It’s good when people think outside the box. We hear fairly often that thinking outside the box is the pathway to innovation and progress, We’re told it is a positive habit to think outside the box and thereby come to see and embrace new ideas and possibilities. Going outside the box has a rebellious American ring to it as well. We don’t want to be and won’t be boxed by or held to old ways. We’ll look, think, and go beyond the bounds of same old conventionality. We’re good, and it feels good saying so of ourselves. The twitchy part of this is going outside the box generally means we’ve fashioned a larger box with bounds not yet recognized as such or firmed up as observable limits. 

Most everyone knows there is contention over what to do with health care beyond the ardent desire by some to get the Obama name off any health care package. This is not a thing I’ll argue here. My bias is for a single payer plan that is universal and basic. Byzantine amalgamations such as the drug coverage plan from Bush and health care from Obama seem to me equally and fatally flawed. I feel universal and basic is the way to go but I won’t, however, argue either the merits, or flaws of these plans. Instead I’ll try to make an outside the box case based on a larger view of healthy caring. From a broad perspective the health of its citizens is already a huge part of government activity; that is, of course, if we stop seeing the little health care box where patients go to clinics or receive more serious treatment from masked beings wearing colored pajamas. What most of us commonly associate as health care is far away from the basics health in the population.

Is it not caring for citizen health when government manages for safe water and clean air? It is difficult to be flushed with the glow of health if the water you drink is foul and the air tainted with noxious molecules. Considered in a broad view a great many things government does are aimed at keeping its citizens able to function solidly and upright before their eventual demise. A sickly or impaired population represents both individual and collective suffering that can and should be rejected as insufficient and unjust. Poor health is a burden on the individual and on society as a whole. Our nation addresses this on many levels. 

Why do we have a USDA if not in large part to help provide safe, clean, and nutritious food for its citizens? Consider the magnitude of ensuring a safe food supply for hundreds of millions at feed three times daily without pause or holiday for twelve months in succession and over three hundred sixty days none on which will start other than right on time. Then in consideration that the USDA was not enough for the enormity of the task there is the FDA adding its oversight to the food supply. Then there are others such as the Department of Labor and branches such as OSHA who look out for health and safety in the workplace. And why would you think we have a Federal Aviation Administration if not in part to keep citizens from not dying while flying or on the ground from air cargo crashing down on them? A single air incident can entirely cancel an individual’s health. A great many things from product safety to auto seatbelts are examined and instituted with the health and wellbeing of citizens as a prime concern.

If we review governmental programs with public health and welfare as an aim I think you’ll find we have quite a focus on health care. The specialty done in clinics and hospitals might better be thought of or even called treatment with the test of our health focus known as prevention. Preventing is widely seen as more effective for the individual and for society than letting things go until treatment is called for. Indeed, there is a concern (and some of you may well know of individuals where this will sadly apply) that the emphasis on treatment encourages passivity in some to be less vigilant about prevention because they rely on the availability of a “fix.” I’d bet the farm you know people who think in terms of their health care as going in to get this fix or that while they carry on with many of the ill-considered habits that got them there in the first place. Is it a public responsibility to cover the costs of individual bad habits any more than it’s up to us to pay for treatment for someone who continually drinks ditch water instead of from the tap?

We know human nature well enough, I think, to sense the blossoming problems if the focus goes to health treatment as THE icon of public responsibility. If treatment is seen as the area of public health responsibility it may grow out of bounds with things portions of the public will consider as proper treatment for them. We can agree on what constitutes safe water because we have an empirical base absent when a citizen requires ritual or spiritual cleanliness in water or in other areas of their care. In order for it not to become financially ruinous the public responsibility for treatment should be on the basic side. I might feel better about my treatment if someone played a harp in the background or six Buddhist monks chanted, but that any many other things should if I insisted on them be my responsibility. For effective health or health care the public responsibility should not stand alone and has to be met with individual responsibility. Without responsibility by the individual health becomes passive as is a patient in a system receiving treatment. A patient is a commodity in a system. If we consider that as health care then I think we’re missing something both inside and out of the box, and that is the manner in which we want to be alive.