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Q: What if some people can't pay?

So I'm out spreading the word on P.S.Y.C.H. and getting great feedback. Most liberal-leaning folks I talk to are all for it but they get caught up in the what-if-someone's-poor-and-can't-afford-even-those-set-prices-for-healthcare question. My standard answer for the time being is that since healthcare will actually be affordable, everyone will be able to pay for it. But there's a larger philosophy that I want to touch on.

Universal access to health care should not be generous. Let that soak in while I explain why.

While I was at Baylor, one of our assigned readings was Machiavelli's "The Prince." I ran across this quote and it's resonated with me ever since:

And there is nothing that uses itself up faster than generosity, for as you employ it you lose the means of employing it, and you become either poor or despised or, in order to escape poverty, rapacious and hated.

Initially, like every young brash college student, I took on lots of Machiavellian dogma; I thought people were "greedy" and "out for their own gain." And while some of that may be true, it's not a universal concept for a society such as ours. After all, if we truly were only out for ourselves, we wouldn't obey traffic laws, wait in lines, keep our hands to ourselves, etc.

But Machiavelli is right about generosity. People value less things that they don't have to sacrifice for. The resulting imbalance breeds social discontent and spite.

Universal access to health care should be fair, and paid for by each able-bodied and able-minded citizen in our society.

As a child psychiatrist, I get to see the beauty of child development almost every single day. I see the wheels turning as I work with the concept of fairness. And here's the heartening part: almost every single kid (barring brain injury or profound intellectual disability) eventually understands the concept.

So fast-forward to today: where did the concept of a generous health care system come from? Where would adult people who learned the concept of fairness at an early age get the idea that it's socially acceptable to use a service (e.g. urgent care) and not give something up in return (time, money, effort)?

I would purport it comes from our internalized anger toward a system rigged against us. It's a "fair" system in that health insurance companies, drug companies, hospitals, etc. are playing by the rules we've created as a society. The rules just don't favor us. And because we are now the victims of a system we helped create but feel powerless to change, we resort to breaking our own tenants of fairness.

But I don't blame us – unless we consciously decide to continue wallowing in our misery despite having a new paradigm to turn to.

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