The Authoritarian Underpinnings of National Health Care
Nationalizing health care has a dark side.
Britain’s National Health Service is widely cited by progressives as a model for the United States. In the ideal, everyone is given access to the best modern care available. In reality, many suffer from long waits, lack of access to the best treatments, and now, a health care bureaucracy that punishes them if they try to compensate for its inadequacies.
The lack of a profit motive in nationalized health care is what produces the problem. Because hospitals have no financial incentive to invest in new equipment, they simply don’t. As a result, critical tools like MRI machines are rare in nationalized health care systems. Those that do exist have massive waiting lines, extending to months or even years.
A similar problem exists with modern drugs, where the massive bureaucracy that must underpin any national health care system displays the worst combined symptoms of an HMO and a government agency. The HMO side works to contain costs by refusing to pay for expensive new drugs whenever a cheaper alternative is available, even if that cheaper alternative is relatively ineffective in the patient’s specific case. All that matters is the dictates of the classification-driven manual of standardized care. If an individual patient falls outside of the standard classification system, tough luck. You can just die now.
The government agency problem adds authoritarianism to the mix. Because the reputation of the health care system becomes a political problem in addition to a functional problem, bureaucrats and elected officials have an incentive to protect that reputation even at the expense of individual patient’s lives. Thus, when frustrated and desperate patients try to compensate for the shortfalls of the national health care system by paying part of their own way through a parallel private health care system, the government threatens to crack down on them in order to maintain the monopoly of the public system.
In the end, it becomes a situation where the political economy of national health care sacrifices patient’s lives and health to its own selfish ends, all the while pompously posing as the protector of the people. Such is not an inevitable outcome — it actually is possible to design a system of national health care that would not commit such travesties as the British and Canadian systems have. But the project has to be undertaken with a conscious and deliberate recognition of the potential problem and a willingness to address it explicitly in the enabling legislation.
Democrats who are prioritizing national health care in the 2008 U.S. elections should start doing that.
Jason, hold on a second. I understand this is a cautionary tale, but I have a basic disagreement with a lot of what’s said here.
First, the "selfish ends" you’re talking about entail making sure everybody has access to health care. And while I’m sure some of the rules in the systems you mention smack of pompousness, I think if weighed fairly against other costly government run programs (like military spending for one), providing health care to all greatly outweighs a few goofy rules. There are NO perfect systems. They all have flaws. But the one that’s most flawed is the one that leaves tens of millions uninsured, yes?
Let’s also remember that the systems you’re talking about are not anywhere close to the plans being proposed by the Dems in this race. Nobody’s talking about single-payer, government run healthcare. We’re talking about subsidies, which interfere far, far less with profit motives and don’t come anywhere close to monopolization.
Another thing I found kind of odd was your position that there’d be support for generic drugs if they were ineffective. Since when has this EVER been a position any politician in this country has supported? Generics are always meant to provide a level of effectiveness nearly equal to the brand name. This is a position that has never changed, at least in my experience.
I do think it’s fair to start talking about how best to sell health care, but are you really suggesting we start from such a shaky logical base as this? Isn’t covering everybody better than not covering tens of millions of people?
Subsidies have proven a great way for the federal government to start expanding its own power and to make people do what it wants people to do.
If I remember correctly you were positive about Ron Paul. Where in the Constitution does it say that the federal government can "provide health care" to citizens? If it’s not in the Constitution the federal government has no right to mingle in an issue. That’s the entire idea behind it.
Secondly, military spending is of an entirely different nature than health care. They’re not even almost comparable.
Not per definition. Castro ‘covers everybody’ but I wouldn’t call his system better than that of, say, the US (unlike Michael Moore of course). Would you?
Justin: the shaky efficacy of many generics is a huge problem that HMO’s are unwilling to deal with, because their bottom line says that if there’s a cheaper alternative then that must be used (quality be damned.) And that’s only considering the brand name/generic question- there’s also the issue of using a different class of drugs that’s more effective for a particular patient, which the doctor agrees is better, but the ins. co. won’t pay because it says the cheaper alternative should be just as good. If you don’t think that these problems would be magnified by a govt bureaucracy, then I can’t imagine that you’ve had much dealings with govt agencies.
Incorrect. The first and most fundamental goal of any bureaucracy is to ensure its own survival and expansion of power. Providing services is only the secondary goal. And nationalized health care sometimes tends to put the primary goal in conflict with the secondary goal, leading to organizational dysfunction.
Maybe you should deal with what I actually said instead of making stuff up. I said that Democrats should account for problems like occur in Canada and Britain in designing their systems. I did not say that they should abandon the goal of universal coverage. In fact, had you bothered to read thoroughly, I specifically said that it was possible to design a system that avoided the British problems. But we have to recognize and admit to those problems first.
To Michael’s point: subsidies can be a sneaky way for the government to infiltrate the free market but I’m willing to consider them as part of a reconfigured healthcare system. But I won’t support any single-payer system or government price-controlled system because that eliminates the kinds of innovations that could help control costs without reducing quality of care (the cost/quality problem is the #1 obstacle of all modern healthcare systems).
To get the best handle on how costs and quality relate and interesect in both positive and negative ways, we need to clearly understand the failures of other nation’s nationalized systems just as much as we need to understand the failures of our own. Good piece, Jason.
Please medical literature. With few if any exceptions I’ve not seen strong medical research suggesting signficant therapuetic differences between brand name and generic equivalents.
shourld read “Please cite medical literature:
Heh, I should have known better than to have written a statement like that without having time to do a lit search for citations to support it. I admit I base it partly on anecdotal information (personal experience and discussions with physicians who are friends) but here’s a link to a discussion about the differences in bioequivalence (FDA only requires the generic to be within 20-25% of bioequivalence of the trademarked drug) and the problems with that variance with drugs that have a narrow therapeutic index.
