My apologies for the delay in this piece; I was rather delightfully distracted online last night.
So, we've established that our health care system works pretty damned well, but the way we pay for it is seriously bollixed. Just what the hell should we do about it?
Well, I am innately suspicious of any heavy-handed government solution. There's an old saying that "the power to tax is the power to destroy," and the power to regulate and control is not that far removed from the power to tax. I would be very concerned about having the government "fix" the financing end without totally wrecking the important part, the part that works -- the actual health care.
Historically, government regulation and control has been more destructive than beneficial -- especially when it comes to financial matters. Witness the "luxury tax" of the 1990's that utterly devastated the luxury yacht industry, putting a lot of skilled workers out of their jobs.
Also, I find myself philosophically opposed to the government setting price controls on anything. It's not that far removed from turning medical professionals into lifetime indentured servants, controlling just how much money they can make.
It troubles me, too, that the experiments we've seen in regulating the costs of health care around the world have ended up hurting the actual providing of services.
For example, in Massachusetts, they've started really ratcheting down on things. They now require all residents to carry health insurance, and have previously instituted tight controls on the medical field -- all in the name of saving people money.
Not so coincidentally, they find themselves lacking doctors. Not only are established doctors and practices relocating across the border (old blog-friend Giacomo is a great example), but even the Boston Globe has noticed that the state is seriously short of general practitioners.
Gee, Massachusetts institutes a whole bunch of "reforms" that have the end result of limiting how much doctors can make, and is surprised when skilled, experienced, veteran doctors decide to skip across the border. Further, those doctors who don't flee -- seeing that the state is focusing mainly on general practitioners and letting specialists slide a bit more -- are choosing to go into more profitable specialties. Toss in the mention of how the doctor shortage isn't so bad around the teaching hospitals, and you have a simple explanation for it:
Young would-be doctors go to Massachusetts to get the best possible education and experiences, then -- as soon as they can -- move into either fields where they can actually make what they can, or move to states where they can make what they can. Who remains behind? Those who are truly dedicated to their craft beyond economic sensibility, those who can't master the skills to go into a specialty, and those who have other attachments to the state.
OK, that's Massachusetts. It has its problems (obviously), but one element that doesn't scale is the ease with which doctors can "opt out" of it by moving no more than a hundred miles. What would happen if the system was larger? If it was far tougher for doctors to escape the grasp of government control?
Well, you might end up like Canada.
Or Great Britain.
Horror stories from each abound. Long waits for critical procedures. Rushed exams by doctors who have to meet their "quotas." Botched operations that take forever to correct. And so on. And so on.
The Declaration declares that we are all endowed by our Creator with certain inalienable rights, and cites "life, liberty, and the pursuit of happiness" as examples. Some would argue that health care falls under the "life" part.
But there is no right to demand something from someone else for free. And that is the crux of the health care argument -- people want free health care, but they don't want to think about just how that happens:
"Health care" means people providing services and material goods changing hands. All of those have a cost and a value. "Free" just means that "someone else pays for it."
It's a great system, for the recipient. For the provider, not so much.
Right now, we have the greatest providers in the world. Our health care is the gold standard by which all others are measured -- and found lacking.
So whatever we do to fix the problem in financing our health care system, we must be extremely careful not to destroy the most important part, the part that works so damned well.
Or we end up with the ultimate socialist fantasy -- true equality, with everyone being equally miserable.
I'll pass, thanks.
(Title stolen from one of the funnier episodes of "Xena: Warrior Princess.")