“I like to pay taxes. With them, I buy civilization.” –Oliver Wendell Holmes Jr.

Hello friend,

Have you ever been in the middle of one of your most mundane daily activities—exercising, depositing money at the bank, adding two numbers, driving to the grocery store, tying your shoes, stuff like that—doing your thing the way you have always done it, when someone comes along and points out a totally different way to do it? Or maybe they even ask you why you are doing it in the first place? Suddenly you are forced to defend something you have never even thought about before. You have always just done it. It’s how you learned, and you never considered another way. Never even realized there was an option. But then there it is, right in front of you. It seems so obvious that you cannot believe that you didn’t notice it all this time. And here you are, your mind freshly blown, with a workout that suddenly has you losing weight, doing “new math,” banking online, having your groceries delivered, or using the “Circle Technique” on your laces. It seems crazy! Has that ever happened to you?

I think that is happening to me with health care. I suppose it has been happening for many years, but it feels sudden. My mind is spinning with a new possibility that was there all along.

Let me just say up front what I want and why. I want “free” health care for all people, and I want it because ensuring people’s health and well-being is at the core of the kind of common human decency that I believe we owe to the people we share space with.  

I could go on and on for pages about the Why part, but let’s get right to the meat of things. I look at health care like any other thing that our parents and grandparents believed was the job of the government–using our tax dollars–to provide for our care and convenience. Without any of us even thinking about it, of course our tax dollars pay for a police force, the fire department, streets and highways, a sewer system, drinking water, a strong military, elementary and high school education, and environmental protection.

Seriously, have you questioned lately why we all pay taxes on those things? Have you ever questioned it? I haven’t. And when I do question them now, my answer is, “Of course I am willing to pay taxes to fund those services. They exist to provide my most basic needs and things that I value: protection from hostile forces, safe travel, order in my neighborhood, health, safe food and drink, education.” I can’t imagine ever opposing chipping in for those basics for all people. They are what I would deem essential, and no more for me than anyone else. I won’t say it is technically everyone’s “right” to have these basics, but it reflects our basic human decency that we see them as essential for all. Therefore, it is our obligation to provide them.

If you are with me so far, I think now is a good time to sneak in my basic question: How is health care NOT on that list of essentials? Honestly, I am trying to see how it differs and am struggling for answers. The only thing I can come up with is that, “It’s just how it’s always been in America.” (And, I must add, only in America.)

I suppose we all have the same blind spot I had until recently! I don’t think I am the only one who, if pressed for an answer, sees caring for the health of all as at least as important as providing fire protection for all or education for all. I don’t want to get into splitting hairs here since I have already deemed them all essential, but if forced, I don’t think it would be farfetched to suggest that, of those three just mentioned—health, fire protection, and education—health care just might be most important. In any case, I have yet to hear an argument that kicks it off the list.

But perhaps you want to quibble. Maybe you think the health and well-being of your neighbors should not be your concern, and anyway, you aren’t interested in paying more in taxes to help them out. They aren’t that valuable. So let’s look at some of the other stuff you regularly pay taxes for. As we do, try to build a sort of ranking system for how important—indeed, how essential–you believe these are relative to your own health and that of others you know. Here are just a few:

• City parks
• Space exploration
• Street sweeping
• Recreational programming
• Subsidies for agriculture and big oil companies
• The Arts
• Lifetime salaries for Senators and Congressmen
• National Parks
• Science research
• Zoos
• Corporate Bailouts (e.g. the auto industry or Wall Street)
• Libraries
• Snow removal

We could go on and on, of course, as our taxes go to so many different and important things. How is your ranking system going so far? I won’t bore you with how I rank them. I will only say that I don’t value any of them—value them for me or for others (and believe me, I really love libraries!)—more than I do health care.

