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The Centrality of Values

The sun doesn't rise on a day in America when someone isn't making breathless pronouncements of impending doom about the dire state of rising health care costs.

Unless we do something soon – let the market work, find a government solution – the health care system will collapse under its own weight, American productivity and quality of life will decline, and millions will face a bleak future of rationed care and no good way to either access or pay for it unless they count themselves among the privileged few.

Leaving aside the historical point that pundits have been predicting the collapse of the American health care system for the past thirty years, what's really going on here?

In the larger sweep of things, the American health care system is the canary in the mine of competing social paradigms: growth and material progress on the one hand, and sustainable development on the other. As the $1.6 trillion industry grows to consume an ever larger share of the material pie, it threatens the future health and well-being of the very people and communities it seeks to serve.

What profit in a Medicare prescription drug benefit if we saddle future generations with its costs? What profit in a genetic fix for lung cancer if the air we breathe grows thick with pollutants? What profit in the profits of health insurance plans if the gap in health access and outcomes between the rich and the poor grows wider and wider? What profit in a massive system of acute, high tech health care if it begins to crowd out housing, education, transportation, environmental safeguards and other expressions of the public good that communities value?

Our bloated health care system is an expression of bloated social values, which grow exponentially to include erectile dysfunction, skin wrinkles, marriage counseling, aromatherapy, sexual addiction, social anxiety and God knows what else as potentially insurable events. Health care becomes a menu of "lifestyle" choices, the outcomes of which are increasingly measured in terms of the system's economic exchange activity, and less in terms of individual and social well-being. That's because the bottom line isn't health improvement, but economic growth. GDP share is how we measure progress.

There is a sense in which the proponents of an unfettered free market approach to health care get it right. Do away with the tax breaks, mandates, regulations and other impediments to the voluntary exchange between informed consumers and profit-seeking producers. Let information, goods and services flow freely. If we have to pay for it ourselves, the market will determine what we truly "value." With someone else picking up the tab, we're like the kid in the candy store. We want it all, and we want it now.

The other side of the growth coin is that more and more is not necessarily better and better. Physicians complain of doing more and enjoying it less; patients yearn for quality, caring relationships with providers; researchers demonstrate that higher rates of health care services don't necessarily lead to better health outcomes.

Many people working in health care aspire to a higher calling than creating wealth through economic growth alone. As professionals, they actually profess something: an abiding belief in helping those in need, a desire to maximize the health and well-being of others, a willingness to work together for the benefit of the entire community.

These people choose to remain part of the nonprofit world. Whether that choice will continue to be viable in the emerging industrial model of commodity-driven health care is the issue.

While we stand at the wailing wall of health care costs, a revolution of rising expectations in a shrinking world swirls around us. We won't see a clear path ahead if we look through the lens of business and economic models alone. We need to rediscover the language and means of civic discourse where freedom, fairness and compassion are more than marketing slogans. We need to restore meanings and values to the centrality of the health care debate.