Why Would It Not Work Here?
We Stand Firm has written an interesting article about the Colorado Medical Society and their support of health care coverage for Coloradans that should be “universal, continuous, portable, and mandatory.” I’m strongly in favor of health insurance for everyone in Colorado (and indeed, the US) that is universal, continuous, portable, and mandatory. I know this is a controversial topic, but I find it interesting to note that the Colorado Medical Society also supports the idea of some sort of universal health care. The hows and whys are yet to be hashed out, but it’s good to see that this is their overall position.
The article from We Stand Firm includes a letter from Dr. Bruce Fisch, a nephrologist in Denver, who is very opposed to universal single-payer health care. I find it interesting that he thinks that health care models that are working all around the world could not work here:
“The values here in America are unique, contrasting drastically with Canada, Europe, and Asia. Liberty and free thought with regard to one’s health and health care are paramount among them. One cannot accurately apply European models here in the USA.”
Why not? What values do we have that make it ok for 47 million of our people to be without health care - without access to any sort of quality health care? How are we so different from Europeans? I could understand if people wanted to point out how our values are different from say, Cuba’s. But Europe is full of democracies. Canada is not a Communist country. These are places with ideals that are very similar to ours in a lot of ways.
When people are opposed to universal health care, they almost always cite the problem of waiting lists in countries with national health care, and people dying while waiting on the list for treatment. I agree that this is a problem. But how is it any worse than the problem we have right now, with such a large number of people who are waiting for care that they are never going to get, and are not on any sort of waiting list at all? At least with a list, there’s a light at the end of the tunnel. And while I know that some people die on waiting lists in countries with national health care, lots of Americans die while waiting for organ transplants. The problem of waiting lists and lack of care are not unique to countries with universal health care.
A good friend of mine lives in New Zealand, and is battling ovarian cancer. It was first diagnosed in 2004, and within 24 hours of the diagnosis, she had been flown to Christchurch for surgery, along with her husband and daughter. Everything was paid for by the national health system. Her care has been proactive, top notch, and she’s still alive (currently in her third round of chemo since 2004) despite a prognosis of 2 - 4 years when the cancer was diagnosed. Her mother had a hip problem diagnosed around the same time as my friend’s cancer. Since the hip problem, while painful, was not life or limb-threatening, out came the waiting list. She waited about six months to see an orthopedist. Eventually she was seen and treated - paid for by the national health care system. Yes, she had to wait. But her daughter did not. It’s possible to have a universal health care system that applies waiting lists only to conditions that are not life threatening. From the time I spent in New Zealand. I’d have to say that the basic values of the people there are pretty similar to the basic values we have here. Life, liberty, and the pursuit of happiness are high on their list too. But nobody there gets cancer and has to figure out how to pay for the treatment.
Anecdotal evidence is only as good as the underlying principle it is meant to illustrate, and in this case the principles are wrong. The principles are: to force people to provide care for others (be it doctors, insurers, or taxpayers) is morally wrong, and the market interference this entails, like all such interference, always results in less productivity. You can only *appear* to support socialized health care using examples because the preponderance of evidence is against it.
An extreme example of this would be: Put everyone in prison except one person. Now, make everyone in prison turn the cranks of electric generators to create electricity for the home of the one free person. Look: Free electricity! Isn’t our plan great?
Louise writes: “Why not? What values do we have that make it ok for 47 million of our people to be without health care - without access to any sort of quality health care?”
First, I’ll point out that health care is not the same as health insurance. But that is not the underlying issue.
Nor is whether someone’s plan for politician-controlled health care “will work.” The hidden premise behind that is that it’s OK to use people as a means to your ends, rather than respecting their rights to live their own lives as ends in themselves.
People claim that “it won’t work” if people are free to donate (or not donate) to a health care charity, and hence government should punish people who do not donate to government charities like Medicaid and Medicare. “It won’t work” is shorthand for saying that people, if free, will do what they want to do rather than what politicians force them to do.
When talking about “values that we have,” why must our values be channeled through a government program? That sounds like a rather intolerant way of going about things, as surely some people will be forced to pursue the values of others, and be prohibited to express their own values.
Even if we all shared the value of people having access to health care (or education, or food, etc.), a monolithic government-controlled charity would have one vision of how to do this, whereas individuals would have several and differing opinions on how to achieve this goal. It’s immortal to force other people to donate to someone else’s notion of a good cause.
Economist Frederic Bastiat wrote in The Law (1850):
One step toward a more tolerant method of charitable giving is charity tax credits, which I address here.
Thank you, Louise, for commenting on Dr. Fisch’s letter to the Colorado Medical Society. I’ve posted a reply onto the FIRM blog at:
http://www.westandfirm.org/blog/2008/06/would-americans-accept-european-medical.html
Respectfully,
Paul Hsieh, MD
Louise,
Thank you for your thoughtful reply. Please allow me to clarify why it is that we Americans are so unique and why we differ from Europeans in both thought and action. Our history, culture, geography and expectations differentiate us. We can’t help it. We prefer to stretch the limits of innovation, both in technological realms and liberties. Our government is unique, our transportation systems, public education, how we wage war, and our treatment of our elders all differ from those in the rest of the world. Our customs may not always be better, but they identify us as American, nonetheless. One theme permeating all these endeavors is our individuality. The USA brand of individualism dictates that we get what we want as consumers and as healthcare workers. Yet, our decency as a society mandates that we care for those less fortunate.
Thus, with respect to your examples of New Zealand’s healthcare system working for the people you described, I counter with the 30 or 40 patients I saw last week in the hospital, in dialysis clinics, and in my office, who – aside from those who already covered by government insurance - have no means to afford the actual cost of their care. Luckily, our built-in safety-net composed of Medicare, charities, and simple gratis service, saves the day. No patient in America is being left to die in the street for lack of insurance. While optimum healthcare is not considered a right, America has made it a human right. And much more so in the US than anywhere else in the world. It is precisely a socialist movement toward universal healthcare that will reverse that, turning a human right into a guaranteed legal right, and thereby denying both in the end. Some of us believe that the free-market can (and does) supply the solution. My hospital will continue treating people who cannot pay. They will still turn a profit. I will continue to hop out of bed at 1AM to save the life of a patient who I know will never pay. It is just the way we work. When universal healthcare imposes rules on me, I think I would still go in to treat the patient in the middle of the night, but only if the governmental oversight committee has decided that it’s reasonable to spend the money to save that particular patient. In the end, better to leave those decisions to me and my patients.