Wednesday, March 24, 2010

Off-Topic: Mark Steyn on Obamacare

It passed. The healthcare reform thingy got the green light, despite Americans not wanting it.

This piece is very good, and the reason Mark Steyn is always worth reading.


Health care is a game-changer. The permanent game-changer. The pendulum will swing, and one day, despite their best efforts, the Republicans will return to power, and, in the right circumstances, the bailouts and cap-&-trade and Government Motors and much of the rest can be reversed. But the government annexation of health care will prove impossible to roll back. It alters the relationship between the citizen and the state and, once that transformation is effected, you can click your ruby slippers all you want but you’ll never get back to Kansas.

Why’s that? Well, first, the “health care” debate is not primarily about health, which chugs along regardless of how the debate goes: Life expectancy in the European Union 78.7 years; life expectancy in the United States 78.06 years; life expectancy in Albania 77.6 years; life expectancy in Libya, 76.88 years; life expectancy in Bosnia & Herzegovina, 78.17 years. Once you get on top of childhood mortality and basic hygiene, everything else is peripheral – margin-of-error territory. Maybe we could get another six months by adopting EU-style socialized health care. Or we could get another six weeks by reducing the Lower 48 to rubble in an orgy of bloodletting, which seems to have done wonders for Bosnian longevity. Or we could lop a year off geriatric institutionalization costs by installing some kook in a pillbox hat as Islamic dictator and surrounding him with a palace guard of Austin Powers fembots. It’s as likely to work as anything Congress will pass.

What explains the yawning chasm of these gaping six-month variations? Lack of funding? The United Kingdom spends three times as much money on “health” as Poland and their cancer survival rates are more or less identical. Okay, forget the cash and consider the treatment: Even within the United States, even within the Medicare system, there are regions that offer twice as much “health care” per patient – twice as many check-ups, pills, tests, operations – for no discernible variation in outcome. To one degree or another, any health care “system” is a giant placebo. Right now, in a fit of mass hypochondria, large numbers of Americans have convinced themselves that they – or, at any rate, their uninsured neighbors – urgently need the magic Euro-cure-all. If they get it, it will improve their health not a whit.

But it will make a lot of other things worse. Government-directed health care is a profound assault on the concept of citizenship. It deforms national politics very quickly, and ensures that henceforth elections are always fought on the left’s terms. I find it hard to believe President Obama and his chums haven’t looked at Canada and Europe and concluded that health care is the fastest way to a permanent left-of-center political culture. He doesn’t say that, of course. He says his objective is to “control costs”. Which is the one thing that won’t happen. Even now, health care costs rise far faster under Medicare than in the private sector.

By the way, to accept that argument is to concede a lot of the turf: Why is the cost of my health care Barack Obama’s business? When he mused recently as to whether his dying grandmother had really needed her hip replacement, he gave the game away: Right now, if Gran’ma decides she doesn’t need the hip, that’s her business. Under a government system, it’s the state’s business – and they have to “allocate” “resources”, and frankly at your age your body’s not worth allocating to. Why give you a new hip when you’re getting up there and you’re gonna be kicking the bucket in a year or two or five or twenty?

There have been two trends in US health care over the last decade. On the one hand, a lot of Americans have become, in any rational sense, over-insured: They get tested for things they’ll never get. On the other, there has been an abandonment of health insurance by the rich. If you peel the Census Bureau and DHHS figures, of those alleged “45 million uninsured Americans”, one-fifth aren’t Americans; another fifth aren’t uninsured but are covered by Medicare; another two-fifths are the young and mobile (they don’t have health insurance, but they don’t have life insurance or home insurance, either: they’re 22 and immortal and life’s a party); and the remaining fifth are wealthier than the insured population. Really. According to a 2006 Census Bureau report, 19 per cent of the uninsured have household income of over $75,000. Since the last round of government “reform” in the Nineties, wealthy Americans have been fleeing insurance and opting to bring health care back to a normal market transaction. And, if you look at the “uninsured discount” offered by doctors, one can appreciate that, for everything but chronic disability, it’s not an irrational decision to say I’ll get a better deal for my broken leg or my colonoscopy or my heavy cold if I just write a check for it.

