Bottom Line

Looks like we've got a spirited debate going on in the comments section, and all I ask is that participants show respect for their ideological opponents and avoid namecalling. Otherwise, traffic numbers are up!

I was at a big Hollywood fundraiser for Multiple Sclerosis tonight and was struck by one honoree who appears stricken with the disease but, as a historically successful entrepreneur, has created the Myelin Repair Foundation to bring scientists together in open collaboration with the goal of reversing the core progression of the disease. It made me think about the value of entrepreneurship in America, and health care's place in it, specifically health insurance.

America has the reputation for being a place where entrepreneurship can flourish. By the very act of emigrating to this nation of immigrants, those who come to our shores are entrepreneurial. They are taking risks and looking ahead to a better life for their families. The most successful entrepreneurs are usually those who have a vision of "changing the world," per the recent work of my uncle, Michael Maccoby and his book, Narcissistic Leaders: Who Succeeds and Who Fails. We're grateful (even with inevitable grumbling, jealousy and suspicion) when they do; i.e. Bill Gates.

However, as the centuries have progressed in the U.S. we've recognized that unbridled or unchecked entrepreneurship can lead to robber barons, labor abuses or even outright gangsterism. We accept, and I think even the most conservative readers would agree, that a Hobbesian state of uncontrolled selfishness would be a brutal and egregious one based on the principle of might makes right and loaded with suffering, pace the industrial 19th Century, child labor and all. We accept checks on certain (harmful or predatory) entrepreneurial behavior by laws and government, with the goal of creating a level playing field free of the basest fears.

I've come to the bottom line that health care is not an area for unregulated entrepreneurialism, and in particular health insurance is best provided by government, most simply in Single Payer form but obviously tough to institute in America at this moment. The reason is that health insurance, rather than an area best provided by corporations looking to improve the bottom line by taking 30% profits and above, is actually infrastructure, much as clean water, fire departments, meat inspection and creating the Internet are state responsibilities.

he state supplies these services because they actually help encourage entrepreneurial behavior. Imagine if you had not reliable Internet to work with, or that you had to get your clean water from robber barons or even more benevolent corporations. Our civil society is structured so that you don't have to worry about any of that, and with good reason, so that we don't waste our days trying to meet those basic needs.

Now, I recognize that there are some innovative drugs that come out of profit-motivated research, albeit paid for through the nose for the first X years of release. But even if we have a hybrid system which doesn't take all the worry away, at least there will be a competitor in place to keep any monopolistic or "robber baron" behavior in check.

With health insurance reforms enacted and everyone essentially covered, American businesses can beat out foreign countries where state health coverage is already in place, reducing their uncertainties as well as costs.

That means more hiring, more portability to take entrepreneurial risks, more reason to take that world-changing dream to fruition.

After all, would you be a happy entrepreneur if you had to worry that no fire fighters showing up the weekend that your house accidentally caught on fire?