I listened with great interest to the lecture given by David Palm last week.  From a lack of the financial means to exact change to the “very limited visibility and understanding of public health,” Nebraska was in a precarious position health care-wise.  The truly interesting path taken by Dr. Palm and others to revamp the Nebraska Public Health system show the true ingenuity of people acting with a purpose.  Multi-county health departments were a great idea as were media contacts (to help spread the needed message(s) of public health issues).

With that being said, I was saddened to hear him echo the thoughts of one of the assigned articles last week, “What does social justice require for the public’s health? Public health ethics and policy imperatives.”  Central to both the article and Dr. Palm’s final minutes was the concept of social justice (a goal to be lauded, especially when using one of the original definitions as provided by Pope Leo XIII circa 1890) and its role in the government coercion of health choices.

Social Justice is not the Panacea it’s Touted to be

While I do not disagree with the tenets of social justice, I strongly disagree with the modern interpretation of its original intent.  From the Vatican website,

It must be first of all recognized that the condition of things inherent in human affairs must be borne with, for it is impossible to reduce civil society to one dead level. Socialists may in that intent do their utmost, but all striving against nature is in vain. There naturally exist among mankind manifold differences of the most important kind; people differ in capacity, skill, health, strength; and unequal fortune is a necessary result of unequal condition.  Pope Leo XIII, circa 1890.

Pope Leo goes on to say,

Such inequality is far from being disadvantageous either to individuals or to the community. Social and public life can only be maintained by means of various kinds of capacity for business and the playing of many parts; and each man, as a rule, chooses the part which suits his own peculiar domestic condition.  Pope Leo XIII, circa 1890.

As the owner of a health care business, I am faced with those struggling with finances and access on an almost daily basis.  I have chosen to address those struggles in the best way I know how.  I opened the clinic to help as many people as possible, so that’s what I do.  I have written off more balances and treated more patients without payment than I can count.  The reduction of income is well over $100,000 for the past seven years.  But that was my choice and not one that should be mandated by the government.

During the opening session of this class, the question was asked, does (or should) market justice or social justice function as the driving force in healthcare?  As I just pointed out, social justice plays an important role and absolutely should not be ignored.  However, without an eye to the market ramifications of our choices, we won’t be in a position to help anyone.

One final (and quite illustrative) example is our own UNMC.  I first attended school here in the mid to late 1990s.  To say there has been a large shift in the appearance of the campus is a huge understatement.  Specifically, the new, gleaming (and still transforming) campus is one of the jewels of Omaha’s Midtown.  That could only be possible if they were attracting patients; the market(ing) solutions have played a very large role in that success.  By comparison, Creighton’s Medical Center has struggled.  I also attended Creighton (early 1990’s); their spending on certain of programs, when done, has paid large dividends (e.g., Creighton Cardiac Center, select undergraduate programs).  However, I constantly hear of their care for the less advantaged as one of the Creighton Medical Center’s missions.  It is not a stretch to conclude, when comparing these two venerable medical centers, that the system focused on a market-based approach has thrived while the system providing care with social justice as one of its primary tenets has struggled.

Social justice has a role in our society, but it should not be, as the article by Gostin and Powers suggest, be the impetus for government redistribution of resources.

Government Coercion

It should not be the government’s job, regardless of the governmental level (city v. state v. federal) to tell its people how to live their lives.  While some type of order and legal system is obviously needed, the framers of our government did not plan for our government to tell us how to live.

This type of arrangement has interesting and, I would suggest, unintended (at least I hope they’re unintended) consequences.  It should not be the role of the government to dictate what should be regulated and what shouldn’t be.  As an example, why has smoking been banned in all Nebraska public places, but alcohol has not?  Both have terrible outcomes; that is, nothing positive, in a health context, happens as a result of partaking in either.  But, one is regulated much more stringently than the other.  (As an aside, I am adamantly opposed to both smoking and drinking, but I do not believe it is the government’s right to dictate that.)  There are too many other situations to discuss in this short essay (abstinence education is a positive for the public health, but government funding is said to be decreasing while funding for needle exchanges—not healthy at all—is increasing; obesity; seat belts; helmets).