Back to Ranting

That's not America! That's not even Mexico!

--Homer Simpson

Well, if that isn't smiley-faced facism.

--Glenn Beck

Can you guess what we're going to talk about today, ladies and gents and kids of all ages? I include the kids, since it's going to be their debt slavery, too.

(Before we go on, I should say that I took this photo off a website that I couldn't get the URL to paste over for. If the photographer happens to see it and object, I'd be happy to take the picture down, but I didn't mean to take it without credit. However since I think I have a readership of 6 or so, I don't think that it'll be a real big problem.)

We are, as you thought, talking about Universal Health Care today, since the political ads have begun urging you to call your congressmen with a variety of urgent and twitterpated messages. We're not so much discussing whether or not PBO's plan is a good one--it's not really articulated enough for that to be argued in any meaningful way--but whether the very concept of Universal Health Care is a good idea.

First, in any discussion but especially in ones with a lot of emotional tinder, we should define our terms. What do we mean by "Universal Health Care"?

Universal-- we don't, I take it, mean that we're providing health care to the literal universe, since we don't even know how big the universe is or if there's life on other planets. I don't believe we even mean that we're providing health care for the whole world, since most Americans, even in Congress, expect Norway, for instance, to be able to fend for itself. I think that most Americans assume that by "Universal" we mean "everyone in the USA".

This becomes problematic, however, when you attempt a more precise definition. Do we include foreign students who've come here to study? Illegal immigrants? Resident aliens? Do we require at least citizenship to access "universal" health care? Let's be charitable and assume so.

Health-- of what? Physical? Mental? Spiritual? It's to be hoped the government won't, at least, interfere with the third, but what about the second? (I've seen a state mental hospital; I'd rather take my chances, I think, with getting mental health care from the people who try to sell you pirated Japanese DVDs on street corners.) I think most Americans assume that the government will provide for physical health; let's continue our charity and assume that they will also provide treatment for, say, anorexia nervosa or paranoid schizophrenia.

Care--*snarf* HA!

Sorry. Excuse me. Back to defining. Presumably what we mean by this is that someone, somewhere, will "take care" of us. Though what is scarier than a government reassuring you that they are here to "take care" of you is difficult to imagine. Let's be still more charitable and take the word in the sense it's commonly used: necessary treatment and comfort measures.

So, is Universal Health Care a good idea?

Not really, but I think we're going to get it anyway, if for no other reason than "all the other countries let their kids do it."

We've decided that by "Universal Health Care" we mean "Necessary treatment and comfort measures for physical and mental disorders provided for each citizen". Most people think this is a good idea for somewhat fuzzy reasons; there is an idea that people have a "right" to health care.

The sort of ethics used to frame the debate is called utilitarianism, which is making decisions under the criteria of "the greatest good for the greatest number". Aside from the problematic fact that utilitarianism doesn't define what "good" is, it certainly doesn't provide a framework for the idea that people have a right to health care. It might prove to enhance the "good" of numerous others, for instance, if people with incurable diseases (or merely expensive ones) were euthanized instead of treated, thus freeing up time, money, and medical resources for others who presumably deserve them more by virtue of being young or having appendicitis instead of cancer. The euthanized, under this framework of reasoning, didn't have any sort of right to health care.

Actually, the reason most people think that everyone has a right to health care is because most people have fragments of Judeo-Christian ethics still rattling around in their consciousness. It's Christianity that teaches that individuals are important, that physical suffering is worth allievating (although it will never be eliminated), and that even people dying of cancer or living long years profoundly mentally retarded are worth treating and comforting. These are ideas that create the idea that everybody deserves health care; it's no accident that many hospitals began as religious institutions.

So why do I think, if Christianity says that everyone should be cared for, that Universal Health Care is a bad idea? Because the government is doing it.

In the Christian idea, health care is provided by individuals, or, collectively, by the church. Even in our current medical system this is a problem: why do we, for instance, routinely birth and die in the hospital? Most deaths are not materially helped by hospitalization--medications and comfort measures could be maintained much better at home. Most births, likewise, don't require hospitalization. There are large and eloquent arguments against both of these situations.

