Health Care Insurance as a Shared Commons
Today the Supreme Court considers the constitutionality of requiring people to participate in a national health care insurance program. Do you think they will see health care insurance as a commodity or as a shared commons? Their perception on this issue may well determine their ruling.
Insurance, of course, is not a commons like the land or cultural knowledge. It is something created by communities for their protection. The idea is simple. If we all participate, each one of us shares the cost of any one of us needing the service. This is the principle behind the idea of insurance.
In traditional societies, people lived in communities where everyone was “insured” of care if they had participated in the sharing of care—in reciprocal relationships with communal members. Members would care for each other because they had been cared for before and they could count on being cared for in the future. It as a caring community based on reciprocity.
While there are efforts to restore such relationships of reciprocity today, the cost of some provisions we might need are simply too high for the capacity of local communities and health care is one of them.
We need enough people in the insurance pool to pay the costs and we need everyone in the pool so they have access to health care when they need it. For the 99% of us, we do not have the means to pay for the health care we might need. If we want a fair share of the care, we need to pay a fair share of the costs.
With insurance, a fair share is not the same for givers and receivers. Not all of us will need extensive health care, so our share of the costs will be small. For the few of us that need extensive care, the share we receive will be large. That’s the way it works. We are all civic members who together create a shared commons that works for everyone. I can only hope that the Supreme Court judges understand that health care insurance is not build for property owners but for civic members.