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July 4 reminds me of our nation’s founding ideal that all of us are created equal. How does this “self-evident” truth inform debate about national healthcare? Beneath and beyond the dizzying numbers of fellow citizens covered or omitted and dollars spent or saved are questions more elementary than abstractions about the government’s size or policies of one political party or another: What kind of nation are we? What kind do we wish to be?

The words of the Declaration of Independence may be immutable, but expectations of lives we hope to lead are not. We internalize change across generations: The 1940 census reported that 55 percent of Americans had indoor plumbing, by 2000, 99.36 percent did. Owning a telephone, television, or computer no longer suggests affluence. In 1950 about 40 percent of American households had access to a car; today, more than 90 percent do. Implicit expectations about what constitutes a “normal” life expand as economic prosperity grows. Before Pearl Harbor, 5 percent of Americans had college degrees; today, 25 percent do, and in 2014 women graduates outnumbered men for the first time.

None of these tacit assumptions about daily life is enunciated in the Constitution.

Human rights have expanded too. Ideals of 1776 are now international; in 1948 the UN’s’ Universal Declaration of Human Rights articulated fundamental rights of all humans, not just those born beneath a fortunate flag: “All human beings are born free and equal in dignity and rights.”

The evolution of such rights is “self-evident” in my family: My grandfather was born (overseas) before we abolished slavery; my mother was born before women had the right to vote; my parents met during the Depression when job ads in The Chicago Tribune advised, “Jews, ni__ers, and Catholics need not apply;” (yes, the entire offensive word was used) my high school required courses in European and American History, but my children were required to study these and history focused on Asia, Africa, or the Middle East too; when a cousin bought a home with another woman, my devoutly Christian uncle was disturbed, but his attitude eased once they adopted a daughter from Asia, and he embraced their marriage. Gay rights were unimagined by the Founding Fathers.

During my 1950s childhood, Thanksgivings were routinely disrupted by arguments about Social Security’s “socialist” corruption of American values. It had passed the Senate 77-6 in 1935 and diminished poverty from nearly half of seniors in 1950 to less than 10 percent today. My relatives cashed their checks when they retired and also enrolled in Medicare, which cleared the Senate 68-21in 1965. Such votes approximating consensus seem impossible today.

Another uncle declared, “If you figure it out ahead of time, no one can afford to have a child or own a home.” Somehow, many manage both. I suspect he might call healthcare similarly unaffordable if he were alive today. While the U.S. has grown more prosperous than ever, our riches are enjoyed less equitably than ever.

As healthcare debates persist, I read stories of fellow citizens anxious about preserving their well-being, or becoming ill, or being unable to care for their families. I understand how primal instincts to protect our health can lead to mortal fears. These seem more threatening to me than nukes from North Korea or attacks by ISIS.

Like my relatives, I pay into Social Security and Medicare before claiming their protection, but I do not contribute directly to healthcare for those under age 65. None of us do unless we earn over $200,000 ($250,000 as a couple), a tax to be eliminated if the Senate approves its current bill. How does that “promote the general welfare” as the Constitution declares? We could do so if every worker contributed to medical care as we already do to Social Security and Medicare. Under current law, employees receive more than they give when insurance through our employers is subsidized as an untaxed benefit.

We could further stabilize healthcare if we held ourselves to the standard expected of NATO allies, 2 percent of Gross Domestic Product for military defense. Ours is currently 3.3 percent, which explains why we account for 37 percent of the world’s military spending and more than the next eight nations combined. Meeting the NATO standard would add 240 billion dollars for butter over guns, and that’s ignoring the additional 54 billion for guns the White House has proposed. We would still spend more than the three next biggest spenders combined (China, Russia, Saudi Arabia).

It seems “self-evident” that we are responsible collectively–and patriotically–to assure the rights of all Americans to life, liberty, and the pursuit of happiness. Such responsibilities are a worthy price for the privileges of citizenship in the wealthiest nation on earth.