In the current, secular government idea of Universal Health Care, health care is provided and centrally planned by the government. That they have made giant quagmires of every other private enterprise they've taken over and tried to centrally plan is, for the moment, irrelevant. The point is that centrally planned healthcare almost has to be run on a utilitarian basis, since individual evaluation and individual treatment plans become almost impossible to implement. I have no doubt something called an "individualized treatment plan" would be required after the flaws in the system became evident, but as I imagine it would have to be written on a government form in order for a physician to get paid, one thing it would not be is individual. As money ran lower and lower (at the moment there has been no clear explanation of how all this would be paid for), utilitarian ethics would inevitably take over. The officals in charge of the decisions wouldn't even have to be particularly evil; it's easy to make wicked decisions when instead of looking at people, you're looking at numbers. From there it's a short step to policies that, for instance, pay for "patient choice euthanasia" but require the patient to pay for radical chemotherapy out of pocket.

Don't I want people to have health care? Do I like things the way they are?

Of course not, but it doesn't fix one wrong thing to do another thing that's even more wrong. At least the current crappy medical system doesn't increase our government dependence or our national debt slavery any further. The arguements I've been hearing about health care are the same ones that have bothered me before about bailouts and Patriot Acts--"there's no time, if we don't act now, it'll be too late!" This is the classic line of all hucksters and tyrants, and I see no reason not to suspect it now.

Well, Miss Bossyboots, what would you do about it?

Take the government out of it altogether and outlaw the concept of private insurance.

*GASP!* But how would people pay for their medical care?

Well, at first it would suck, yes. I'm afraid it's going to have to suck at some point anyway, since the structure we're building up in healthcare is like one giant, huge, horrible housing bubble that hasn't burst yet. But you can't get away from supply and demand (even in a socialist or fascist setup)-- you can get on top of them or be squished under them, but you can't get away from them. I think a much better idea than national health care would be to make it legal for each individual citizen to have a private, TAX FREE savings account similar to an HSA, and then let the market take over. The cost of health care would HAVE to go down to what the market can bear.

A number of other problems would solve themselves as well. A good bit of our medical costs in this country are for unecessary things--butt lifts, antibiotics for colds, and Botox, just to name a few. If folks had to pay for these things themselves and could see each dollar leaving their account, they might think twice. Doctors might have to get more creative about treating depression and other illnesses and not rely so much on prescription medications. Illegal immigrants would have a harder time accessing health care without exposing themselves as illegal, making illegal crossing into the U.S. at least a little less attractive. Businesses, freed of having to provide their employees with insurance, would be able to pay them more in actual dollars.

It'll never happen, of course. For one thing, doctors wouldn't get paid nearly as much, and thus their med-school debts and malpractice insurance money wouldn't be feasible. Universities and insurers, among others, have a vested interest in seeing that physician care stays expensive. The AMA would never stand for reduced physician prestige and pay. And nobody will ever have the guts to stand up and propose something in the U.S. Congress that would get them accused, among other things, of pandering to the rich, hating immigrants, wanting people to get sick and die, and of caring more about money than people.

So what do I think will happen?

I think we'll get some morphing version of Universal Heatlh Care that will work like a Yugo. Health care will stay expensive. The fund, whatever it is, won't be able to keep pace with costs that are not allowed to have real market controls on them. Individual people will find themselves booted off of employer insurance and shunted onto government insurance--because which employer would keep an expensive plan if their employees can automatically get on a government plan? especially when they'll be fined if their employees are underinsured?--and they will almost certainly find the government plan to be crappier. The Canadian oxymoron of a ten-month waiting list for maternity care will become our reality.

Instead of increasing the normal person's access to health care, such a plan will decrease it. People will once again be treating themselves, having babies at home, and dying at home, not out of choice and not with any support, but simply because they can't get to the hospital when they want to.

You heard it here first.

Breanna