#someanswers

SOCIAL CONTRACT THEORY: The Basis of American Values and Governing

“Because before we can go outside the box, we first have to know what’s inside the box.” -Bobbi Miller, Adjunct Instructor of English at the University of Hartford

Let us embark on a journey to the scorching June 1776, when Thomas Jefferson, John Adams, Benjamin Franklin, Roger Sherman, and Robert R. Livingston were appointed to a committee to draft a declaration of independence, and their britches were stifling. Look good, feel good...right? 

What a time! Thomas Jefferson especially found himself consumed with the ideas of the Great Enlightenment, ft. our star philosophers: John Locke and Jean Jacques Rousseau.

Jefferson was a very self-conscious person but despite this, the other members of the committee voted for him to make the rough draft of the Declaration of Independence. They thought that he was the best writer of the group, although John Adams would come in second place in the vote. 

As it pertains to the Declaration of Independence, the ideas from Locke and Rousseau that Jefferson drew from specifically were in the area of social contract theory. Here I should note that while the Declaration of Independence holds no legal standing today, it is the document that dissolved our paternalistic bond with the British Crown. Therefore, it is the founding document of our nation and relevant to the conversation we are having about why the government is allowed to do certain things. By the end of this, you will come to see how the recent legislation on health care is well within the social contract which founded our country effective July 4, 1776. 

The social contract depicted in Jefferson’s Declaration of Independence was used to justify the dissolution of ties with the British Crown. Here, Jefferson combined the ideas of Locke and Rousseau on social contract theory to form the amalgamation of ideas that went into the Declaration.

Locke said essentially:

All men were born in a “state of nature”, where they had “natural rights” to life, liberty, and property by virtue of existing.

Here, natural rights are defined in the above bullet and are precluded from infringement due to the nature of their existence.* A social contract exists to protect the natural rights given in a “state of nature”, where other rights are limited in exchange for protection of natural rights.

For clarity’s sake, I am going to quote Locke directly: 

“A state where men have the right to freedom, to order their actions, and dispose of their possessions as they think fit. A state of equality, no one having more than the other.”

Rousseau on the other hand, brought in one of the most important pieces of the social contract which is at the heart of our government: that a social contract has to be a “reciprocal commitment”. Meaning - the people being governed must consent to the proposed government, otherwise the government is invalid. 

Essentially, it all boils down to this:

^here, “give power” may be equated with the giving up of certain rights in exchange for protection of natural rights. 

The diagram should allow you to easily see that from Jefferson and those who recognized social contract theory’s point of view, their replacement and overthrowing of the British Crown was 100% justified. 

Jefferson & the Continental Congress @ the British Crown:

So, how does any of this relate to government involvement in health care?

One of the more beautiful things about our government is precedence. The precedent that the Declaration set forth was that this new government that “was and of right ought to be, free and independent states” existed for the purpose of protecting natural rights, which, as we all know, they enumerated as life, liberty and the pursuit of happiness. 

Thankfully, this precedence showed up again when we decided that America needed a constitution. Article 1, Section 8, clauses 1 and 3 of the US Constitution is where the government derives its ability to make these laws. You’ll see that life, liberty, and pursuit of happiness have been condensed to “general Welfare of the United States”. Here’s the text:

Clause 1: The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States; 

Clause 2: 

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

Just to break things down, here’s what the government has the power to do re: healthcare, in theory, by clause:

Clause 1: 

Ability to define “provide for the...general welfare” to include health care, and therefore use that definition to enact laws regarding health care and everything which it encompasses. Of course, there are limitations, and that is where the Bill of Rights comes in. But, it should be duly noted that the due process clause of the fifth AND fourteenth amendments can be used to expand even further the government’s ability to make laws regarding health care.

Clause 3:

In an economic sense, health care is a good, and therefore commerce. This clause has been expanded to include regulation of all commerce, especially after the Wickard v. Filburn ruling of 1942. This gave the federal government power to regulate all commerce at interstate, intrastate, and international levels.

I would like to close with a very recent example of the social contract theory being invoked, by none other than Senator Elizabeth Warren (D-MA):

Modify that last part:

Part 3: What Now?

The GOP measure to repeal and replace Obamacare has failed. 

(RIP BIG ANG I MISS U)

Senator Mitch McConnell (R-KY) was stunned by the decision of Senator John McCain (R-AZ) to vote against the repeal. He then called the Democrats to action to “propose what they think we should do”. 

Here’s Some Answers on that!!

This comes as a big win for the millions of American families who would have been robbed of their healthcare by this repeal. That said, Obamacare does need some important adjustments. 

Rates, while rising slower than in the past, are still rising.

Drug companies have benefitted from longer lives of patents.

Drug companies are profiting from selling drugs developed using our tax dollars.

Deductibles are inhibitory to the use of insurance.

There are still uninsured people. 

A complex tangle of payers and providers still exists, at large cost to patients. 

Thankfully, someone has been trying to give us the answer we are looking for: Rep. John Conyers (D-MI)

Rep. Conyers has been drafting a bill since 2003 on single payer healthcare. As is standard procedure here at Some Answers, we must first begin with all of the facts.

In Part 1 of Some Answers re: American Healthcare, we went over how Article 1, Section 8, clauses 1 and 3 of the US Constitution gives the legislative branch the right to make a law on single payer healthcare. Here, it would be an extension of their power to “provide for the General Welfare” of the United States. For more info, check that link above to the post^.

