A laissezfairehealthcare blog comment turns the raging American health care debate on its head by posing the question: what are Americans willing to do without. In a country where food, shelter and entertainment are readily accessible to an overwhelming majority of the population (relative to other countries with our size and immigration levels), most American children are taught they can be anything and have anything.
This is a fantastic framework to create for children — build imaginations that can craft all the possible joys of life to come. But there’s a caveat. Perhaps the biggest lesson I learned once the my rose-colored glasses were removed…when I entered the real world…was the notion of compromise. In this country, happiness, fulfillment and self-actualization aren’t promised and certainly aren’t guaranteed. It’s the opportunity to pursue these things that we value. This is a critical distinction that a surprisingly small number of people have made. If you work hard and create opportunities for yourself to be lucky – you can have it all. But don’t expect anyone to give it to you. But…in order to take a specific path, you have to give up the opportunity to take other paths. You have to make compromises…and without the benefit of hindsight. This is the notion of risk and reward.
The comment on this blog discusses health care as a compromise, where we can’t have all of the following:
(1) quality health care that is affordable
(2) health care that is accessible to all
(3) health care which is unlimited
Read each of these as if they exclude the others. E.g. (1) is basic, non-comprehensive health care for most; (2) is low-quality health care for everyone; and (3) is comprehensive health care which isn’t necessarily accessible or affordable. I would argue that “quality” is a very relative term. We’ll assume for the sake of argument that “quality” means basic, preventative health coverage without resources for catastrophic health events. “Unlimited” means coverage for everything.
Hillary Clinton and Barack Obama probably opt for (1) and (2). This is where the “socialized medicine” argument comes into play. Would Americans be willing to choose this path at the exclusion of others? It’s difficult to analyze the argument in a vacuum…that is…a priori, without consideration of empirical data. If we were to engage in the academic exercise…it would seem like a reasonable choice. Everyone gets basic health care, without the bells and whistles. And this is the card politicians play. It’s a brilliant play, really. The notion of “universal health care” sounds fantastic — I’m willing to bet it is great for a presidential candidate’s poll numbers. But if we accept the notion of the exercise…that is…compromise, we need to look at what we would have to give up – and we can only do this with real world data. Providing basic, quality health care to every person that resides within our borders…which is affordable, would take away so many bells and whistles that we could arguably acheive the same patient outcomes by distributing pamphlets about the dangers of smoking and obesity, and spend hundreds of billions less. To make it affordable for everyone and maintain some semblance of quality and accessibility – the economics dictate that you strip it down to such a bare-bones affair – that a flu shot may not be covered. Even with conservative estimates of illegal immigrants and low-wage workers, the endeavour would represent a tremendous transfer of wealth from the productive to the non-productive. There are plenty of legitimate arguments for a “Robin Hood” approach in other scenarios…if it’s economically viable. In this case, I can’t see how it is. With the federal government acting as single payer and health care indemnity monopoly – all possible efficiencies are worked out and resources are wasted. The second act of my economic argument is motivation. It’s the classic confusion of the American Dream – guaranteeing the pursuit of happiness vs. guaranteeing happiness itself. If you allow people to think that the government will always bail them out – they have no motivation to take reasonable, calculated risks. They are working less efficiently. Hillary Clinton is arguing for a 90-day moratorium on home foreclosures — obviously for political reasons. If the government bails out Americans who borrowed more than they could afford to pay, it trains everyone to be wasteful and reckless. If America chooses (1) and (2), resources will be transferred from the responsible to the irresponsible, and those who can truly afford (3), will create a second, private tier of health care anyway. And the irresponsible have no incentive to become responsible. But everyone is paying more of their income for a system that necessarily, empirically, gets less efficient and sustainable over time…until we’ve trained ourselves into a welfare state.
This is why a truly efficient market always wins. As an American and an advocate for some form of consumer-directed health care, I believe picking (1) and (3) at the exclusion of (2), in a real-world, non-academic sense – is the appropriate compromise…because over time the economic incentives are in place to increase efficiencies, rather than reduce them…meaning if people learn to take enough responsiblity, we might get (2) as well. The notion of investing your health care dollars into people with a reasonable chance to recover is unfair. Many people with resources and no reasonable chance to recover will invest in hope…and choose to spend their resources however they see fit. And if everyone in this country is responsible for some of their own health care risk…they will train themselves to either make more money or reduce their cost of care through healthier choices. If Americans had an incentive to be just a bit more disciplined, we wouldn’t see skyrocketing cases of type-II diabetes.
Laissez-faire Healthcare Blog 