This is perhaps the most complicated policy debate ever. Not having a mind for details or for finance, monetary and fiscal policy tend to bore me and often confuse me. Finance is incredibly complex, what with it being run by a conglomerate of shady right-wing Trotskyite Freemason Rosicrucian Merovingians, but I think healthcare actually beats it by a healthy (heh) margin in terms of complexity. There are a few key points I'd like to draw out from the get-go, and I have no question I will display my ignorance at at least half a dozen points of debate. Here goes.
Staying healthy is in large part a function of taking care of oneself. For millennia, individuals have seen to their own well-being, at times seeking the advice or care of specialists who were advanced in certain crafts. With medicine advanced to its current level, these crafts are highly specialized and the corpus (heh) of knowledge is mastered only by those rightly exalted for their mastery of it. Still, for all that, the vast majority of health is maintained on a personal level, and the most common ailments - tooth decay, the common cold, minor lacerations and contusions - are dealt with by pastes and salves and chicken soup, or rest and waiting. The next tier of problems are addressed in a way that doesn't exactly require 17 years of education and thousands of dollars to treat. Infections need antibiotics. Painful swelling needs anti-inflammatories. Sleeplessness calls for a sedative and perhaps some counseling. I begin to imagine a system far less complex than the one we have concocted for ourselves to address the vast majority of health concerns.
As for the current debate, let's see what we can do.
Health vs. Health Insurance. All sorts of lefties are clamoring about all sorts of rights. Rights ethicists seem to make a business of declaring various things to be rights, and then making arguments for why they are super important, or why they are basic to the human condition. Much of the work they do is critical to improving the condition of the truly impoverished, so I don't knock them as a class of activists (the above-linked professor is one of my philosophical mentors, even if I do break with him in methodology, disposition, and conclusion). However, there is an important distinction between these two things.
So is 'health' a universal human right? Or perhaps we can all be positivists for the sake of argument and be willing to assert it as one. In that case, what defines health? Do we defer to the medical community and DSM-IV type publications and declare that health is the absence or, failing that, management of disease? You see the problems coming down the pike. In a public system, there isn't a potential for abuse, there is an open invitation for it. For some reason, full medical and prescription coverage is a statutory part of the compensation package for all military members. And believe me, in a universally funded community, everyone abuses the system. One time my eyes were puffy so I went to the emergency room, because I could, and because finding my actual primary care provider was an inconvenient process. Prescriptions are free to the , and so long as you can find a prescriber, you can get all the drugs you want. The only thing that keeps this program from being absurdly expensive is the fact that access to almost anything, including healthcare, is at least monitored by the chain of command, and soldiers can't just go at will for anything, and the fact that most of the providers are military, and none-too-sympathetic to outlandish claims (a curious exception exists for mental health claims). So if health is defined by statute and is an entitlement by statute, we are asking for abuse gone rampant.
Is health a right? That has to be a silly thing to say. I can't make that make sense. Health is a construct, or at best a concept, and as I discussed briefly above, consists largely in doing things for yourself. I imagine what people mean by this is that treatment of disease is a right? Perhaps one of my colleagues can straighten out what is meant by this.
Is healthcare a right? I doubt it, but it is certainly something a nation as wealthy as ours could figure a way to provide for even 'the least of these', to use the parlance of Our Savior.
Is health insurance a right? I don't see how. Apparently we've chosen it as the best way to provide ourselves with healthcare, or most of us have. I understand the very wealthy dispense with it altogether and just pay for things they need. Why is that the exception? Prices, of course, are astronomically high. And why is this? Current regulations have nothing to do with it? A topic for another post, to be sure, but worth giving it a mention here.
Rationing. As best I can tell, no one denies that rationing is a necessary part of any healthcare system, or really any economy. The question is one of who gets to do the rationing. My friend the Blackslug presents the view that it is better to have our friendly legally accountable government making these decisions for us rather than the profit-mongers at Aetna and Prudential and their ilk. My liberty argument was rather unpersuasive with the Blackslug, as the impression is that these companies are so incredibly powerful, with such a strong influence in Washington, that there is liberty only in name, and not in any way in fact. De jure liberty, but de facto oppression and tyranny. As the son of a primary care provider, I've heard the stories. I've heard the stories of my mother and her colleagues on the phone badgering insurance companies to pay for this additional test or this specific type of treatment. So the sentiment I get.
