Not long ago, a facebook friend put up a quote from a friend of his about how “unbelievably stupid” many Americans must be for thinking that “Obama-care means FREE health care.” I responded by saying this sounds like a condescending straw man argument, or at least talking about whether or not it will be “free” seems to be a distraction from the reasons why many people actually want universal health care coverage, regardless of the price tag.

But I’ve thought some more about it, and there’s a bit more to say of this. First of all, I should note that the term “Obama-care,” while being widely used, is a bit of a misnomer. Though he has made known his general expectations, President Obama has not presented his own detailed health care plan. He has left that up to Congress. Further, there is not just one proposed bill for health care reform, but a few different ones.

Now to the “free health care” part. I imagine the point (which I think was being made) that what, if any, government-sponsored plan comes of this will not be free is rooted in the reality that the cost of government functions and services, of course, ultimately falls on taxpayers in some way or another, at least in theory. Yet, I think there are a couple key things to consider here.

First, I don’t think the government-sponsored “public option” that has been proposed would be without a direct cost, in the form of low premiums, to many who enter in. But, conceptually, it may be that such a government provision could technically be considered “free,” and be as good as such, for those whose economic status puts them in the position of greatest need for such services (think Medicaid). But the response to that is often that it isn’t free, because, of course, someone, somewhere will have to pay for it. As a result, I don’t doubt that the long-held disdain for “welfare” and distribution of wealth and resources toward the poor is playing some part in the knee-jerk opposition to any new kind of government-sponsored health care plan.

Beyond that – and this is the second point here – there is a significant difference between a service that is treated as a guaranteed right of citizenship or a return for paying taxes, regardless of personal level of tax obligation (the major house bill being covered so much in the media certainly doesn’t go nearly this far, like a single payer system would), and one that is based solely on the individual’s ability to pay. Whether we refer to the former as “free” or not really isn’t the point, because what we really seem to have beneath the surface here is a divide among us over which one of the two above choices health care coverage should be.

Those who oppose any form of national health care plan or system must necessarily see health care coverage as any other commercial good, one that is privileged according to personal economic status and is an “individual responsibility.” Those, like myself, who would like to see a national/public health care system created in some shape or form are more likely to think access to medical care should be considered a basic human right and major social goal, coverage for which should somehow be made available to all, to a certain point, regardless of economic condition. This seems to be an essential part of the debate we’re currently having as a nation, though it is largely unspoken.

And it’s really amazing to me how begrudgingly we seem to approach such issues in this nation. Considering the freak out that health care reform might mean scary “socialized medicine” (actually, no one is calling for that), it is amazing that we actually have the great amount of services we do which, by that standard, have long been “socialized” to some degree or another. And of course, such public services are not deemed to be “socialist” evils and haven’t destroyed the country: to name just the obvious few – police, fire, public education, public libraries, roads, etc. These are fundamental services that we long ago decided should be universally guaranteed to us regardless of status (in theory). And we do not expect such services to be left up to market forces and private, for-profit decisions, or based on individual ability to pay, though we do, in fact, maintain alternative private options for many such services at the same time.

But we do have quite a few anti-government, market-worshiping folks in this country who are not satisfied by that. They not only do not want any more such “government involvement,” but would love nothing more, I think, than to see such services become more and more privatized (for reasons I can’t fully understand coming from average people, except to think that maybe a certain level of comfort and a blind faith in “the market” prevents them from properly appreciating government’s role and the real possibility of being failed by “the market” and priced out of crucial areas). As for “privatization” of public goods, though, it seems across the world, in more and more areas, we’ve been seeing it happen in recent decades. In the U.S., this has generally taken the form of contracting what were or might have been public services out to large private firms.

In practice, though, what the “privatization” efforts of our antigovernment, market-ideologue politicians actually result in appears to be something of a shrewd sabotage and heist; as they preach for and cut taxes with an almost religious zeal, eroding the public’s willingness to properly count the cost of and pay for government functions, even as the need and want for such functions expands. Then, key public services become starved for funds and resources even as huge deficits are steadily incurred overall, and like a self-fulfilling prophecy, already much-maligned government looks just as bad as they have always claimed it was. Meanwhile, the privatization dogma starts sounding better and better to more folks, and more and more public services get sold off or doled off to powerful private contractor/corporate cronies instead.

