Of course I don’t really want to spend a lot of time talking about the American health care debate, but I can’t resist putting in my two cents’ worth. I’ll try to keep it brief.
First, let’s stipulate that our present system is a mess from almost any point of view, and is in serious need of far-reaching reform. But let’s also stipulate that merely calling something a reform does not mean it will be an improvement. I hear people say “anything would be better than what we have,” which is an extremely foolish thing to say, and I hope my judgment on it will not have to be proven by experiment.
One of the wisest things anyone has said on this subject appeared some years ago as a letter to the editor in National Review. I can’t remember exactly when it was, so I couldn’t easily find it even if I had access to the back issues, but I think it was at least four or five and less than ten years ago. It was from a Dane, perhaps a physician himself though I can’t remember for sure.
It’s a frequent tactic in the U.S. debate to refer to Scandinavia for examples of government-run health care systems that work very well. And this man agreed that the Danish system does in fact work well, and that he is very happy with it.
But he went on to say that such a system would never work in the U.S. Denmark, he said, is a small, homogeneous, unified country where most people have a very strong sense of responsibility and discipline, while the United States is a large and undisciplined country and includes far too many people who would see the system only as something to be exploited. And I don’t mean only the sort of shiftless people who always exploit welfare, social security, etc. as recipients—I mean doctors, lawyers, corporations, and bureaucrats who would approach the system as vultures would approach a big dead pig, and probably be much greater abusers, in terms of sheer dollars, than the mere dishonest recipients. The safeguards required to protect us from fraud would make an already complex system even more so.
Another comment that’s remained with me for years now is one I heard in the early ‘90s, when Hillary Clinton’s plan was being debated. In a Catholic forum on one of the pre-web online services, there was a woman, a lawyer, who was vigorously promoting the plan. Much of her law practice was devoted to health-care consulting. There is something wrong with a system so complicated and regulation-ridden that such consulting is required, and something even more wrong about making it more so. Yet that was what she expected, and she quite liked the idea. Someone asked her, finally, how the new plan would affect her business, and she admitted that she would do quite well out of it. She saw nothing at all wrong with her intention to be, in essence, a parasite on the system, providing no health care to anyone, only helping them navigate a labyrinth which she helped to construct and could spend all her time studying.
And she was relatively scrupulous. We live in a country where the Secretary of the Treasury, Tax Collector in Chief for the nation, was caught evading taxes.
We live in a country in which the whole concept of “citizen” is disappearing. We have many, many people who feel no personal stake in or responsibility for the nation as a whole. We have three major ethnic groups (African, Mexican, and European) who dislike and mistrust each other. We have two large socio-political factions (broadly if inaccurately labeled “liberal” and “conservative”) who hate each other with an intensity approaching violence. We have a very powerful and very rich central government which is the object of constant manipulation by thousands of people paid very well to direct that power and wealth toward specific organizations, commercial and otherwise.
To attempt to impose a single national system on the whole country is folly. And I don’t mean just the euphemistically-named “single payer” system, but any system which is managed by the government. Among many other problems with the idea is that it would increase the polarization of the country by locking our disagreements about abortion, euthanasia, etc. into a health care system that no one can escape, either as a patient or as a taxpayer.
Yes, there is a lot of misinformation and hysteria among the opponents of the plan. Yet they differ from the president himself more in their tone than in their degree of error. Mr. Obama’s declaration that what he proposes will provide better care for less money is simply a fantasy (assuming he really believes it) which few take seriously. For twenty years and more we’ve been told that Social Security and Medicare are heading for the financial rocks. Mr. Obama’s assertion that we can painlessly add universal health care to that burden has been shot down by no less an authority than the Congressional Budget Office.
What should we do instead? Well, I have no detailed plan, but I can see a more productive direction. The craziest thing about our system is the assumption that one’s employer pays for one’s health insurance. That connection desperately needs to be broken. I’ve read that it’s a consequence of wage controls implemented after World War II—employers who wished to pay their people higher wages started paying for their health insurance instead. The result is a testimony to the power of unintended consequences, and one of those things that only seems reasonable because we’re so used to it. No one expects his employer to buy his house, or his food, or his car, or to pay for the education of his children. We should be aiming for a situation where most people, people of normal means, purchase their own health insurance, just as they purchase their own house, auto, and life insurance, and those who can’t afford it are assisted.
We are indeed an undisciplined people, but we are also an enterprising one, and we are very good at finding clever solutions to practical problems. We need an approach that, while making sure that everyone has access to some reasonable and decent level of medical care, works with rather than against the temperament and gifts of the American people, does not dig our national financial hole far deeper, and does not exacerbate our internal tensions.
To that end, if you’re interested enough to read further, please take a look at this post by John Schwenkler at Upturned Earth, which provides some more specific diagnoses and solutions. I have not read the long piece to which he links and which is the basis of his post, but I plan to. I can only think about this stuff for so long at one time.