Labor Act, which essentially requires all hospitals with an emergency department to treat individuals regardless of their ability to pay. This requirement has been reinforced and upheld ever since by politicians of every stripe.

Although the law only puts into words what most people would do anyway, it does mean that our medical system will treat and care for millions of people every year who do not pay for their services.

In order to have a hospital and staff, someone has to fund the physical plant and labor costs of running it. That means that those who are insured will pay for the free health care of others through their insurance premiums. Given that there are 48 million Americans without health insurance, that bill can be quite large.

How long would the automobile market hold up if anyone who had a car break down could go to the nearest dealer and demand a replacement without having to pay for it? How long could any market survive if the company selling the good or service could not exclude those unwilling to pay?


This is not the first time that Americans have had to deal with a crucially important service that can’t be supplied in a normal marketplace. In the 19th century, both fire and police protection were services that people purchased when they needed them.

If you lived in Portland and your house caught fire, you would contact the nearest fire station crew and they would try to put your fire out – after they determined if you were going to pay for the crew and equipment.

If you needed police protection, you hired a private detective or bodyguard. There were no public police departments as we know them. If a law were violated, you would complain to the court and they’d send a sheriff to investigate.

It was only after the population explosion in East Coast cities and major fires that burned out huge urban areas that police and fire protection became an obligation of the government.

Citizens of the day were every bit as incensed over the creation of municipal fire and police departments as they are today over Obamacare. They could see no reason why the government would tax them for a service that only a few would enjoy. Then, as now, most people could not appreciate how the general benefits of security for property and safety would enrich society.


The health care market is very sick and cannot survive on its own. No matter what we end up with for a health care system, the government is going to have to play a huge role in its administration.

Many, including myself, were not big supporters of the Affordable Care Act but supported some sort of government intervention in the market. Yet if Obamacare is anything like the great social legislation of the Johnson years, Medicare and Medicaid, it will undergo a host of changes and amendments over the next 50 years as we smooth out the problems and unworkable policies. The important thing is that we stop arguing about it and get it going.

One of the foundational themes of American conservatism used to be a belief in individual responsibility. At a minimum, requiring every citizen to help defray the national cost of health care by purchasing insurance is one way to get all Americans to share the cost of a service all Americans use. Given this point of view, you have to wonder if the real issue in conservative opposition to Obamacare, is Obama himself.

To quote the last email I received from a friend: “Please!!! ……… forward this threw to all the people on your mailing list so that we can save America!!!!!!!!!!!!”

– Special to the Telegram

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