Preventive Totalitarianism

Stated in passing — as an inarguable truism — is the most eerie part of President Obama's recent healthcare remarks (video, at about minute two):

We're now at a point where most everyone agrees that we need to invest in preventive and wellness programs that can save us money and help lead healthier lives.

Put aside that some folks — John Stossel among them — do question the "preventive care" shibboleth. One gets the sense that what Obama is saying and what many Americans will hear are two different things. To my ear — and I offer this without intending to express favor for any particular policy — an "investment" in such programs means funding to make them available, with the option of whether to partake left up to the individual. General experience suggests that, when government officials use the term "investment" in this context, they mean at the very least some form of compulsion, as in: "We'll subsidize your healthcare, but you must do X and must not do Y."

Let's be clear about what's going on conceptually. The premises on which the debate is being framed are that private healthcare is en route to pricing itself out of the reach of a broad swath of our society and that the portions of the industry directed by the government are finding costs unsustainable. By "investing" in "wellness programs" as a means of lowering costs, the government would be putting the weight of the nation's entire healthcare system on individual citizens' behavior. What couldn't be declared intolerable with such a consequence as the collapse of everybody's medical care?

The national and state governments have already instituted the practice of disincentive taxes (as on cigarettes), they regulate what plans must cover, and so on. Imagine what political leaders will do when they can dictate health-related behavior directly, especially if it remains a commonplace that preventive care is key to affordability. With the passage of Rep. Patrick Kennedy's healthcare "parity" bill, eliding the distinction between mental and physical ailments, "health-related behavior" would be tautological. We can only imagine what behaviors and life decisions will qualify a person to be locked out of the healthcare system.

President Obama illustrated his perspective on the ownership rights of a government "investor" when he changed the leadership of GM. In like fashion, healthcare "reforms" that entail greater involvement of the government and greater reliance on its "investments" will inevitably prove to be about the very ownership of individual Americans. One already reads stories from other nations of rationing based on habits like smoking, but the principle needn't halt there.

It's certainly objectionable enough that mandatory coverage of abortions appears now to be a component of the Senate bill. What begins as a "medically appropriate" option could easily make the transition to classification as "most appropriate" — say for one of those inspiring mothers who, under the current system, accept the risk of their own lives for their children's births or for those who choose not to kill their unborn offspring despite known disabilities. When a centralized government becomes a "single payer," those risks and those offspring are a burden to the whole system. One can hear the argument that they're free to do so, but that society cannot be expected to pay for "excessive" procedures during birth, let alone a lifetime of specialty care.

We daren't even contemplate the possibility that women with psychological problems (religious views considered to be extreme, for example) may be deemed ineligible to bring children into the world. We further daren't consider that a government empowered to tell its healthcare dependents what risks they are not permitted to take may, given circumstances, quickly decide that it also holds the prerogative to place risks before them — whether of a martial or occupational character. For the time being, it is enough simply to acknowledge that the party that pays is the party that controls and that to control a person's health is to control the person.