Saturday, August 27, 2005

Liberals Can't See Reality: Healthcare as an Example

Kevin Drum highlights the Malcolm Gladwell article in the New Yorker:
The Washington Monthly: "Malcolm Gladwell asks the key question about American healthcare in the New Yorker:
"One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. Six times in the past century — during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during the Clinton years — efforts have been made to introduce some kind of universal health insurance, and each time the efforts have been rejected. Instead, the United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year."
Gladwell mentions the historical fact that unions in the U.S. worked individually in collective bargaining to get health care for their members; in Europe they worked together through social democratic parties to get health care for all. The theme of the article is tracing the impact of ideas: Americans focus on individual responsibility and moral hazard, therefore on actuarially sound insurance; Europeans focus on the community and sharing the burden of accidents and random illnesses.

I don't quarrel with this, but I do note with bemusement the blinders that liberals wear. Americans spend much more on health care than others--that's the message that Kevin Drum and other liberals repeat incessantly. What I don't see is analysis of what it means, as thus: If we spend more on healthcare, that means organizations and individuals who are getting the money. All of the paperpushers in each of the separate laboratories, medical practices, hospitals, research organizations, rehab units, nursing homes, hospices. All of the professionals in these places. All of the individual practitioners. Now they aren't all overpaid by comparison to a French style system. But they all can and will fear that they are. It's eminently rational for the participants in the current system to fear any proposed changes, particularly when we say that the system is wasteful. (Just as government bureaucrats rationally fear the politicians who attack government waste.) Under a new system, most of today's fat cats would lose and they'd hate that. But even the alley cat who works hard for a meager diet of leftovers from the fat cat meals has fears. Better the known present than the unknown future.

With this as the background, is it any wonder that Harry and Louise saturated the airwaves?

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