We Hold These Truths

It’s July 4^th – Independence Day for those of you who remember your U.S. history.  There’s already too much talk about loss of rights, political tyranny, militias, even succession, and I don’t want to wade any further into those troubled waters.  But I thought I could at least try to reimagine what a Declaration of Independence might look like if it was aimed at the American healthcare system. 

I’m no Thomas Jefferson, or even a Roger Sherman, but here goes:

When in the Course of human events, it becomes necessary for one people to dissolve the system of healthcare which has been responsible for its health, and to design a new such system to which the Laws of Nature and of Nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all people are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, health, and the pursuit of Happiness.

That to help secure these rights, healthcare systems are instituted, deriving their just powers from the consent of the people --That whenever any Form of healthcare becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute a new healthcare system, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Health, Safety and Happiness.

Prudence, indeed, will dictate that healthcare systems long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that people are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design that hinders their well-being, it is their right, it is their duty, to throw off such healthcare system, and to provide a new one for their future health needs.

Such has been the patient sufferance of the American people; and such is now the necessity which constrains them to alter their former healthcare systems. The history of the present healthcare system is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these people.

To prove this, let Facts be submitted to a candid world.

• It has led to declining mortality rates, lagging behind peer countries;
• It trails peer countries on most measures of health outcomes and quality of care;
• It spends much more than other countries, despite the greater mortality and morbidity it achieves;
• It wastes as much of a third of its spending, such as on unnecessary/inappropriate care and excessive administrative costs;
• It causes as many as a third to have medical debt and is a major factor in many bankruptcies;
• It causes as many as half to delay or skip care due to costs;
• It has allowed intolerable health inequities, such as in access, availability, cost, and outcomes of care;
• It causes health to be dictated by zip code, race/ethnicity, employer, age, and legislature(s);
• It does not recognize that almost 40 million of the population are in poverty and are food insecure, and 30 million live in hazardous housing or are homeless, all of which impact current and lifelong health
• It accepts that 80% do not get enough exercise and over half are eating less healthy than twenty years ago, both of which  impact current and lifelong health;
• It has morphed/is morphing into a series of monopolies/oligopolies, in both the provision and payment of care, not for the purpose of better care but for increased profits;
• It has violated our privacy and treated our data as a commodity for its benefit.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A healthcare system whose character is thus marked by every act which may define a defective system.

We, therefore, the American people, do solemnly publish and declare, That these United States are, and of Right ought to have a more effective healthcare system; that we are Absolved from all Allegiance to the existing system, and that the existing healthcare system, is and ought to be totally dissolved; and that as Free and Independent people, we have full Power to create a healthcare system that will support the health of each person, in all aspects of that health and taking into account all the factors that contribute to that health.  

And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.

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The American Revolution wasn’t supported by the majority, took years of violence, some strokes of good luck, and a crucial ally, to bring about that Independence.  Its founders created a form of government that was brilliant yet tragically flawed (e.g., slavery, restricted voting rights), and which we are still working through, with progress not always forward (I’m talking to you, Supreme Court, the 116^th Congress, and many state legislatures).  As Winston Churchill said more generally about democracy, it is the worst form of government – except for all the others that have been tried.

Unfortunately, no one can claim that our healthcare system is better than all the other healthcare systems that have been tried.  There’s no perfect healthcare systems, and there are worst ones, but our healthcare system is the envy of no one.  It makes achieving health a matter of random chance, or size of pocketbook.  It takes a narrow definition of health and pours tremendous amounts of effort and money into trying to achieve that, for brief periods, for some people. 

We can do better.  The status quo is not working, and has never worked, not for most people.  On Independence Day, then, while you are watching fireworks, eating hot dogs, and (maybe) thinking of our brave Founding Fathers, try to think about how we can revolt against this very flawed healthcare system – and what a new system might look like.