And, if you disagree, so what? In a free society, Mr Smith should be free to be excessively prudent and over-pay to be over-insured, and Mr Jones should be free to conclude that he wants to pay cash down and get the best price for his broken leg. But a government system usurps both Smith and Jones’ right to calculate their own best interests. Whenever I cite some particularly lurid tale from the front lines of Euro-Canadian health care at The Corner, I always get a flurry of e-mails from American readers offering horror stories from US hospitals. And yes, it’s true, bad things happen in American hospitals. But the Euro-Canadian stories are not really about the procedure, the operation, the emergency room, the doctor, the nurse. They’re about impotence – not in the “Will Obama pay for my Viagra?” sense but in terms of civic dignity and individual liberty. I think of a young man called Gerald Augustin of Rivière-des-Prairies, Québec, who went to the St. André medical clinic complaining of stomach pain. He’d forgotten to bring his government medical card, so they turned him away. He was a Quebecker born and bred, and he was in their computer. But no card, no service: that’s just the way it is. So he went back home to get it, collapsed of acute appendicitis, and by the time the ambulance arrived he was dead. He was 21 years old, and he didn’t make it to 22 because he accepted the right of a government bureaucrat to refuse him medical treatment for which he and his family have been confiscatorily taxed all their lives. “I don’t see what we did wrong,” said the administrator. “We just followed the rules.” No big deal, M Augustin wasn’t anything special; no one in her clinic even remembered giving him the brush.

Roy Romanow, the Canadian politician who headed the most recent of the innumerable inquiries into problems with the system, defends the state’s monopoly on the grounds that “Canadians view medicare as a moral enterprise, not a business venture.” If the St Andre clinic were a business venture, they’d have greeted M Augustin with: “You’ve got stomach pains? Boy, have we hit the jackpot! Let’s get you some big-ticket pills and sign you up for surgery!” But because it’s a moral enterprise they sent him away with a flea in his ear. If you have a bad experience in a private system, there’s always another doctor, another clinic, another hospital five miles up the road. But, when the government monopoly denies you health care, that’s it: Go home and wait – or, like M Augustin, die.

“Morality” is always the justification. Inaugurating Britain’s National Health Service on July 5th 1948, the Health Minister Nye Bevan crowed: “We now have the moral leadership of the world.” That’s how Obamacare is being sold: Even The New York Times (buried deep down in paragraph 38) reports that 77 per cent of Americans are content with their own health care. But they feel bad about all those poor uninsured waifs earning 75 grand a year. So it will make us all feel better if the government “does something”. Not literally “feel better”: We’ll be feeling sicker, longer, in dirtier waiting rooms. But our disease-ridden bodies will be warmed by the glow of knowing we did the right thing.

What’s so moral about relieving the citizen of responsibility for his own health care? If free citizens of the wealthiest societies in human history are not prepared to make provision for their own health, what other core responsibilities of functioning adulthood are they likely to forego? Oh, Smith and Jones can still be entrusted to make their own choices about which movie to rent from Netflix, or which breakfast cereal to eat. For the moment. But you’d be surprised how quickly the “right” to health care elides into the government’s right to tell you how to live in order to access that health care. A government-directed medical system can be used to justify almost any restraint on freedom: After all, if the state undertakes to cure you, it surely has an interest in preventing you needing treatment in the first place – or declining to treat you if your persist in your deviancy: Smokers in Manchester, England have been refused treatment for heart disease, and the obese in Suffolk have been told they’re ineligible for hip and knee replacements. With a staff of 1.4 million, England’s National Health Service is supposedly the third biggest employer on the planet after the Chinese People’s Army (2.3 million) and Indian National Railways (1.5 million). And those couple of million Chinese and Indians are mere drops in oceans each over a billion strong, not a significant chunk of the adult population of a tiny strip of land in the North Atlantic. But they still have to ration treatment. Patricia Hewitt, the former Health Secretary, says there’s nothing wrong with the state forbidding treatment on the basis of “lifestyle choices”. And apparently the “pro-choice” types who jump up and down in the street demanding that you keep your rosaries off their ovaries are entirely relaxed about the government getting its bureaucratics all over your lymphatics.

