Healthcare and the Benefit of the Commons

​Famously the only certainty other than death, taxes are not just a part of life, but for many people, they are a means to a quality one. Essentially, as citizens of the United States, we agree to pool some portion of our individual resources and allocate them to the shared needs of the community. Neither the collection nor distribution is equal; but there is an attempt for it to be equitable. That is, some people will require more of these shared resources that others. 

This is the advantage of pooling resources, or the benefit of the commons. Most people are familiar with the tragedy of the commons--when individuals expend a shared resource until it is depleted. ​The benefit of the commons is when individuals expand a shared resource until it is even more productive. Imagine you go out with 5 friends, and everyone agrees to split the bill. If someone order nachos ‘for the table’, and you eat half of the plate, you overutilized a common resource. If, on the other hand, you don’t like nachos, but agree to split the bill anyway, you increased the utility of that resource for the rest of the table.
​
This is common practice with pooled resources. For instance, we all pay federal taxes for social security even though not everyone may receive this benefit. We all pay for public education even though not everyone has children. We all pay for FEMA even though not everyone lives in disaster prone areas. The rationale is simple: we are all better off if the elderly are cared for, if children are educated, and if disasters are mitigated. We are a stronger society when we choose to invest in the collective good.
​
So why does this argument lose steam when it comes to healthcare? Health insurance (including Medicare, Medicaid, CHIP, and the ACA) now comprises the biggest government spending sector, and in a recent “The Weeds” episode, Dylan Scott expertly lays out how we got here. However, 40% of Americans struggle to afford healthcare, and this number is disproportionately higher for Black and Hispanic adults. So, why do some welfare programs face an uphill battle while others do not?

It could be semantics. Many dislike the term entitlement or welfare programs, but I would argue that all government spending from tax revenue is for the welfare of our country. Social security, public education, and disaster relief are obvious, but infrastructure, public transportation, medical research—even paying down the interest on our national debt—increases our collective welfare.

Consider defense spending. These funds go toward protecting our country, supporting our service members, and providing international aid, among other things. But at the end of the day, it is about keeping 332,000,000 Americans safe. We do not balk at the national defense budget because it literally saves lives, and as Thomas More said: “For nothing in the world can be of equal value with a man’s life.” Shouldn’t we apply the same logic to healthcare? The discrepancy may be explained in part by Hofstede’s cultural dimensions. For instance, the US is highly individualistic compared to other countries, focusing on ourselves and immediate families rather than larger social networks. Or it could involve our bias toward masculine values (heroism, achievement) over feminine ones (caring, quality of life). Perhaps as we move into the feeling economy, an attitudinal shift toward empathy will bring about a cultural shift in perspective.

To be clear: 1) much of our tax revenue already goes to healthcare, 2) a growing national debt is bad, and 3) fiscal responsibility is good. At the same time, the U.S. ranks 32nd out of 38 OECD countries on tax-to-GDP ratio, and we have the means to change this statistic. Still, my argument is philosophical not fiscal. If we agree on what we want our country to look like, we can work backwards to achieve those goals. Perhaps we believe that every American should be able to walk into a doctor’s office, clinic, or hospital and receive quality care. Perhaps we believe that this care should not depend on a person’s demographic profile, employment, socioeconomic or marriage status, accessibility to services, or ability to complete paperwork. If we prioritize those things, we can make it happen. We wanted the best military in the world, and we made it happen. We leveraged the benefit of the commons to ensure the well-being of our society because we made it non-negotiable. Our health deserves the same consideration.