It is outrageous when the people in the above camp come around at times like these, and start crying about big deficits and “our children’s future,” and insist that government can do nothing right and “is the problem,” after they have done so much to damage and debilitate it and destroy the public faith and will. And it is stunning to see so many average people cheering on such reckless destruction of the general welfare or yelling about how much they don’t want government in their lives or “socialism” to come to America, when they’re often just being deceived into fighting against more of the kinds of “socialism” that would actually serve and have served them and/or their fellow citizens in need instead of the financially powerful and publicly unaccountable. Unfortunately, as such folks have been convinced they must valiantly resist “socialism,” what we ironically appear to move more and more toward instead is what John Médaille has coined, “privatized socialism,” wherein risks and benefits are largely socialized, but the resulting profits, of course, are privatized (or some might also refer to what we have as ”socialism for the rich”).

(Sigh) I digress. But the last point can be seen very much in our health care system, which not only has socialized areas of payment and delivery but also of research and development, but in the end it is largely determined by and rewarding for powerful, extremely profitable entities. And the point here is, there are some areas, as I’ve listed above, that should rightly be beyond the grasp of the private economic sector and profit-driven market forces alone, if only that there may be a level of guaranteed access for as many citizens as possible, rather than leaving a contingent to be priced out. Payment for health care too is, I think, one of these areas, and it’s an area that demands certain amounts of compassion as well as just and egalitarian distribution.

It seems like we know this at some level instinctively, yet we also seem to experience a lot of cognitive dissonance over the matter. In piecemeal fashion, and sometimes amongst similar opposition to what we’re seeing now, we’ve accepted socializing health care coverage for soldiers and veterans, then for the elderly, and then marginally to the very poor, and, of course, we will treat anyone in emergency rooms if necessary. But then we’ve tried to keep our larger system for everyone else as private and profit-driven as possible, even though this has created a messy, inconsistent system that is failing many people while it is making a few very rich off of sickness and granting varying degrees of privilege to health and life based on money and position.

Of course, part of the aim of having private health insurance plans as we do is to collectively pool risk in order to broaden access and moderately ameliorate the financial obstacles to high quality, specialized treatment. This has worked in a limited fashion to technically cover the majority of people with moderate incomes and decent jobs, but at what rising cost and technical difficulties for individuals, families, and employers, not to mention those without coverage? And even then, it does not provide many with absolute protection or security. They can lose their job, be denied coverage, be very underinsured, have treatments go uncovered, and still be left at risk of financial ruin despite their coverages, all in the midst of huge industry profits.

I’m not saying the reform proposals out there are the only road to take or that they shouldn’t be at all questioned or concerning, (though my own worry is not that the plans being considered go too far, but that they actually are not likely to go far enough to bring about significant change to the system, challenges to the cozy industries, widest possible access, or better control of costs). But I know the current system needs to be changed, and that we can at least do better than we are now doing, if we will just seriously give it an effort. But first, I think we would do well to make up our minds and be more consistent about what we want our health care to be, a commodity or a basic guarantee, and for whom. If we believe everyone should be guaranteed it at some level beyond only private options (like in, say, education), then we should be able to figure out how to make that happen, just like every other western industrial/capitalist nation has.

Will that be free? Technically no, of course. Someone, somewhere will always be paying for it whether it is directly for them or not, and (ideally) we will all be paying into the system collectively for ourselves and one another, just as it often happens to us now to some degree whether we like it or not. For me, that is no reason to object to it. However, for anyone who, on principle, thinks it is, well then, I guess it’s time to get rid of public education too…and libraries…and the police…and fire departments…and public roads…and the military…and the VA…and medicare…hell, let’s just get rid of it all, because we seem to just hate paying for it so much. I’m sure we’ll be so much happier and burden free when all those things are gone, and we’ll have such glorious individual freedom to pay straight from our own pockets for everything we might possibly ever need at any given time (assuming such things will even be available then that is).