Ultimately, it’s not the nationalization of health care but the nationalization of your body. Right now, if you want an MRI, it’s between you and your doctors. In a government-run system, if you want an MRI and you can’t get one, it’s the government’s fault. And the government should do something about it. Not give you the MRI, of course (that’s too obvious, as well as too expensive), but at least introduce a new Patient’s Bill of Rights, as Gordon Brown’s just done, promising every Briton the “right” to hospital treatment within 18 weeks. Or your (tax) money back? Ah, well, no, but the Prime Minister’s charter will also give you “guaranteed access to cancer treatments”, as well as “the right to die at home”, which sounds a bit as if Mr Brown is covering himself. Scotland’s male cancer survival rate is 40 per cent, compared to America’s 66 per cent. So if the other 60 per cent of Scots all exercise their right to die at home that might free up some “guaranteed access” for the remainder. And, if it doesn’t, the Prime Minister will perhaps introduce a new helpline - 1-800-PATIENT begin_of_the_skype_highlighting 1-800-PATIENT end_of_the_skype_highlighting – in which all you have to do is punch in your postal code and some bureaucrat will come on the line to explain that that new cancer-survival targets for your area will be introduced circa 2012, so call back then, if you’re not dead.

So elections dwindle down to a sterile argument over how to “improve” the system: The left-of-center party usually pledges to throw money at it. The right-of-center party is less enthusiastic about that, which generally makes it suspect on the issue, so it settles on some formulation to the effect that it can “deliver” better “services” more “efficiently”. In other words, the only viable rationale for the right becomes its claim to be able to run the leftist state more smoothly than the left. Every footling reform with any whiff of the private sector about it has the ranks of the great and the good lining up on TV to drone the indestructible cliché that “the NHS is the envy of the world.” Years ago, in The Daily Telegraph, I wrote that I’d seen a fair bit of the world and had never met anybody who envied the NHS, although presumably there must be a Bhutanese yak farmer up country somewhere who’d be impressed by it. A couple of days later, Mr Sonam Chhoki, a Bhutanese gentleman, wrote to the paper to say that, while not a yak farmer himself, he came from good yak farming stock and, after a bit of grumbling about my outmoded ethnic stereotyping, declared that he certainly didn’t envy the NHS. His British parents-in-law “have had to wait more than two years for operations, after being turned away several times for lack of hospital beds. However basic the Bhutanese health service is, it has not yet come to this sorry state.”

And yet Mrs Thatcher, one of the great fearless conservative figures of the age, could do no more than insist to a skeptical public that “the NHS is safe in our hands”. In the 2000 Canadian election, Stockwell Day, leader of the allegedly right-wing Alliance, found himself forced to make similar prostrations after entirely unfounded rumors that the party was thinking of “permitting” private health care back into the country. In the leaders’ televised debate, he wanted to be certain that, whatever questions he was asked, the public got the message that he had no plans to monkey with the government monopoly. So he brought in a little handmade sign and propped it up in front of the microphone to advertise his fealty: “NO TWO-TIER HEALTH CARE.” While he was distracted by a question on some inconsequential topic like foreign policy, Joe Clark, leader of the Progressive Conservative Party (think RINO squishes with bells on) swiped the little placard and gleefully scored through the “NO” to let viewers in on Mr Day’s hidden agenda: “TWO-TIER HEALTH CARE.” This is what it’s come to: The leaders of the two soi-disant “right-of-center” parties competing to see who can grovel most abjectly before the state monopoly. That’s the Republicans’ future if they collude in the governmentalization of health care – as Democrats well understand.

When health care is the government’s responsibility, it becomes its principal responsibility. Because the minute you make government the provider of health care, you ensure that, come election time, the electorate identifies “health” as its number one concern. Thus, in a democracy, the very fact of socialized medicine seduces the citizenry away from citizenship. Buying health care is no more onerous than buying a car or buying a house – which, pre-Barney Frank, most Americans seemed able to manage. Indeed, most of the complications are caused by existing government interventions. If you were attempting to devise a “system” from scratch, you might opt for insurance for catastrophic scenarios and, for PAP smears and colonoscopies and whatnot, something similar to the tax breaks for a Simplified Employee Pension: C’mon, how difficult can it be? Back in the day, your grampa managed to go to the doctor without routing the admin through Washington. Matter of fact, the doctor came to grampa. That’s how crazy it was.

But the acceptance of the principle that individual health is so complex its management can only be outsourced to the state is a concession no conservative should make. More than any other factor, it dramatically advances the statist logic for remorseless encroachments on self-determination. It’s incompatible with a republic of self-governing citizens. The state cannot guarantee against every adversity and, if it attempts to, it can only do so at an enormous cost to liberty. A society in which you’re free to choose your cable package, your iTunes downloads and who ululates the best on “American Idol” but in which the government takes care of peripheral stuff like your body is a society no longer truly free.