I don't necessarily think it's so straightforwardly oppressive, though. For one, if it weren't for current regulations that restricted individuals from choosing their own insurance, but rather mandating employee provision, there would be quite a bit more pressure on these companies to provide a better caliber of coverage. Also, it is unclear how to square the talk of the waste of the current system providing too many unnecessary procedures against the sympathy-mongering of the current system constantly denying claims. One or the other, please. (This is rhetoric the politicians play, I don't accuse serious policy debaters of this fallacy.)
In the end, there is a degree of freedom currently. As a last resort, an individual can resign from his job and find another to change plans. Or an individual can usually decline health insurance and purchase private insurance. Regardless of how it might often shake out, it is currently between an individual, his doctor, and a financier with whom he has a private contract as to whether his request will be financed. Enter the government, and we suddenly have an entity backed by the power of the sword deciding what healthcare I receive. And hence the fears of so many in the 'death panel' crowd.
Simply saying there are going to be death panels either way is not a very convincing counterpoint.
Current Systems. Finally, there have been some comparisons of our current private insurers to two different alternatives. The first is Medicare, and the folks at Heritage have done a fair job of dispelling the alleged advantage of Medicare in terms of cost control. It is beyond me how someone can hear a claim that a government program is more efficient than a private one and not immediately sound all the bells and sirens blaring in their "No Conceivable Way" alert system. Worse, it seems like Medicare is engaging in just the sort of 'ever declining coverage' behavior that critics of the market system like to criticize.
The other comparison is to Canada or Britain. Britain seems to be worse off, as it is more often cited by critics and Canada is more often cited by supporters. But both systems are used by both sides to support their argument. In the end, from what I can tell, they have to be willing to say that providing healthcare to all citizens is worth the trade off in efficiency and cost. And for our side of the aisle, we have to be willing to say that the price of liberty is that some go without, and that their need does not automatically generate an obligation, legal or moral, on anyone else.
My Proposal (well, not mine, but the one I like). Congress needs to deregulate to a large extent, but other than that, I'd like for them to just stop doing whatever it is they are doing. I find the current proposal to be perverse. The federal government is out of hand at this point, and almost every newsworthy actions either administration undertook over the past 2 years has been a severe abrogation of the Constitutional limits. Despite the Supreme Court often having been flat out wrong about what the federal government can and cannot do, it seems that even it and the web it has woven disallows at least the mandate aspect of the current proposal.
It is a sad but easily discerned path that led us to the point here an A.D. 2009, just over 200 years since the miracle of the inception of the American Republic, where the Congress of the United States thinks it has the authority to regulate health, and not too many people in the opposition dare to question the limits of their own power. Much better to score points now without tying your own hands in the future, the better to enrich yourselves, no? Perhaps.
I try to draw this distinction often. There is a difference between policies with which you disagree (tariffs, for instance) and those that are actually illegitimate acts of a government (where to begin? Gun free schools act?). Healthcare falls into this category. I think these proposals are bad ideas, but they are also not supposed to the stomping grounds of the federal government.
What can states do? A lot more, having the general police power reserved to them. Two Heritage Foundation scholars support the universal plan administered in Mitt Romney's Massachusetts. Perhaps these 'laboratories of democracy' can come up with universal insurance plans that provide insurance to the underprivileged, retain liberty for the regularly-privileged, and drive down overall costs. Perhaps they can, and if one state wants to go insane socialist with their plan, so be it. The citizens of that state should fight it, but so long as they don't violate any individual liberties of the U.S. Constitution or their state constitution, then they can have fun with it. I won't live there, but it's a matter for their polity, not me or the federal government.
Best of all, if one system works, other states will adopt it. And leaders at the national level can leverage these other states to adopt it. Insurance companies are sure to benefit by roping all 15 billion uninsured Americans into the insurance system, so they will likely leverage any plan that is of a similar. Several of the Several States should get in to the act now if they are interested in their own sovereignty, a concern I am sure Massachusetts did not have in mind. And for those on the left who are actually driven by compassion (I suspect it is a very small number), this is a practical approach towards insuring more people that doesn't involve some scary gargantuan federal program.
Can all problems be solved by Federalism? Why yes, yes they can!