The fulfillment of the United States Constitutional Directive to Promote the General Welfare: In Search of a National Health Care Purpose

Kelly M. Bell

The U.S. constitution's preamble specifically addresses having a "common defense," and as such the current military fulfills that directive. The words "health care" are not expressly worded in this document however, leaving it to interpretation whether or not health care should be provided by the government to all U.S. citizens. Because the constitution does state that one purpose of this country is to "promote the general Welfare" of "We the People," it can be construed that the constitution would support a national health care plan that included the entire populace. While Americans would never tolerate the military only protecting three quarters of the population, somehow, we tolerate this in health care. This paper explores the fundamental lack of purpose found in the United States health care policies that has led to greater disparities of health as well as leaving more than 16%of the populous of this country uninsured. Despite the great wealth of this country and health care expenditures of $1.1 triIlion in 1998, more than 40 million people are without health care insurance, and consequently, without health care access. Despite the fact that the U.S. initiated Healthy People 2000 and 2010 with two national goals of increased quality and years of healthy life and to eliminate health disparities among different segments of the population, there is no mechanism to assure that private markets share these goals or will implement policies to attain them. The current system that provides health care in this country does not execute the U.S. constitutional directive of "promoting the General Welfare" of the entire population, but the continuance of the status quo that continues to benefit physicians, insurers, the pharmaceutical industry and well-insured Americans. Current health care spending and programs such as Medicare, Medicaid, employer-based insurance, and tax subsidies as well as proposed programs such as a Medicare drug benefit and national health care insurance are evaluated and costed. Legislative attempts to stem the tide of uninsured Americans are assessed as less than adequate as the cost of maintaining insurance was never addressed. Trends in population demographics and health care usage are confronted along with looking at governmental macroeconomic projections for future health care usage and cost as the population continues to age. Market based health care financing is seen in violation of supply and demand law of economics. Current as well as future rationing and the ethics that drive health care are challenged as unbalanced towards autonomy, neglecting social justice. By keeping health care insurance tied to employment means that all Americans, except the very wealthy, are one job away from not being able to access health care in time of need. It is past time for Americans to embrace their collective national inheritance to "promote the general Welfare" for all of "We the People," and to insure that legacy to "our Posterity" by insisting that health care access be provided for everyone equally.

The fulfillment of the United States Constitutional Directive to Promote the General Welfare: In Search of a National Health Care Purpose

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