What You Should Think About Health Care

“Expensive medicines are always good:  if not for the patient, at least for the druggist.”

–Russian proverb

I recall, as a libertarian-minded youngster, becoming upset that media coverage of reforms advocated by Bill and Hillary Clinton referred to “the American health care system.”  I noted a fact as true today as it was then — this nation does not have a systematic approach to health care provision.  It bothered me to think that the implication of a “system” was misleading people into believing there was some sort of problem in need of a solution.

Today I remain concerned about use of the phrase “health care system.”  As a grown man with knowledge of the world that books alone cannot convey, I understand the grotesque inhumanity of American policy as relates to the provision of medical services.  It is a real and grave problem, a problem every other prosperous civilized nation has already solved within its own borders.  Arguments about the precise number of uninsured citizens only distract from the reality that tens of millions of Americans have no practical alternative to emergency medical services.

For some, this means sicknesses and injuries are only addressed in moments of desperation, with inefficient use of precious resources.  For some, this means sicknesses and injuries are endured despite protracted or even lifelong suffering.  According to [warning: PDF link] a recent Harvard study, for around 45,000 people each year, this leads to death.  Effective universal health care policy could save as many American lives as preventing one 9/11-magnitude attack every forty days!

Perhaps it is unfair to compare Republican party leaders with the leaders of Al Qaeda.  Yet the scope of preventable deaths brought about by human choices begs the question — to whom is that comparison unfair?  Are working class families caught in the gap between Medicaid and affluence somehow less innocent than the final occupants of the World Trade Center?  If expense is the real issue, why does solving the much more deadly problem of health care access warrant so much less support than the problem of terrorist attacks?

At a disturbing nexus of ignorance and irony, proponents of universal health care have been cast as villains who pose a threat to the American way of life.  That ignorance stems from some notion that it is unconstitutional for the federal government to see to the general welfare of the American people.  Never mind that the Article 1, Section 8 explicitly provides Congress with that power.  Never mind that the very first sentence of the Constitution articulates that duty as one fundamental purpose of our government.  As with so many other areas of debate, many critics of reform are unwilling to be swayed by even the most obvious facts.

If there has been any betrayal of the American way of life, it has been the institutionalization of political dogma holding that government action impedes private sector solutions.  While political leaders in the opposition party have either failed inexcusably in their duty to be informed or deliberately shirked their duty to serve the public interest, their followers are typically less villainous.  A month or so ago, one well-meaning and apparently patriotic woman shouted out that “the good hearts of the people” should be given a chance to address this problem.

As long as the problem has existed, public goodwill has had unfettered opportunity to provide relief to the sick and downtrodden.  In the early 1990s, it was already clear that philanthropy was inadequate.  In spite of enormous tax breaks for wealthy Americans in the interim, our nation has only seen more and more of our citizens uninsured or underinsured.  The notion that government cannot play a constructive role is repudiated not only by dozens upon dozens of foreign realities, but also by our own increasingly bleak public health reality.

Yet narrow interests remain zealously defended.  Some say that universal access to health care would somehow inhibit the development of new drugs and other medical technologies.  Does our nation lose nothing greater from tens of thousands of deaths (not to mention uncounted lost hours of productivity) brought about by inadequately treated medical conditions?  If medical innovation really suffers somehow from the provision of universal access, how much blood must be spilled in its name?

Yet even that is a false dichotomy.  Several European nations are each home to large thriving medical research enterprises.  Heck, even Cuba, in spite of scant national resources, manages to develop lifesaving new drugs at an impressive pace.  The idea that America, with so much raw wealth and so much intellectual capital, cannot meet the needs of its own people and still outshine the inventiveness of those other nations is a very strange assertion for a self-identified patriot to voice.

If there is any valid criticism of reformers, it would be about their widespread willingness to compromise with a political movement utterly at odds with facts.  In months of high profile public debate, few voices have been raised to ask just what profit-based health insurance actually accomplishes.  In effect, these institutions serve as private sector death panels. Somehow that term has instead achieved cultural resonance based on the fictitious and absurd rationing no public official has ever proposed to end the lives of Americans no one wishes to see dead.

Certainly there are times and places where compromise is in order.  When good faith efforts to get at the facts yield inconclusive results, bold action may be unwise.  Regarding the state of American health care today, it is only efforts made in bad faith that prevent widespread clarity about a national body count caused by a cutthroat economic paradigm applied to health care policy (not to mention monumental losses to productivity suffered by survivors of that same blight.)

Perversely, even as national media outlets are assault by propagandists, they continue to indulge purveyors of misinformation.  Again and again, transparent lies and the unrepentant dissemblers behind them are put on equal footing with provable facts and earnest informed advocates.  As with the disastrous plunge into Iraq, this critical political decision is being shaped by dialogues that equate major league national scoundrels with genuinely wise national leaders.  Yet whatever wisdom exists to promote reform, it seems unable to bring our nation anywhere near the kind of sweeping overhaul that would bring great benefit to each and every other enterprise by way of marginalizing a single parasitic industry.

Neither conservative nor libertarian thinking is without wisdom of its own.  This wisdom becomes folly when it relies on misinformation and hostile emotion.  Every day, more of our own citizens die because this particular folly continues without remedy.  If a few thousand Americans dying in 2001 justify enormous changes to our way of life, on what basis does anyone reject less dramatic change in to prevent the deaths of so many more innocent citizens?