The Right’s Story on Health Care
I really hate being put into a position in which I’m defending “the Left”, even more so when my post might be taken as opposing that of my fellow associate blogger Steve Verdon since he and I are in substantial agreement on health care and health care reform.
Here’s how I would characterize “the Right’s” story on health care:
- The U. S. system is flawed.
- Other countries’ systems don’t work nearly as well.
- The U. S. system relies on the free market.
- There are two systems of health care in the developed world—ours, and the one every other country uses.
The first proposition is obviously true. The second is shaky: other countries’ systems work better in some ways, worse in others. The third is on the outskirts of Looney-land, heading for town center. The fourth is a baffling over-simplification: every developed country has a health care system with unique features of its own (as one might expect) but the system in the U. S. resembles that of, say, France more than it does the system in the United States 75 years ago.
Notice something about that list? If it’s a fair characterization, “the Left” differs from “the Right” only in its view of the systems of other countries.
Those aren’t scare quotes around the characterizations of political positions above. I’m using quotation marks because I’m quoting other people. The terms “Left” and “Right” refer to sitting positions in the French Legislative Assembly of the early days of the French Revolution and have never been particularly relevant to the United States. Virtually every mainstream politician in the United States is center-right or right wing by, say, French standards. I believe this is a source of confusion to our European cousins who are lead by the use of the terms here to believe that there’s more political diversity here than there actually is. Both our Democratic and Republican parties would fit, from an ideological standpoint, handily into the Tory party in the U. K. with lots of room on the sides.
I am very, very centrist (as Americans use the term). I am what used to be referred to as a “Scoop Jackson” Democrat. I think there are lots of good, freedom-loving, patriotic Democrats and lots of fine, compassionate, caring Republicans. I’m more concerned with outcomes than with counting political coups.
Politically cynical Democrats are promising people that they can get something for nothing. It’s not true. Politically cynical Republicans are warning people that something’s going to be taken away from them. That’s not true, either. Or, more accurately, while there’s a kernel of truth in both positions neither is entirely true.
Like most developed countries we have a hybrid health care system. Some financing is private; some is by the government. The likelihood of our going to a system that is completely public or completely private approaches zero. If your proposal requires a completely public or completely private system to achieve its objectives, make other plans. It ain’t gonna happen.
I think that Democrats are over-estimating the economies that can be realized by achieving universal coverage because, as I’ve noted before, they’re under-estimating the costs of public administration of such a system in the United States and they’re over-estimating the present system’s excess capacity. I think that Republicans are over-estimating the economies that can be realized by compelling people to make more prudent choices about health care (at least not in a manner that’s consistent with reasonable public health). I don’t get two legs put into casts when I break a leg because the insurance company is paying for it nor do I get two heartvalves replaced instead of one. Plus, so long as health care providers are deciding what does and does not need to be done, they’re an important component in the cost equation.
That’s essentially where I come down. I think the real issue on health care in this country is that the costs are too high. Unless you believe that health care providers will be willing to take a pay cut (I don’t) that means that significant savings in health care require a substantial increase in the supply of health care. That’s what we need to think about rather than whether 60% of the costs of health care come from tax dollars or 80% do.