In a nanny state, big government becomes a kind of religion: the church as state. Tommy Douglas, the driving force between Canadian health care, tops polls of all-time greatest Canadians. In Britain, after the Tube bombings, Gordon Brown began mulling over the creation of what he called a “British equivalent of the US Fourth of July”, a new national holiday to bolster British identity. The Labour Party think-tank, the Fabian Society, and proposed that the new “British Day” should be July 5th, the day the National Health Service was created. Because the essence of contemporary British identity is waiting two years for a hip operation.

They can call it Dependence Day.

from National Review

10 Opinion(s):

Piet the Pirate said...

A really good article. Reiterates what Ron Paul has been saying for years. Federal government should not be involved in medi-care. That is not what they are elected for. Besides, this bill is more about medical insurance than it is about health care.
BTW, I noticed Israeli companies were buying substantial interests in American and European pharmaceutical companies last week. They obviously knew which way the bill would go. I wonder how?
Am I the only one who is concerned about who is in charge of manufacturing our medication?

Lime Lite said...

Good article which sums up where the USA finds itself. Obama promised to fundamentally change America and he has. He has high jacked health care and made it a federal right to the people. This is in direct conflict tf the American constitution which doesn’t list health care as a right. Once the government is in control of this right, then they can also withhold/control/remove this right. Pure Marxism in action - control of the people. Obama is the Trojan horse of his time. Next is the immigration bill. Not sure what he hopes to accomplish here (I'd be grateful if anyone can enlighten me), other than to grant citizenship to all the illegal immigrants, which are estimated between 10-30 million (exact figure unknown). These instant citizens will more than likely vote for the Democrats as a token of their appreciation. It will also give them instant entitlements as citizens and allow them to outbreed the white population - whilst being supported by them. These Marxists hate America and have plotted it’s downfall for years. The American people have awoken too late. God bless America – she’s going to need it.

Expat Joe said...

What a load of rubbish. Health care in the EU is compulsory and definitely not for free. Because everyone pays, the premiums are affordable. Health insurers cannot refuse customers or load the premium for existing conditions. Clients have the right - not privilege- to choose the doctor or hospital of their choice, they have the right to ask for second opinions.
The greed of the health insurers cartels has effectively been curtailed.
Hospitals and doctors may not refuse treatment.
As an expat from SA, I am presently living in the Netherlands and the "healthy" attitude in the Netherlands and elsewhere in the EU is that the patient comes first. At least I will not have to worry of being bankrupted by the high costs of a dreaded disease or losing my health insurance should I lose my job.
My younger son was stricken by cancer and thanks to the excellent medical care, he has fully recovered.My elder son has a chronic condition and cannot work. Thanks to the social security and health care system, he can hold his head high and by settling here, his dignity has been restored.He is no longer reduced to being dependent on others and figuratively holding up a begging bowl.
It is beyond my understanding why anyone would opt to go without an affordable health insurance. To say, as Lime Lite says "This is in direct conflict to the American Constitution which doesn't list health care as a right" is a spurious. The American constitution could and cannot foresee or make allowances for anything that was not, or is not yet in existence. That is why there are law makers and a legal system.

Expat Joe said...
This comment has been removed by a blog administrator.
Viking said...

@Expat Joe

There's so much there to respond to I don't know where to start. Countries like the Netherlands and Belgium have excellent healthcare systems, and they're also a) bankrupt/have high taxes and b) targets for immigrants/welfare tourists who will soon bankrupt you if they haven't already.

There is something to be said for economies of scale, yes, which is one justification for high taxation with 'good' services, but in terms of healthcare this comes into effect anyway when large competing companies offer insurance packages, many of which are designed for large employers. In the US, the largest customers of health care insurance are large companies, who buy corporate plans for all their employees.

Health insurance is expensive because health CARE is expensive, not because of 'greedy' corporations (why are only HEALTHCARE companies called greedy and not car makers or fridge manufacturers? is it because we believe doctors should, uniquely, work for free?). An operation costs upwards of $100k. Who pays for healthcare has little bearing on what it costs- BUT when the government is the only payer, costs remain high and only get higher.

