Over the course of eight years I had conversations with my wife's doctor about the issue of health care on many occasions during her appointments. He was a Rush Limbaugh fan and I am a social liberal with moderate fiscal leanings. It probably had a negative impact on her health care but he and I enjoyed our little debates too much to resist temptation. One thing that become clear to me over those years was the fact that our arguments consisted of policy minutia and political talking points. We never got to the heart of what needs to be decided by our country. You see it really boils down to a very simple choice on two points of view. The question is not so much how to deliver healthcare, but how our society wants to define the nature of healthcare. Is healthcare a commercial product or a public service? How you answer this question gives a very clear and simple answer to how health care should work.Putting ethical arguments aside, I want to focus on basic system efficiency.
The conservative point of view is that the free market will create efficiency by lowering cost and increasing quality. If health care is treated as a product they are right. But it would have to be a true free market. Mandatory care laws would have to end. A TV manufacturer can not be efficient if he gives away some TV's and then charges twice what they are worth to the next customer to make up the difference. Propping up unprofitable institutions like hospitals with public money would have to end. The only function of government would be to regulate product safety and ensure honest business practices just like other industries. The result would be like the health care system of Thailand. Low costs and high quality, more affordable to the average American than the current system. Only the bottom tier of the socio-economic ladder would be excluded, depending on private charity for health care. Conservatives feel that private charity would be well funded when private citizens have more discretionary income from the savings of this approach and they might be correct. The only way to know would be to implement the changes.
The progressive point of view is that health care should be a public service like police or public schools and this approach would yield greater efficiency in cost and quality. If health care is treated as a public service they are also correct. Most components of the health care system would become public institutions without any profit motive. Health care workers would become civil servants with set salaries determined by legal statute rather than market forces. Suppliers like drug and medical device manufacturers would be required to prove efficacy, meet price points and engage in competitive bidding like other government contractors. Like any other public system it would be funded by progressive taxation based on an individuals ability to pay and provide equal services to everyone. This would be like the systems of Europe and Canada. They provide a high quality of care at a very low cost and would be much more affordable for a majority of Americans than our current system.
Obviously I've excluded a lot of related issues for the sake of clarity. My purpose is to point out that like most of our politics, our politicians rarely present us with clear and simple choices even though they know that is what lies behind their rhetoric. The fault lies not in our politicians but in ourselves. Our inability as a nation to reach a clear consensus on any subject leads to politicians offering us policy choices that appeal to multiple constituencies with often opposing interests. We try to have everything both ways and that leads to situations like our current healthcare system, a misbegotten hybrid of the two systems I outlined above and arguably worse than either one. We must resist the temptation to always view our opinions as right and the opposing view as wrong. More often than not they are differences of vision, not truth. Which vision best represents us as a people? Also I would remind you that nothing in our system is cast in stone, not even the Constitution itself. Anything can be altered through a consensus of political will. Think of prohibition or women's suffrage. The quickest way to determine if a policy is flawed is to allow it to be implemented and out of that experience comes true national consensus. The world is not going to end if the other party wins. We've survived multiple wars, epidemics and natural disasters. There is no political choice that we cannot survive or recover from. A friend of mine related her fear of the future her child might inherit. Such fear is misplaced. Any nation we choose to build can and will be un-built by our children and reformed in their image. This is the power and beauty of the American experiment, always fluid, always changing and arcing towards a future that can always be improved. But I think the first step towards that future is to have clear conversations about our choices with out the distorting lenses of fear and anger.
In memory of Dr. Michael Moore, good friend and loyal partisan. I will always miss you.