MvdG, I see healthcare and military spending as very comparable. The roll of government should be to protect life, liberty, and the pursuit of happiness. Both health care and military spending are directly tied to those three. It then becomes a question of weighing risks, benefits and costs of a government program towards those three goals.
This might be old hat, but it still seems to me that a place where liberals and conservatives could find good common ground is in universal preventative care. The largest, most inefficient, and most distributed (meaning spread to people not physically receiving the care) costs of a hospital is the emergency room. Good preventative care can dramatically reduce that cost and the cost of the whole system, and seems like a perfectly reasonable place to start with our health care system. Sorry, no time for a citation
Kevin, I disagree with your assertion that military spending and health care relate equally to the fundamental rights listed in the Declaration of Independence.
The military effectively creates the environment in which those 3 rights can be exercised.
Your personal health situation is one of many factors that governs your use and relative success within that environment but is no more a guaranteed right than other success factors such as intelligence, skin color, or genetic heritage.
Jason, sorry it has taken so long to respond. Been on a biz trip.
But first and foremost, I did read what you wrote, and I’m not making anything up. I asked you a fair question, given that your basic premise is that the Dems are seeking to nationalize health care and should avoid the pitfalls of England and Canada’s programs. See, I disagree with the very idea that you made a comparison between unlike systems, but since you did I’m asking the question. That’s fair.
More importantly, what I’m saying is that the proposals already put forth DO address what you’re afraid of. And beyond your worries about bureaucracies, I still go back to my point that a system that covers everybody is better and more moral than a system that leaves 45 million uncovered. We can not claim to have the best health care system in the world when we leave 15% of our population without care. Personally, I don’t like nationalized health care systems, but no system is perfect and if I had to choose between having everybody covered or leaving millions hung out to dry, I’d choose the former. Thankfully, we’re being given choices in this election that offer different options. But that’s only a good thing if we adopt one of those options. If we don’t, our system is simply not as good.
To respond to Michael, he can try to frame this issue if he wants, but an overwhelming majority of first world countries have universal health care programs, so why he brings up Cuba is silly. Especially since the country he now resides in offers pretty much exactly the same plan that Obama and Hillary are offering. Once again, Michael proves he’s only interested in scoring cheap political points instead of engaging in real debate.
One last thing, I want to see more than just one link to one study on this "relatively ineffective" issue of generics. I’d also like to see proof that this will be a problem in the programs Obama and Hillary are proposing, because, again, what is being offered is not nationalized, government run health care.
My point actually still stands. You seem to be incapable to understand what arguments work and what arguments don’t. For instance, when someone says "covering all is per definition better than not covering all," another one can say "they do that in Cuba, do you think Cuba is better in that regard than the US?" That’s fair. But by saying "well, they have it to in the Netherlands" you don’t address the point that, in fact, not all coverage automatically means it’s better than some not covered. That might be difficult to grasp for you, but I’m sure you’ll figure it out after a couple of philosophy or debating classes.
As for the Netherlands, it’s typical that you talk about things you know little of. For instance, the government played a very big role here until a couple of years ago when we reformed the system – the reforms being led by my party – which would allow more competition. Slowly but surely we’re decreasing the role of government and if it’s up to me we’ll continue to decrease it for quite a while to come.
As for your personal attacks: I have enough of you Justin. You’re warned. One more personal attack and I’ll ban you personally. You may be a blogger, who thinks he can ignore traditions on a blog, but I’m not willing to let you do this time and again. Try it again and it’s the last time you were allowed to comment here. I think that readers can see that you’re not exactly free of scoring cheap points when you can. You do so constantly (moderation and all that).
You’re threatening to ban me? What’s interesting is a lot of people around here have recently said you should be commended for not deleting comments, not banning people and letting everybody have their say. And while you haven’t technically banned me, you may as well have.
Take care Michael.
To respond to Michael, he can try to frame this issue if he wants, but an overwhelming majority of first world countries have universal health care programs, so why he brings up Cuba is silly
Yeah too bad the overwhelming majority of first world countries that have tried universal health care are seeing their medicare costs skyrocketing to the point of bankruptucy. Oops! Too bad most of us are trying desperately to figure out a way out of the "free" health care hole we have dug ourselves into. D’oh! Here in Quebec, in a quasi-socialist part of North America, of the kind that the self-delusional Obamimites seem to want to emulate, a year long study was just released a few days ago which basically says that we’re screwed and if things proceed as they are, we will no longer be able to afford our "free" health care. Fortunately our cowardly government mostly ignored the findings. Yay for us!! Yay, massive new taxes on an already overtaxed, over indebted, over regulated, massively over bureaucratized nanny state society. Woo hoo for liberalism, otherwise know as "paradise on Earth". Luckily, if things proceed as they are, Americans will soon be able to share our miseries, errr, I mean the "wonders" and "joys" of big government, nanny state "free" health care. I mean, it’s not like American can’t already afford His Obamaness’ generosity, especially with the coming baby boom retirement looming…right? Oh well, ideology trumps reality, shockingly.
May His Obamaness bless us with His hope, His "change", His new visions of government (that noone else apparently outside of the US has tried, but He, He has the will and the strength, the experience and the wisdom do to what normal men and women and politicians have tried for a generation to do yet failed spectacularly time after time outside the up until now ignorant US).
It’s not that
communism, errr, universal health care is inherently an unworkable system, it’s that the "wrong" people are that ones who always keep trying to implement it. It’s not the system, it’s the people, dontcha know. Oh well, thank Obama for Obama. If anyone will get it right, He will.Sad.