What does freedom mean in health care?

Is anybody there? Does anybody care?
Does anybody see what I see?

I see fireworks
I see the pageant and pomp and parade
I hear the bells ringing out
I hear the cannons roar

I see Americans – all Americans
Free forevermore!

– John Adams, in 1776 

Every 4th of July, I watch the movie musical 1776, which is about the creation and signing of the Declaration of Independence. I know that description doesn’t sound thrilling, but to me it is an incredibly exciting portrayal of how just a few people created a new country against all odds, because they cared that much about their vision of freedom and liberty. 

Throughout the course of American history, the desire for freedom has driven so many conflicts and political choices; it’s embedded in our culture. But what do we mean when we say we value freedom? And freedom for whom? The Founding Fathers’ view of freedom was not really freedom for all, because they kept slavery intact (the play foreshadows the consequences America faced from this offense). 

In the health care discussion, as in most political debates in the US, freedom has a multitude of possible meanings. Does freedom in health care mean the freedom to live life without worry about accessing health services or going bankrupt from paying medical bills? Or does it mean the freedom from paying for anyone else’s health care but your own?

During the Obamacare debate, we also heard “repeal and replace” advocates arguing for freedom of choice – to choose their own doctor and shop for health care, as well as freedom from government intervention against the individual mandate to purchase insurance.

As political science scholar Deborah Stone wrote in “The Struggle for the Soul of Health Insurance,” the great debate in health care politics has been whether communities should give mutual aid to the sick, or whether each person alone should be responsible for their health risks. In essence, this is the same question of whether freedom in health care means “freedom to” or “freedom from.”

Why should anyone have to contribute to anyone else’s health care spending? After all, the American revolution was sparked by frustration over England taxing the colony and stifling its economic growth. Government involvement for the purpose of redistributing money is tyranny, the Founding Fathers might have said. 

And yet, could the Founding Fathers have envisioned such a backwards health care system? In a country where a woman who has her leg mangled in a subway accident begs bystanders not to call an ambulance because she can’t afford it; where someone is charged more than $5,000 just for sitting in an ER waiting room, never getting treatment; when families have to fight to get their epileptic children access to $125,000 life-saving treatment; when pregnant women in rural areas have to drive 50 miles or more to get to a hospital to give birth; not having access to affordable health care can be devastating.

Americans value individualism and personal responsibility. But freedom does not just mean we all get to keep everything we earn. I would argue that kind of freedom is not as important as ensuring freedom to live healthy lives. Health is a prerequisite for enjoying life. “Every man for himself” health care is not an option if we wish to give everyone the opportunity to pursue happiness.


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