So, it is constitutional to do something like this. Yet, even things that are constitutional can be bad ideas. What else makes single payer a good idea?

What we have tried before:

No insurance: let us recall that insurance was created out of the fact that healthcare was too expensive for Americans to afford in the Depression. 

Limited Insurance: as we all know, pre-ACA insurance was a “you’re covered if” “but not if” “or if” “without X condition” entity. Here, the people with the most need for insurance couldn’t access it. The ACA worked toward more uniform coverage benefits. 

Insurance Required: The ACA required employers to offer qualified insurance plans, and for citizens to purchase insurance. While coverage expanded, many families still experienced significant hardships because of the high deductibles that these plans carried, along with huge prescription drug costs. Additionally, the ACA did not deal with the issue of underlying costs from insurance companies themselves, medical institutions, and doctors. 

What we have not yet tried:

Outlawing of insurance: in theory, without insurance medical institutions would be forced to charge market rate prices in order to see patients at all, as no citizen would be able to afford care at the current exorbitant costs. 

Single Payer Health Care: many are in love with this idea, but critics have spread many myths about this system. In this post, I shall dispel the myths and present why single payer is the option we need now. Essentially what we will find is that many Americans will come to love the idea, but as such a European concept, we need to Americanize it. 

DISPELLING THE MYTHS:

Access: “you’re going to die before you see the inside of a doctor’s office or emergency room”

Dispense with the dramatics, please. We’ve enough to deal with here. 

All nations with single payer or something similar prioritize urgent needs, like, if you have cancer or are bleeding profusely from a gunshot wound. 

Here’s the data for urgent but not emergent situations: 

Just to start, you’ll find that the US compares similarly to Canada in that it’s a 50/50 shot to get a same or next day appointment when sick, and in the percentage of people waiting six days or more for an appointment.

But, if you look at New Zealand, who has single payer, things seem to be working quite well! The majority of people get a same or next day appointment when sick, and the minority of people wait six days or more to get an appointment. 

tl;dr: NOT ALL SINGLE PAYER SYSTEMS ARE CREATED EQUAL. The good news? There are so many systems out there that we as Americans have the unique opportunity right now to pull all of the best parts of each plan together and create the best one to exist.

Cost: “why should I pay for someone else’s care”? or alternatively “how much more is this gonna cost me?”

The answer is: likely less. Surprisingly less. 

As we saw in Part 2 of Some Answers on American Health Care, there are many cost exorbitancies that the US does not address that every other system in the world does. Looking at the difference between US and NZ, there is an over $5k/person decrease in switching to single payer. What could you do with an extra $5k?

“BUT THE TAXES WHAT ABOUT THE TAXES”???

I told you to dispense with the dramatics. Here’s the data from our friends in NZ:

Here’s our current state of affairs:

Not that different, huh?

tl;dr: a modest increase in taxes, but mostly on high-earners, yields a great healthcare system for our friends in NZ. 

Take a look at what happens to the perceived health status between NZ citizens and the US. (data shown is % of people who feel that they are in excellent, good, or very good health)

NZ would see a higher perceived health status, but methodologies differed between the US and NZ, resulting in the decline between the two countries in high income perceived health status. 

tl;dr: a small tax hike on the wealthiest results in a ~14% increase in perceived health status among low income people. 

It’s time to change.

Here I have dispelled the four top myths about single payer healthcare:

You will not die waiting to see a doctor. 

It costs less.

It does not result in a burdensome tax.

It makes our most vulnerable low income populations feel healthier.

It’s possible.

The GOP wants to hear our plan? This is where we are headed. In the fourth part of this series, I’ll address the concept of “Americanizing” single payer healthcare to make it more attractive and in alignment with American values (including addressing medical education).  Why?

Last week, Senator Bernie Sanders (I-VT) and Senator Ted Cruz (R-TX) had a debate on CNN regarding the fate of American Health care. While watching, it occurred to me that the majority of Americans are simply uninformed on the issue and therefore may not be able to make the best decisions on the care they receive, or in voting for the people who make laws regarding their healthcare. 

Over the coming days, I will convey some answers to America which take into account the entire scope of the health care delivery system:

Part One: Why is the government allowed to make laws concerning my health care and my providers?

Part Two: What makes health care so expensive in the first place? Is Obamacare an adequate solution to lowering costs?

Part Three: Where do we go from here?

What is this?

Increasingly I see a massive amount of misinformation being spread, and I’m not talking about fake news. The above Oprah gif represents so many of us who just have no idea anymore. It has been the tradition for many years now that answers were equated with personal views. That is not correct. An answer (a correct one at least) is a fact based response to a question, and that is what you will get here.

Why are correct answers important?

Without correct answers, the world becomes a place where nobody is sure of anything. When answers stop being correct and begin to get subjective, the people who can kick and scream and cry the loudest get to spread their misinformation like a malignant tumor. Don’t believe me? Check on who we’re inaugurating this week... 

Further, think about a multiple choice exam, the current standard of accreditation for many professions. If your professor or teacher stopped holding answers to a standard of being based on facts and evidence, you would be able to bubble in any answer and get the credit. When this happens, anyone becomes qualified to be anything. This is dangerous, especially in high stakes job industries, like politics, finance, and medicine. Do we want to live in a world where:

Anyone can be qualified to manage your retirement account?

Anyone can be qualified to perform surgery on you?

Any person, regardless of track record, can be qualified to run your country?

These are true dangers and if we do not return to an era where correct answers are expected, they will become our reality.

Who are you?