Sense and Nonsense in Policy Making

The right rages and rants on the healthcare hobbiehorse, but it's not helping me much. They are busy blowing buzzwords out their betooshkas. I haven't dug in deep to the data. I am working too hard just to keep my head above water. But here is what I hear, out of the corner of my ear, and I don't like it much.

Socialized medicine

This is apparently the horror of all horrors. Unfortunately it is rather bloblike, with a clearly undefined shape. No one seems to want to explain what they mean by it, or why it is bad. It is socialist, though. That seems to be enough. But...are the proposals on the table REALLY socialized medicine? No one seems to be able to tell me.

Health Care will be Rationed

OK, it is rationed now. My insurance company has some strong opinions about what they will use my premiums for and what they won't. I'm not saying this is a bad thing. That is how insurance works. But why shout as if everyone has indiscriminate access to medicine now? It ain't so. Should it be so? Maybe. Maybe not. That's a different question.

Bureaucrats will make your healthcare choices for you

Again, they already do. It's just that they are paid by the insurance companies, not by the government. And again, I'm not saying that's bad, but you can't talk like there aren't hundreds of thousands of pasty faced cubicle dwellers checking off forms to determine what procedure they will or won't pay for right now.

Government ruins everything it touches

Could the gummint be more efficient? Sure. Could the gummint be more effective? Sure. Is there a tremendous amount of waste, boondoggle, porkbarrel and earmarking? Absolutely. But seriously, if we had anarchy -- no government at all -- do you really think that life would be better? Like the Israelites shouting for a king, all human societies must organize somehow. Tribes or Kingdoms or Nations -- every society forms some kind of government. Ours is actually pretty sophisticated and just compared to what history has served up. Without the government we have - flawed as it is - we would not be enjoying the freedom and prosperity we enjoy today. Sure, keep governmnet in check. That's wise. But don't go around blathering about how government is by nature the greatest evil, and must never be trusted with the public welfare in any form. That's just ignorant manure coming right out of your mouth.

Healthcare Reform will Balloon the Budget

I think it already is. So we can't just sit still. This is not to say that would should adopt something that would be financially disastrous in the long run just because it is politically expedient now. Nevertheless wouldn't it be better to do SOMETHING about it, even if it is less than perfect? Obstructionism is not going to get the budget under control.

So I don't want to know what horrible apocalyptic fate will befall us if we actually do the tiniest smidgen of what Mr. Obama has in mind. Don't rail prophetically about the awful desolation that will be post-healthcare reform America. Tell me how YOU would fix it. Present private sector solutions that will work. Give us counter proposals. The antithesis to the thesis of a proposed bill is not to scream hysterically at the congressman. The antithesis is to present your own bill, with different solutions. Then lets pick something that looks like it might actually solve some of the problems, get it passed, and move on.

Stop bloviating. Start renovating. Give me fewer bumperstickers and better ideas. Stop throwing those sticks and stone. Let's use them to build us something useful.

National Dyspepsia and Me

I’ve been thinking much lately of the national discussion shaping up around national health care programs (or not). It’s been fascinating for me to watch my own thinking, as limited and clumsy as it is, developing on that topic. I have always listed myself as Independent (in New Hampshire, this is my actual registered "party" affliation) while definitely leaning toward the conservative republicanish column. I am finding such labels less and less useful. To be honest, my current political position seems to mesh liberal amounts of libertarian gush with sizable piles of communitarian hoohah, a few globs of personal pork, and good dash of wwjd philosophy. That odd blend tends to create a certain degree of dyspepsia. When I apply it to the healthcare debate, I find myself in places I never thought I would.

Republican objections that I have heard seem more knee-jerk than thoughtful and substantive. Hysterics about bureaucrats taking away your ability to decide about your health care when such decisions should be “left up to you and your doctor” just strike a false note with me coming from these corners. You can’t accuse the Democrats of using that as a smoke screen to push through abortion legislation, and then use it as your own smokescreen. And the warnings about “rationing” are a bruised reed. Healthcare is already rationed, just not in a rational way. It is rationed by chance and circumstance. In the aggregate, you might barely be able to argue that it works, but if you look at the direction of the aggregate is actually going now, indications seem to be that it is not working.

It could be that I listen to NPR way too much. I’m hearing words like “unsustainable” and “untenable.” These could also be hysterics, but the seem right to me. This may be in part because my own view is skewed heavily by my own currently unsustainable and untenable economic condition – and the economics of my personal and family healthcare are a big part of that. I am paying easily 20-40% of my monthly income (my monthly income varies) toward just my insurance. This does not include actually paying for any actual healthcare we receive. Needless to say, I don’t go to the dentist very often.

The argument I hear most speaking against some form of consistent national health plan is that it is not the responsibility of government to provide such a service. I can see that argument. The constitution clearly delineates the role of the federal government and that of the states. Providing an army for the national defense is in there. Providing health care is not. And yet I think this may be placing the emphasis on the wrong principle. A national health care plan is not forbidden by the constitution. Such a need could not have been envisioned by the founding fathers to either forbid or recommend. We have to find our own way.

Let’s stipulate for a second that providing health care is not rightfully a responsibility of government. So then, whose is it? Right now it falls to business. But why does it make any more sense, on principle, for business to be saddled with that responsibility. It is the job of business to provide value for customers through products and services, and value to shareholders through profits, and value to employees through pay for services rendered. Who says this OUGHT to rightfully include health care? What does Acme Plumbing know about health insurance? What does Atomic Widgets know about managed care? There is a strong argument to be made that business should be freed from this additional burden so that our economy can grow.

Oh…but if government takes over managing healthcare then we are “letting employers walk away from their responsibility.” First, I would dispute that is really their responsibility. Second, they are already walking away from it by cutting their own costs, reducing benefits, pushing premiums onto the individual. That is the irrational rationing I spoke of earlier.

Will it be expensive? Oh, certainly. But what costs are we bearing now that are not accounted for? And wouldn’t a healthy population become part of our common wealth. We invest in roads and sewers because we all benefit. Such infrastructure helps us to conduct our lives, exercise out liberty and pursue all that happiness. If providing more consistent and rational healthcare coverage would move us in that direction, I think I’d be for it.

I also think that it is possible to design a system that could do that. It won’t be perfect, but I think it can be done. We’ll see.