Previously…

We are all either free or slaves. The marker that defines in an instant into which category we reside is our ability to say no. Choice is the only measure of freedom. One of the strange realities in this calculus of freedom and choice is that we are free to choose, as in the economy of ancient Israel, to be slaves, to nail our ear to the doorpost. We surrender our freedom in exchange for real and perceived benefits and, occasionally, to escape the burden of responsibility that freedom entails. Freedom is a heavy load that few are able to carry.

In the United States of America our national myth is that we live in the land of the free. There may have been some small truth to that claim when Francis Scott Key penned his battle poem, but it has long since ceased to be the case. We are freer than many citizens of other nations, but we are not Free. In any society we choose to reside in we take on the laws and conventions of that society in order to enjoy the benefits of that community. In a microcosm, one of the most important benefits of living in community is that we have others to care for us when we cannot care for ourselves. The Mountain Man, our mythological hero of independence and freedom, can be brought down by an illness that in community would be little more than a bothersome complication. A broken leg or inflamed appendix is a death sentence to the truly free person.

Missing from our current national debate – ignoring the third-grade shouting matches involving the ill-informed and plainly ignorant – is the recognition that our health and the care we as a community provide to our collective selves is a stifling burden that twists our economic and social lives. Setting aside the millions who have no health care other than what they find in our emergency room, those of us with health care live one catastrophic illness away from bankruptcy and penury when our insurance company is rewarded for not caring for our life needs.

Not so long ago, near to my own lifetime, illness, even great illness, was our lot. Cancer, Polio, Tuberculosis, heart disease and failure, Diabetes, bacterial infections, birth defects, these were all part of the human condition and the medical profession could do little more than treat symptoms and make the afflicted comfortable while they awaited death. Such palliative care was not expensive and because we still died in our own beds, the end of life was not an event that consumed generations of accumulated wealth and life savings in a matter of a few weeks. None of that is true today.

While Dr. McCoy might scoff at 21st century medicine (Kidney Dialysis?! My God, I”m in the Dark Ages!), it would be nothing short of a source of wonderment and amazing magic to any practitioner from even the 19th century. Even Dr. Bennett, the man who drew me into the world and treated my various coughs and complaints as a child, would find his head spinning if he were given the grand tour of a hospital in 2009. Medicine is truly astounding, and expensive. And despite all the claims and promises of eliminating waste and finding savings in economies of scale, it will never again be cheap. Medicine will never again be a cost that we can afford out of pocket. And we don”t want to die.

We all die, of course. Regardless of the volumes of fiction that pretend the contrary, we all reach the end of our lives. And again, regardless of other volumes of fiction masquerading as truth that ensure us differently, we have no idea or understanding of personal events past the moment of death. From dust we come and to dust we return. We cling, then, to what we know to be true: that to varying degrees we all breathe and eat and move about in our environment and attempt to grasp in some manner how to assemble these disparate pieces into the figure we call our life. If we cannot in any sensible manner ensure life after death, we can insure life before death. And from there comes one set of our current manacles.

Insurance companies are for-profit enterprises created as a way of spreading risk across a larger enough population so that those included in a risk pool would, as individuals, be safe from financial disaster from the targeted risk. Take life insurance as an example. When you buy life insurance, you”re placing a bet that you will die young, before you have paid premiums that exceed your benefit. The life insurance company is betting that you will die of well-advanced old age, long after it has invested your premiums and skimmed a nice profit off the top before paying out the agreed upon sum. In the insurance business, life is a very predictable risk when the number of people swimming in the pool is large enough. The insurance company, using its actuarial tables, can predict nicely how much money it must collect monthly in order to cover expenses, profits and payouts over the lives of its customers.

Health is different. The range of unknowns is too great to predict with any accuracy the total health of a group of individuals when it is quite possible for a single person to overnight accrue expenses measured in the hundreds of thousands, if not millions, of dollars. No private insurance company can grow large enough to weather such medical storms with impunity. The alternative is to limit risk, to diminish exposure as much as possible to the unknowns; to include only those risks that it perceives as manageable and provide a backdoor that allows the company to deny coverage and preserve the wealth of its stockholders when calamity strikes. In short, the mission of a health insurance company is not to provide, but to deny payment for medical expenses. By design, any corporation exists for the good of its shareholders, not the good of its customers. And when it comes to the health of our fellow citizens, that is unacceptable.

Last Wednesday Evening, President Barack Hussein Obama delivered yet another home-run speech on healthcare to the nation. Others have eloquently remarked on the President”s words and the task ahead. But none, to my knowledge have written about how our current system enslaves us to the detriment of our families, our communities and our nation. We all know people who, or ourselves may, feel the burden of keeping healthcare. Who would not be terrified of the specter of paying out thousands or even tens of thousands a dollars for medications that keep us alive, functioning and healthy if it were not for their current health insurance? What abuse might we be willing to endure to preserve that insurance? Would a spouse endure emotional or physical abuse? Would an employee tolerate a dead-end job? Would any citizen think very hard before striking out in an risky but promising field knowing that in doing so they would put their very life at risk when the insurance safety net disappears? What innovations have we as a people forgone because risk meant medical suicide?

We speak a great deal about a free market, but the greatest barrier to freedom in our current economy are the slave masters who hold the keys to our health chains. In a truly free market economy, workers would be able to move without hindrance from industry to industry. to strike out and better themselves as our national economic needs inevitably change. In our current system there is no such freedom because workers are held back by fear of denial of health insurance due to pre-existing conditions or the vagaries of coverage. Few are rightly reluctant to make bold moves when the lives of their would be put at risk.

Very few want to experience the ultimate freedom of Jeremiah Johnson, but most dream of throwing off restraints that lower their horizons and limit their potential. If President Obama is to truly be the last President to address healthcare reform then life decisions must no longer depend upon the profits and policies of corporations. We, as individuals, must be free to realize our potential unfettered by a fetish for next quarter”s P&L. We, as a nation, must be free to fulfill our promise unrestrained by the greed of those with no accountability to our dream. We, as a people, must ensure that all are free and not held down by a few.