Is public health the new commons?
In a 2010 lecture about fish and oceans for Dr. Colin Campbell's online Plant Based Nutrition, Dr. Bruce Monger, an oceanographer at Cornell University discussed the principle of the commons. The commons, in this context, holds that a commonly shared resource (such as the ocean in Dr. Monger's case) belongs to all, and ought not be monopolized for profit or for other reasons.
Can the principle of the commons be applied human health?
Virtually all "affluent" nations have publicly funded health care to some degree. In the US we have Medicare, Medicaid and the Children's Health Insurance Program. As of this writing we may have still more public coverage under the Affordable Care Act.
We also subsidize, de facto, "uncompensated care" through increases in costs for certain services provided at no cost but which translate into increased health insurance premiums. And then there is the more indirect social cost of caring for families in the event of illness or death of the breadwinner, and the other indirect costs of illness. Our social welfare system spreads many of these expenses among the taxpayers generally.
This being the case, can we view public health as a social benefit resembling the traditional commons in many respects? Can we view the costs of attaining and maintaining health be viewed as a responsibility of our "economic commons."
Professor Monger spoke of the "tragedy of the commons" occurring when a few industries benefit from exploiting a resource. This raises many questions which need to be answered in arriving at a rational, fair health maintenance system.
Do companies which produce unhealthful foods exploit the commons of health?
Do they do so when they do not pay for the external costs in poor health generated by their products?
Do they do so when, via trade associations, they adversely influence government agencies established to protect health?
Do health care providers abuse the commons when they are more concerned with profitability of their facilities than with the application of more effective, safer, "low tech" approaches to health care?
And do individuals who "know better" -- who have seen the statistics and have even been told by their health care providers to change their diets -- abuse the commons when they continue behaviors which pass their health care costs along to the public?
Perhaps this last sounds like "blame the victim" and we must be mindful of how companies use to their advantage the addictive nature of unhealthful foods. The question remains: How far can we take the principle of the commons as applied to the oceans and other environmental concerns to the economics of health?
