As we approach Father's Day, who can forget Bill Cosby's celebrated monologue on Fatherhood?  Among its many comedic gems, one of the more memorable describes the parent whose patience, having been exhausted listening to loud and endless quarreling among siblings, announces a verdict that displeases one or more of the children.  Their invariable complaint over this perceived injustice - "That's not fair!"

As Cosby observes, "The truth is parents are not really interested in justice.  They just want quiet!"

In the same spirit, I suggest that most Americans are not really interested in Health Care fairness at the national level.  They just want to receive good care that they can afford.  This is not to impugn their inherent sense of fairness, which is likely to operate at a high level in personal relationships.  Fairness in the abstract, however, lacks the potency needed to overwhelm more immediate concerns among Americans who approach the debate without entrenched opinions on Health Care reform.  Their questions are more pragmatic. This is why opposition to a proposed Health Care reform program priced in excess of one trillion dollars has begun to resonate with the public.

What puzzles me, therefore, is the insistence by some proponents on emphasizing the fairness aspect - the need to provide for Americans who have previously suffered because they lacked adequate access.  Matched against a trillion dollars or more, fairness as an abstraction tends to fall into second place - it would be something that would be nice if we could afford it, but we can't.

For full disclosure, I will say that I favor fairness, but I'm not convinced of its power as a political argument among Americans who haven't yet made up their minds in the face of issues of affordability.  Rather, as President Obama has asserted often, but as is increasingly drowned out by the "price tag" noise, it is not reform that we truly can't afford, but rather the perpetuation of the current Health Care system that leaves millions of uninsured and underinsured Americans at risk for catastrophic illness and catastrophic expenses, and which undermines the competitiveness of American businesses in a global market..

The two long-established criteria used worldwide to measure a nation's health are life expectancy and infant mortality.  Among the industrialized nations, we rank close to the bottom when judged by these criteria.  Equally important, almost every one of these nations has achieved better health for its citizens at a cost substantially below ours.  Currently, U.S. healthcare costs us approximately 16 percent of GDP, while these other nations pay percentage points less for a better outcome, and accomplish this with care available universally to their citizenry.  I won't address the debate over the merits of single payer systems vs. those that involve a public component shared with the private sector, as embodied in recent "public option" legislative proposals.  Some nations use one, some the other, but they all do better at health care than we do, at a lower cost - one  that would reflect annual savings of trillions of dollars in an economy the size of ours.  I would only add that these two choices - single payer vs. a public option - appear to be true alternatives.  No nation that began with a public option has later gravitated into a single payer system.  Readers interested in more details of what other countries do can pursue these at the following site and the links within it -
 http://en.wikipedia.org/wiki/Universal_health_care

Perhaps then, proponents of reform might consider putting aside fairness, and promoting self interest as the dominant issue.  The outlay for reform may be one trillion dollars or  more, but the savings will substantially exceed that figure if the experience of dozens of other nations is a guide.

In one sense, though, the issue of fairness remains relevant.  The other industrialized nations have accomplished what health care reformers now propose here - universal care, better health, and lower costs.  One can still ask - is it fair to Americans to claim that we alone are incapable to doing what all the others have already achieved?