OPINION | Health care and the social contract


To paraphrase legendary Hollywood movie producer Sam Goldwyn, a social contract isn’t worth the paper it’s written on.

At the risk of killing a joke by explaining it, a social contract is a complex concept, metaphorically explaining the relationship between government and the governed. It isn’t formally recorded although elements, such as constitutions, may be officially recognized. A social contract isn’t a legal contract between two or more parties so much as it is a collective agreement or framework for governance.

Goldwyn was widely-known for his malapropisms, the incorrect substitution of a word or phrase for a similar sounding one. He famously declared, “A verbal contract isn’t worth the paper it’s written on.”

Now, with all humor exercised, we can down to the business at hand: health care reform.

In Minnesota, we have it pretty good. We’re a high quality, high health care service access, well-insured state. We’re not as well-insured as we used to be, however.

As recently as 2007, Minnesota was America’s best health insured state. Today, we’re number four. If present trends continue, we’ll continue our slow, steady slide to the middle. Should Minnesota abandon MinnesotaCare, the state-subsidized health insurance program for uninsured low- and middle-income working Minnesotans, as conservative public policy advocates suggest, our slide becomes a rollercoaster drop.

According to the United Health Foundation’s annual survey, Minnesota’s uninsured rate has hovered at just shy of nine percent since 1990, the first year that data is displayed. Our rank rises and falls relative to other states’ health insurance investments. Ending MinnesotaCare, however, would change our standing through our own callous indifference.

Health care reform is extraordinarily complicated. I’m not going to try to explain it in six hundred words but I will make a larger observation: we’re debating the social contract.

Here, in Minnesota, our social contract has always been wider-reaching and more encompassing than most other states. We’ve strongly invested in schools, public safety, human services, transportation infrastructure, public health systems and public assets such as parks, libraries and rec centers. In short, we’ve invested in Minnesotans.

This investment comes with a cost. Minnesota has born a higher-than average tax burden but we’ve benefitted. We have a high quality of life. We’re well-educated. We earn good wages. We have more Fortune 500 companies headquartered here than our population should merit.

So why all the fuss? Why are conservatives angrily confronting their elected representatives, demanding opposition to the proposed legislation, and readily accusing reform advocates of socialism?

It’s because conservatives oppose expanding society’s accrued benefits to a greater percentage of the population. They wish to restrict our social contract’s rewards to themselves. Consequently, health care reform opposition isn’t fundamentally rooted in esoteric notions of liberty and happiness’ pursuit. Rather, it’s a selfish impulse. While I can criticize selfishness, I can’t condemn it because selfishness is central to the human condition.

We routinely act in our own self-interest yet community life requires balancing self-interest with community interest. Negotiating between the two, whether internal self-dialogue or a larger societal debate, is rarely simple. The current health care reform debate reveals this process, warts and all.

That being said, Minnesota’s experience points our nation forward. In Minnesota 2020’s most recent report, “Best Practices: Minnesota’s Highest Value Hospitals,” graduate health care policy fellow Kyle Bauser creates an index from quality service rankings and Medicare reimbursement rates. He finds what has become increasingly clear: primary care physicians are health care cost and quality control lynch-pins.

Health care reform’s “public option” — Medicare, nationally; MinnesotaCare locally — already works. Our social contract neatly accommodated this change. The path forward, despite aggressive conservative opposition, is clear. We don’t need conservative distraction; we need affordable, quality health care for all.

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