Ann Coulter wrote a piece recently, which I must post, a one-page Coultercare Bill with only three main provisions. It's excellent, and illustrates why it's the government who are keeping insurance costs high through anti-competitive measures. I asked an American friend of mine recently what she pays for health insurance and she said $60 a month. I don't know if this is average, but it's not a lot of money.

Expat Joe said...

@Viking
The health care system is not paid for by the government, but by the insured, in other words by all.I am not clued up on the role of government in all of this, but the insurance companies advertise and compete widely at the end of each year when the contracts fall due for renewal.
I am an pensioner and have not been actively involved in the Netherlands with the structures of employee remuneration packages , but as far as I am aware, employers have nothing to do with health insurance.
I have nothing against doctors getting their reward for their unstinting hard work and they certainly do get well paid under the health insurance system. Similarly I am not against the competitive element of insurers bidding for the best service at the best price- that is exactly what is being done here, with the added benefit that insurers can cut the costs because of the benefits of scale.
The influx of immigrants and welfare tourists is a problem but not less than the illegal immigrants into the USA , which I understand was one of the arguments of Obama to introduce the health reforms in the first place.
There are certain commodities that simply do not lend themselves to free marketing and competition and have to be regulated in any society : think of energy, influx controls, security of food supplies, health care including the prevention of infectious diseases, centralised disaster relief and last but not least a military machine to keep us safe within our borders. All entities that have to be under supervision of democratically elected civilian control.
Incidentally, health insurers are of course not greedy as such, but there is the temptation of cartel and price fixing but the parliamentary watchdog effectively keeps them on the straight and narrow. Unlike that of the rapacious bankers which nearly caused a complete breakdown of the world's economic system.But that is another story.

Rebel15 said...

@Expat Joe - you don't seem to know much about the Netherlands setup as you can't answer basic question about where the money comes from to pay for your health care. You clearly don't know much about the USA system either - as the article states, all of the people in the USA are currently covered one way or another -they are not destitute (see their life expectancy rates as well). The USA government doesn't allow insurance companies from doing business across state borders - that alone would help to reduce premiums. Why didn't Obama write this into the new bill? The current system could have been overhauled fairly easily to include pre-exisiting conditions etc. but Obama chose not to do it this way. Instead he has implemented a plan that is going to cost upwards of $1trillion but apparently, no taxes will increase and a further 30million people will have free cover! Do you get fined for not having a bought plan? Thought not. Does the Netherlands tax-man make sure you have cover? No? Why has he included student loans in the health care plan? The government now controls who qualifies for a loan. Control the youth brain, control the future!

Ron. said...

Great article on the danger of State intervention because it will only create an ineffective / bureaucratic / monopoly which do harm & control how people get medical treatment. This was not about "accessibility" but about control.

Expat Joe said...

@rebel 15
The money for the health care system in the Netherlands comes from the insurance premiums paid for by the individuals supplemented by government (tax payers funds in other words)Employers do not directly contribute to the health care system of their employees.
Turning to your point that all people are insured in the USA would make a liar of Obama, who has frequently stated that millions were not insured. It was the main thrust of his argument to pass the health act.
Anyone who believes that a private insurance is preferable to a national health insurance like they have in the EU , is welcome to their opinion, but it will be difficult in the EU to find people agreeing with you. When my son did his Master's the health insurance premium,was in fact paid by him seperately from his student loan.
Employment and health insurance is divorced in the EU and the need for health insurance is based on a system of affordable care, paid for by all on the principle of solidarity and not only on actuarial tables. "By the people for the people" to paraphrase Franklin Delano Roosevelt's slogan for the New Deal in 1936.
It is true that I am only the end user of the health sytem and am not an expert on the intricacies of the funding, cross subsidies, opportunity costs and all the beautiful definitions that only serve to confuse me, and I do admittedly get confused easily, but I know for sure that when I go to get assistance to diagnose and remedy such confusion, I will not have to sell my assets to pay the fees of the care givers.
I cannot comment on the restrictions imposed on insurers in the USA.

trey cruz said...

"Impossible to reverse"....in a pigs eye! This pseudo conservative political marrano is trying to plant a meme in the public mind.
Anything can be reversed.
This nasty little example of political prostitution is no different.
But this is how they operate: First they infiltrate and gain your trust---then the knife in the back.
We in America have our "neo-conservatives" every one of 'em a Trotskyite Jew.
And you?
Put some poison ivy on Joe Slovo's grave for me and tell Ronny Kasrils I said "Hi".