Necessary Luxuries: Are we forgoing wealth to be healthy and wise?

I haven't formulated any thoughts completely yet, but lately I've been fretting about America's two cases of runaway inflation in the past few decades: healthcare and higher education.

The first is already bankrupting the federal government, and a subject of much political debate. The second topic is starting to gain steam, and it will be interesting to see what happens when the first generations of college graduates who were subject to highly inflated tuition (I'd say those born 1975 or later) start to discover that those debts can't be escaped by any means, not even Chapter 7 bankruptcy, and the political blowback begins. (Will our generation discourage the next from attending college because we've felt the effects of it being not worth it, financially?)

Politics aside, I think it's interesting that we're loaded up with two heavily subsidized luxuries -- one subsidized by insurance corporations with an assist from the government, the other subsidized by government loans made before the borrower is able to provide proof of creditworthiness. 

Health itself is not a luxury, of course, but healthcare costs haven't soared because the cost of basic care has skyrocketed. We've started battling diseases and chronic ailments that, a mere twenty years ago, were considered fatal or incurable. While these gains have saved many lives at the margin and surely improved the quality of life in America, the cost associated has outpaced our economic ability to absorb it. Nonetheless, it's gut-wrenching to consider turning the clock back on our expected standards of care, especially knowing that some will be able to afford to continue receiving it, thus making any healthcare rationing, no matter how fiscally responsible, morally reprehensible.

Higher education, meanwhile, was also once considered a luxury. Only a fifth of high school graduates were expected to pursue four-year degrees or more. The problem is, the jobs that do not require a bachelor's degree have dwindled, and those that are left have a fairly hard salary cap that lands somewhere below middle class, thus disrupting even the illusion of an American dream for high school graduates. Meanwhile, universities maintain the same attitude about education that they had when it was an elite enterprise for the few determined or privileged enough to pursue it, and such an intensive and lofty education program isn't cheap, especially on a mass scale. Once again, the costs are at the luxury margin, while the goods are hard to imagine as anything but a necessity.

The notion of a necessary luxury is a deeply ingrained one in America. We know deep down that not every American needs a car, a television, a smart phone, a microwave... but each invention sailed from luxury to necessity within a generation or less. The difference is that durable goods can be manufactured to different standards -- there are cheap cars and televisions that do the job well enough -- and so the market subsidized itself through diversification of quality.

We believe in health and education as rights in this country, which is a great thing. However, that is beginning to stretch to a new point, where we believe in quality healthcare and quality education for all. Just as our society can't afford to buy every member a BMW and a 57" flat screen, we can't really swing for cancer-beating therapies and Ivy League schools for everyone. 

Politically, it comes down to something like: conservatives say that's fine, not everybody gets to have it, boo-hoo; liberals say everyone must have it, and if its costs everyone (particularly the well-off) more, boo-hoo. And there's a good moral, practical debate to be had there.

But what if we're missing another solution, one in which quality doesn't require financial resources, but innovation? Studies and pilot programs are showing that both healthcare and education can be delivered in more intelligent, targeted, financially-responsible ways. People's bodies and minds are far too unpredictable and diverse to be subject to one-size-fits-all quality standards, and thus will always resist bureaucratic government solutions. 

As an occasional project, I'll try to highlight some articles and studies on these subjects. In the meantime, I'll try to figure out where I fit on the aforementioned conservative/liberal debate, because I'm honestly stumped. I'd like to believe that more intelligent systems will produce a "have cake and eat it" world, but at some point, there will always need to be a philosophical call between erring on the side of self-sufficiency or erring on the side of society-wide luxury. Both produce desirable outcomes, but only one can be tried at a time. When we go for both (by subsidizing self-sufficient luxuries), we go broke.