U.S. Healthcare Debate
November 24, 2009
New York Times columnist David Brooks has a piece today that casts healthcare legislation as a choice of two different sets of values, an America that offers more security and better decency or one that retains greater economic vitality, and that indeed is how opponents against changing the present system are generally casting this debate. It’s a straw man argument in part because it pits the alternative to the status quo as the various bills and amendments tabled in the congress, which themselves are gerrymandered products of compromise.
I prefer to frame the debate in two questions: 1) does America’s current heath care system deliver better results than any others that have been devised? And 2) Will the system’s flaws increase or decline over time if the system is not modified? The answer to the first is “no” because people are living longer in other countries and paying a much lower relative price for heath care than Americans do. The answer to the second question can be stated with less certainty, but the evidence strongly suggests that health care costs will continue to rise as a share of GDP and reach levels that eventually strangle the very economic vitality that Brooks argues is embodied in choosing the less humane status quo over a system offering a better chance of coverage.
Since the present system is unsatisfactory and unsustainable, the burden of proof lies with those who argue against changing it on the assertion that modifications could saddle America with a more flawed program. Perhaps the most unique feature of the U.S. healthcare system is the prominent obligation of employers to pay the cost. Who has a greater vested interest in the physical health of Americans: business managers, their stockholders, or a government of the people and for the people sworn to “promote the general welfare?” Who has a more natural stake in how the United States looks 25 or 50 years from now, business or government? Outside of ensuring a safe workplace, is it right for business to bear any responsibility for the healthcare of its workers? The firm pays the worker in exchange for services rendered. Workers, who become sick or leave a business for other reasons, are replaceable. The same logic does not extend to the aggregated level of government. As with education, government needs to ensure a competitive workforce both now and through future generations and therefore does have an intrinsic incentive to see that minimum standards get met.
It’s not hard to find signs of a broken U.S. healthcare system. Treatment is stressed more than prevention because treatment is more profitable than prevention. The proliferation of “ask your doctor” ads and the huge share of the national healthcare bill spent on people in the last months of life are two other symptoms of a need for repair. Whether any law out of congress could leave America worse off or better is an open question. Certainly the pharmaceutical law passed earlier this decade was a regrettable piece of legislation.
If congress is so fractious and ruled by powerful interest groups as to render beneficial lawmaking impossible, that’s a problem with the state of democracy, not an endorsement of present healthcare. Such doesn’t prove that the devil we know is better than all alternatives. To repeat, other systems that do not rely on the prominence of employer-financed healthcare already exist and are giving their people longer, healthier lives at much less cost.
Copyright Larry Greenberg. All rights reserved. No secondary distribution without express permission.
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Reducing our healthcare dilemmas to debating points won’t resolve our problems. Comparing survival rates across different countries with varied life styles and genetic pools is notoriously difficult. Within our own population, the results of “preventative medicine” are not uniformly accepted — the recent breast cancer screening brouhaha comes to mind. And I can assure you that what passes for acceptable treatment is not necessarily the same on the east coast vs. the west coast or in New York vs. London.
And who should be financially responsible? Should everyone in the US be responsible for the healthcare of a cancer victim who smoked too much? Should we all be responsible for a cancer victim whose employer exposed him/her to asbestos? Should we all be responsible for treatment of a cancer secondary to AIDS? Or cancer secondary to a familial genetic problem? Capitalism has its own unique solution to such discrepancies; different capitalist societies have similar though varied solutions. In the US, everyone is treated regardless of diagnosis but, mitigated by insurance or not, we are each responsible for our own bills. Which of life’s many maladies will be righteous, sanctioned by the government and paid for, and which of life’s maladies will be subject to a Twinkie tax, or worse, rationing? Will politicians decide which disease is politically correct?
No doubt about it, funding the current healthcare system will become increasingly more difficult over time. People living longer have more medical problems not less; a public health system not immune to this “victim of success” problem. Only rationing or personal financial responsibility deals with this problem.
The devaluation of the dollar has left the Chinese feeling sick and vulnerable as their wealth threatens to slip away. They could have purchased insurance — gold — but they didn’t. Now, China wants the rest of the world to insure it against financial loss — “one world” currency they plead. Really? Let’s first see if we can work it out by tweaking the current system!
This was refreshing. I wished I could read every post, but i have to go back to work now… But I’ll return.