I really want to make clear here that, before all of the defenses go up and we have to start battling each other about how we could pay for it, I am just trying to establish an agreement on what we VALUE. It is a separate issue. My point is that if we all agreed with me (this happens in my dreams, and it’s fabulous!) in thinking health care was at least as important (even essential) as things like education, clean water, and the police, then, logically speaking, we would be forced to agree that we ought to be willing to ensure equal access to health care for everyone by taking care of it with our tax dollars. By extension—and this is the painful realization part—if we have agreed on what we value and yet still fail to act to make it right, we are failing a moral obligation.   The blood of the uncared for is—literally and figuratively—on our hands. I am not okay with that.

I know, I know, you probably wanted to skim through that last paragraph really fast and get to the part where you defend your side by saying it is too expensive and our system is broken and it’s not your fault and such. I feel you. I really do. That’s why I think it is important to first separate the argument so that we are not conflating what we value (morally speaking) and what we are eager to pay for (financially speaking).

And believe me, I make no claim that I am any kind of an expert on how much everything costs and how much more or less we would pay if we blew up our system entirely and went to a single-payer system (a.k.a. socialized medicine, universal health care, or government-run health care). As a total amateur on these topics, my sense is that we already pay a ton for insurance premiums, co-pays, and deductibles, and it also seems like pharmaceutical companies charge through the roof and own so many of our representatives in Washington, DC. My guess is that if the insurance industry was dismantled and the pharmaceutical prices were government-controlled, so much of that money that we now spend could go to getting everyone equal access to quality care. I am sure there is a down side of it, too, because at this point, who really trusts the government to run anything, right?

But we are Americans. We take pride in the idea that we are exceptional. It is supposed to be our thing to figure out the best way to do stuff, and then to keep leading the way with our exceptionalism. If we look at the examples of all the hundreds of other countries in the world who provide health care to their people, and if we see problems in their systems, I feel confident that we could figure out the solutions and move forward with a system that affirms in action what we claim to value (Because Love does, right? It doesn’t just say.). I feel like the “changing our system will be too hard” excuse is weak and lazy, especially if the result is immoral. I think we are better than that. I hope we are. I feel like it is time to put our money where our values are.

How about you? Is health care something you value enough to put your tax money down to guarantee it for everyone? Open up your journal and try to keep an open mind as you parse through this sticky issue. I think this is an especially tough one to tackle with an open heart and mind because, for many of us, it is just something we haven’t ever considered. Our system has been this way our whole lives, and a suggestion to change something long-held usually meets with defense as a first reaction (because of course we are right). So, take a breath, and start with logic. First, is your health valuable to you? How valuable? As important as your safety? Your education? Your water? Your public parks? The arts? Which of the things that you pay taxes for do you think are moral obligations of a society to provide for its people? Which are things that are great and you value, but they aren’t obligations or essential? Which things that you are taxed on do you feel are a rip-off? For the sake of argument, let’s say we had always been taxed for universal health coverage: where would it fit with your last three answers: Moral Obligation, Important-But-Not-Essential, or a Waste/Rip-off? Based on your answer, should single-payer/universal health coverage be a part of the American system going forward? Okay, if you were able to answer most of those logically, relax! Now, feel those natural defenses that probably came up when this issue arose. What makes you most squeamish about agreeing to include universal health care to your list of givens? Is it the money itself (that you think it is going to be much more expensive for you)? Is it that you don’t want to put anything else into the government’s hands? Is it that you don’t think some people deserve it or that too many people who aren’t taxed much because they are poor will take advantage of your hard-earned dollars by using the health care system as much as you do? Do you agree with my assertion that if we agree that health is of such importance to us that we deem medical care to be essential—like we agree on education and safety and the like—then we are morally obligated to provide it? If not, where is the flaw in my thinking? If my thinking is sound, then we are either failing morally on this topic or you disagree that health is of such importance. Which is it? Leave me a reply and let me know: Which things are worthy of your tax dollars, and how does health care fit into your priorities?  

See yourself in your neighbor,

William

P.S. If this made you really look at health care and taxes for the first time, or if it made you think of them in a new light that helped you clarify your position, I hope that you will share it with others. We owe it to ourselves to examine our values. May you be Peace.