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The last healthcare system study performed by the World Health Organization, in 2000, ranked the United States at 37th in the world.  This abysmal performance is startling, since the citizens of the United States pay approximately twice as much per person than France, the nation ranked with the best healthcare system.

How can it be that at least 36 other countries in the world are able to provide superior care to every person within their borders at a much lower cost? The first reason is prevention. The US General Accounting Office estimates that providing everyone with common healthcare prevention tools will save 40% in cost.  Next, it has been estimated that the administrative costs of the current private health care insurance system adds 31% to the cost of the health care. Compare this to only 3% administrative costs for our current government-run Medicare and Medicaid systems. Of course, the 31% does not apply to the entire US population, only those who are privately insured. These people, who don’t seem to understand how it could cost less to provide health care to all of the currently uninsured, might not understand that we are already paying for the uninsured. And we are paying an exorbitant rate for the inferior care of the uninsured. Most of the uninsured receive their health care through emergency rooms:  the costliest means of providing primary health care. Also, since a disease is much less likely to be caught early without full access, the cost of treating the disease becomes much higher when it is treated in the later stages of development. Additionally, when the primary health care is through emergency rooms, there is no coherent treatment plan or ongoing care:  only the emergency room doing just enough to meet the minimum requirements for that moment. Diseases which could be cured, or maintained, with a minimum of care in a normal clinical setting, become chronic and debilitating in the uninsured scheme, extending the expensive, but inferior care that taxpayers end up paying for.

But should we be concerned with providing any healthcare to people to begin with? The answer is a resounding “Yes!” But isn’t healthcare just another commodity that should be treated with the same free market supply and demand parameters as other commodities?  The answer is “Heck no!” The reason that many people do not understand this is that many people have not been presented with the understanding of the difference between a good that operates under Social Norms, and one that operates under Market Norms.

The United States has a social contract with its citizens.  We, as a society, have created this contract in many ways, the most prominent being the expectation that the citizens will defend their country.  When threatened, our society reserves the right to initiate a mandatory conscription, or “draft”, of its citizens into its military. The citizens are required to give up their freedom, and possibly, their health or very lives, as part of the social contract.  In the discipline of Behavioral Economics, the social contract is part of what is called “Social Norms”.  Social Norms create obligations that are not based on monetary exchange.  This is opposed to Market Norms, in which the goods or services are purchased by way of monetary exchange.  So when friends or neighbors help each other without exchanging money, they are operating under Social Norms.  When an employee exchanges their time and effort for a wage or a salary, they are operating under Market Norms. And, there are often situations in which both of these norms are in operation, such as when someone works not only for money, but is also motivated by the belief that they are doing something that is a benefit to society.

In the case of healthcare, the Social Norm contract is that the individual citizens will look out for the well-being of the country, but also that the country will look out for the well-being of the individual citizen. The citizens are this country’s “safety net”, and the social contract demands that the country must be reciprocating by being the individual citizen’s “safety net”. If there is no reciprocity, then the contract is broken, and society is exploiting those citizens that are not enfranchised into the basic life-giving bounty of the society. Instead of the conscription being part of the social contract in a free society, it becomes merely a form of slavery.  And this obligation extends to the family members of those who are subject to conscription. Gaining the basic benefits of society for self and family members is the underlying reason soldiers allow themselves to be conscripted into service. Is this social contract no longer in effect because we now have an “all-volunteer” military? It is not. First, we have an obligation toward the volunteers, even if some believe that the salary of the soldiers makes it a Market Norm exchange.  Second, surely we do not think that volunteers deserve less than draftees in time of war.

In the past, many members of society have hid behind a false reality that did not acknowledge the social contract, in order to deny the benefits of society to those who serve the most fundamental needs of their country. They espouse “free market”, “capitalistic”, or “freedom” values, as the reasons for justifying our society as dog-eat-dog. But now, we have fully articulated the reality of the social contract that exists between society, and those whom society depends upon for its defense and very survival. There is no longer an excuse for denying the obligations that society has chosen to incur.

Universal single payer healthcare is the only rational choice for the United States, on the basis of healthcare quality, economics, and social contract obligations.

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