The most basic question about health care reform is an old one: Should basic care be a right for everyone, regardless of income, pre-existing illness or bad genes, or should it be a privilege obtained by hard work or bestowed by good birth?
We would never argue that police and fire protection should be distributed according to income, so why should health care?
That's an emotionally charged issue, but there is one observation almost everyone agrees with: Our present health care system (a messy mix of personal, employer and government health insurance) badly needs reform.
We spend more than twice as much per person on health care as other industrialized countries do -- about $6,100 here versus an average of $2,550 elsewhere in 2004 -- yet we are the only such country that does not provide universal insurance coverage. How can that be?
Unfortunately, there is often no correlation between amounts spent and results.
For example, in 2000, Medicare spending in Manhattan was more than $10,000 per person versus less than $5,000 in Portland, Ore., and Portland had better treatment results.
We will spend more than $2 trillion (yes, that's a "t") on health care this year. Yet we rank last among 23 industrialized countries in infant mortality. One major reason for these appalling numbers is the huge number of uninsured or underinsured in our country who do not get timely care.
So why not make health care a right so every American can potentially benefit from early intervention and better prevention?
The Abuse Argument
One of the arguments against universal coverage usually unfolds under the ironic label "moral hazard" -- that if morally weak humans are offered something "free" (meaning that someone else is paying for it) they will abuse it.
For example, a bowl of free candy will disappear much more quickly than candy you have to pay for yourself.
But that argument assumes that people would consume health care in the same way they gobble down free candy. I think that conclusion is crazy. Other than seasoned hypochondriacs, who wants to visit the doctor unnecessarily or go into the hospital just because you have insurance instead of going to the beach or playing golf?
Of course, there will be some abuse, but that should be easily outweighed by offering many more of us a chance to become healthier, not to mention have a better shot at life, liberty and the pursuit of happiness.
Indeed, the real moral hazard when it comes to health care is what we are doing right now: not providing basic care to our citizens through cost-effective health insurance for everyone. Not only is it the "right" thing to do morally, but I would argue it makes sense economically by providing prevention and care in the early stages of disease when it will usually cost less and be the most effective.
Better to treat pneumonia early with antibiotics than end up in the intensive care unit on a respirator with lung failure.
Some experts argue that with more thoughtful use of the money we now spend (electronic records to replace paper, better bargaining for drug and device prices and so forth), we can provide basic care to everyone with relatively little increase in total expenditure. Efficient health care systems such as the reformed Veterans Administration hospital system already make a case; the VA, which provides superb care, costs about $5,000 per patient annually versus $6,500 for private Medicare patients.
And here is a final question: How long do we want to be known as the wealthiest country in the world -- and the only one that does not provide universal health insurance when we could and should?
Timothy Johnson, medical editor for ABC News, provides medical analysis for "World News," "Nightline," "20/20" and "Good Morning America." This essay was published in USA Today, a partner in the Prescription for Change series.