In my last post I referenced “the pursuit of happiness.”  These words are from the most important sentence in American history – the first sentence of the preamble to our Declaration of Independence.  You probably remember memorizing them as a 4th grader, but just in case the words are escaping you:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

These 35 words fully capture both the breadth and depth of our American promise – the foundational deal that comes with the privilege of American citizenship.  What distinguishes America as a nation in the arc of human history is not that we’ve perfectly lived these words everyday since July 4th, 1776 – rather, it’s our ceaseless dedication to the journey required to fully realize our founders’ vision.  We have been on this journey for nearly 250 years, and as America moves through a period of significant transition – especially in healthcare – these words must remain the touchstone of both our policies and our practice.

It is telling that Jefferson’s words, honed by the Committee of Five, did not promise happiness for all Americans.  The distinction here is critical – the difference between “Life, Liberty and Happiness” and “Life, Liberty and the pursuit of Happiness” is as wide as the 1.8 billion lightyear Supervoid recently discovered by WMAP.

IDL TIFF file
Helix Nebula, NGC 7293 – NASA

The reasons are myriad but two are specifically important to call out as we enter this new era of health reform.

First, promising every American happiness is impossible.  Our founders understood that no two humans share the same definition of happiness, much as no two humans share the same definition of health.  In order to promise “happiness” for all, the Declaration would need to read “all men are created identical” instead of “all men are created equal.”  Being equal means we can still be individually unique, and our individual differences are exactly what the Declaration sought to protect.

Second, it is the belief that we are born with the right to pursue happiness (balanced by the rights of other Americans to Life and Liberty) that truly defines us as Americans.  The Declaration’s words mean that our Creator grants every American both the birthright and the responsibility to seek our own happiness – that means its up to each of us individually to define and control our own destiny.  And while the community stands as the bulwark for those who fall and can’t get back up, we must simultaneously focus our efforts (in healthcare and beyond) on supporting those who can.

Getting up is hard, but its the choice we make to get up that is most important.  Our founders’ words empower each of us with the right to make this choice for ourselves.  It then follows that our local, state, and national communities must be designed to better serve those who choose to become healthier, ask more of those who choose otherwise, and always support those stricken by circumstances beyond their control.

Applied to healthcare, these foundational concepts can be instructive as we seek a sustainable path forward in 2017.  We must acknowledge that:

  1. Each of us defines “health” in a our own way
  2. The federal government cannot guarantee all Americans some arbitrary “equal” amount of “health” without both fracturing and bankrupting the country
  3. That the right to pursue health – much like the right to pursue happiness – comes with an equal amount of personal responsibility

It is time we acknowledge the impossibility of guaranteeing “health” for all and instead accept the mantle of supporting “the pursuit” and the enormous individual effort to do so that comes alongside.

In this country we are free to make choices – including who or what we worship, how we teach our children, and how we want to live.  Our nation was founded by people who made a choice – pilgrims who decided they were tired of living under the smothering cloak of monarchy and instead declared their independence from a dictator’s definition of what “a good life” must be.  They declared that God made us equal and that our nation stands to protect its citizens lives, their liberty, and their opportunity to pursue happiness.

Let us remember during these months of inevitably divisive debate the role that each of us plays in pursuing both our own happiness and our own health – and (at least as long as government has a hand in healthcare) rededicate ourselves to supporting the pursuit.

The stakes could not be higher.

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