As the August recess in Washington, D.C. began, the White House and the Democratic members of Congress decided to focus on “health insurance reform” instead of “healthcare reform”. This is, of course, a political calculation driven by fear that doing nothing is untenable heading into 2010 House races. It is easy to vilify health insurers, and insurance reform is certainly important. At the same time, it is simply one component, and probably not the most important.

The Wall Street Journal published an article on Saturday by Theodore Dalrymple, aka Anthony Daniels, M.D., titled Man vs. Mutt. As the title suggests, Mr. Dalrymple discusses the differences in the healthcare provided to humans and canines in Great Britain. In turn, Mr. Dalrymple wonders how a National Health Service for dogs might work. As is customary for Mr. Dalrymple, the commentary is subtle, witty, and incisive.

Mr. Dalrymple’s article reminded me of my basic objection to the discussion of healthcare reform, in America. Why have the American people not been asked the fundamental question that underpins the idea of reform, namely whether we, the people, believe that the right to health care is one of the unalienable rights with which we are born?

Of course, we have never had a national conversation about whether our pets are entitled to healthcare coverage. That would be absurd, right? So what does that system look like?

In my experience, pet owners understand the costs of owning a pet, including the costs of its medical care. The price for services is transparent, payment is due at the time of service, and pet insurance is available for catastrophes. Additionally, it is taken for granted that the care will be compassionate and professional. 

So, how can it be that there is price transparency for healthcare for dogs but not their owners? Why does the government have to mandate the measurement of patient satisfaction for humans? Why is health insurance called “insurance”, when it is fundamentally not insurance?

One more key difference between the systems - it would never occur to a pet owner that the government would pay for the costs of veterinary care for the beloved family pet. With a very few exceptions, people with pets take care of them, knowing that failure to do so could result in huge costs, both financially and emotionally.

Where is that personal responsibility for ourselves? Do we really expect a system that allows absolute freedom with little or no responsibility with respect to the decisions that we make about our health? Do we expect our neighbors to pay for the poor choices that we make for ourselves? Do we think that the federal government is the best arbiter of those decisions? Do we think that would violate our Constitutional right to privacy?

I would suggest that the role of the federal government in healthcare should be limited to providing solutions for those who simply cannot afford coverage for themselves, or for those who simply cannot help their DNA. In each case, the federal government could be the insurer of last resort, with insurance in the true sense of the word – coverage against events that are unforseeable or catastrophic.