The health care reform bill has recently been the subject of a ridiculous show called a “health care summit.” The proposed reform is mostly garbage. It does next to nothing to stem the rising costs of health care imposed by the private health insurance system. Even worse, it imposes penalties for not having health insurance; this is the Massachusetts model that is currently failing after only a few years of operation. The reason we supposedly have this wretched bill is because Americans won’t accept “government health care,” despite numerous polls consistently showing large majorities over decades showing that we would, and that we would pay higher taxes for it.
There are two major forms of “government health care” that in the debate on the issue are conflated.
The first is the one that the delusional or dishonest opponents believe is being passed anyway, where the government owns all hospitals and clinics and hires all the doctors. This is the English National Health Service model. The psychopaths think that means the government doctors will come into your home and perform mandatory medical tests, much like the post office kicks down the door to deliver my mail. While the British have no choice but to use the National Health Service, and to pay taxes for its support, they are not otherwise constrained by its doctors and other medical providers. The system has efficiency issues, however, in that it is directly part of the government. Therefore the service is subject to the machinations of the foes of public services in government, including all of the political parties. Since the 1980’s, both Conservative and Labor Parties have added constraints and fees, and cut medical services. The ultimate aim is to privatize health care in Great Britain, despite the enormous popularity of the National Health Service among the British majority of all political stripes.
Another sort of “government health care” is the Canadian “single-payer” model of health care, which is just a universal social health insurance plan. It’s “single-payer” because the government alone pays for medical bills owed to private medical practices. This barely counts as “government health care” at all, considering that the entire medical industry remains in private hands. But the government would then have “monopsony” power, the power of being the only buyer on the market, and could use this power to keep medical costs low. Even if taxes rose, people would find that they had considerable savings from not having to pay for the profits of private insurance share-holders and massively duplicated insurance administration. In Canada, it is also subject to politicized attempts to defund the system and then criticize its inefficiency. However, its doctors and other professionals are private practitioners, and not a part of the government bureaucracy; they cannot be hampered by politicians with axes to grind. Social health insurance is definitely the most effective health care reform.
But what about your freedom to choose from among unreliable and overpriced private insurance plans that will drop you when you have an expensive, life-threatening condition?!? It seems pretty silly when you put it that way, but that’s what this article is really about, so I’m glad you asked. Critics of genuine, effective, rational health care reform claim that people want choices about their health care that only a private health insurance market can provide. And they are only talking about for-profit insurance, not non-profit mutual health insurances (in which the customer is also the owner) which would be better. Americans, these people say, should have the right to be able to choose any health plan they want. Let’s call this paper freedom, because it’s my freedom to choose the administration of my health care. And we can be generous and assume that everybody can get a plan, even though today fifty million people can’t and many are losing their homes to high medical costs. Regardless of this generous position, insurers attempt to maximize their revenues by controlling which doctors I can see and which medical procedures I can have. I can go to some other plan, but they have the same institutional concerns – to maximize profit – that lead them to apply the same controls on my medical care. Meanwhile, under a social health insurance, I can visit any doctor I choose, and have any medical test done that is necessary. Let’s call this material freedom, because it’s my freedom to acquire the actual, physical goods and services that I want (I tried to find a way to make that sound less obviously the better choice, but there is no way). At worst, I may have to wait for care if someone else is medically worse off, but since we’re adults and know that scarce goods have to be shared, we can live with this. Not only does social health insurance manifestly increase my material freedom, but I and the sixty percent of Americans who want social health insurance would actually get what we wanted from the government.
Given these choices, I would sacrifice my paper, administrative freedoms for my real, actual, material, human freedom. People who desire the expansion of liberty regarding health care ought not to be fooled by the claims of the private insurance industry, and take action for single-payer health care.
* Photograph by Jim Kuhn
