Let me say publicly that DonBoy’s answer exudes a combination of intuitive genius and confidence that make me think DonBoy is going to do big things in his life. -- Steven D. Levitt (Freakonomics blog)
Sunday, October 17, 2004
Government Health Care is for Sissies

Mark Steyn (via Volokhite Jim Lindgren), whom I've read about more than I've read, has what you might call an emotional attachment to non-governmentally-run health care. Under the headline GOVERNMENT HEALTH CARE IS FOR SISSIES (no, really), he argues (to a Canadian readership):

My bet is that, in this long twilight struggle brought into focus by 9/11, the hard cultures will survive and the soft cultures won't. And, because I'd like my country to make it, I tend to look at every issue these days on whether it falls on the "hard" or "soft" side of the ledger. For example, Roy Romanow justifies the state's monopoly on health care on the grounds that "Canadians view Medicare as a moral enterprise, not a business venture." Well, if they do, they're very mistaken. Medicare isn't a moral enterprise: what's moral about removing a citizen's responsibility for his and his dependents' health care and entrusting it to the state? If free citizens of advanced, wealthy economies are not prepared to make provision for their own health care, what other basic responsibilities are they likely to forego? Socialized health care redefines the relationship between the citizen and the state. Even if it worked -- even if it wasn't a decrepit, SARS-spreading sinkhole -- it would still be bad in its softening effect on the citizenry.
Wow. If poor people can get socialized health care, Osama will win/has won! The thing is, there's a lot of non-difference hidden under Steyn's invocation of "removing a citizen's responsibility for his and his dependents' health care and entrusting it to the state". Here in Freedomtown USA, here's I provide for my health care: once a year, I get a form from my employer's Human Resources department. I check off "Yes, I do want health insurance at the group rate you've negotiated". Then I get a Blue Cross/Blue Shield card. From there on, it's pretty much like the socialist hellhole they've got up in Canada; I go to the doctor or hospital, show my card, and that's it. Here's what I do NOT do, in decreasing order of likelihood:

-- I do not self-sufficiently comparison shop among other providers; non-group-rate insurance is prohibitively expensive.

-- I do not do without health insurance -- because, after all, risk-pooling is for "sissies" -- and manfully demand that I pay tens of thousands of dollars if I should have a major injury or severe illness.

-- I do not do without medication, resolving to fight off all those germs ON MY OWN, dammit.

Steyn follows up with some horror stories of Canadians being turned away from hospitals because they don't have their card on them at the moment, to which I can only reply: Yes, that's dumb. We shouldn't do that here. I have no reason to believe that, if we moved from what we have now to a system where everyone is guaranteed to have some insurance, more people will be turned away for not having a card.

Not being a full-time policy wonk, I can't speak to the question of economic efficiency of the various systems. But that's not what Steyn's on about. I do feel qualified to brand this particular rejection of national health insurance as a) macho nonsense, and b) a stalking horse for the real conservative objection, which is to the redistribution of income -- in the form of health benefits -- that a national system implies.

The part that Jim Lindgren quotes is less silly, but I think also deserving of a reply:

When health care is the government’s responsibility, it becomes its principal responsibility. Imagine if we had as many high-profile conferences on national security as we do on health. But we don’t. 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 health care seduces government away from its prime responsibility – the defence of the realm. In the Canadian cabinet, the Health portfolio is more prestigious than Defence. Think Donald Rumsfeld would regard it as a promotion if he were moved to Health?
Now, the cost in lives of a catastrophic failure of national defense is obviously, in the worst case of a nuke in one of our cities, appallingly high. In the absence of that, though, the benefit of a national health care system -- in terms of people who get health care that they wouldn't otherwise get, rather than in terms of the out-of-pocket cost to the consumer -- could easily dwarf that of any non-WMD defense failure. Consider the flu, since it's on everyone's mind right now. Supposedly, 36,000 people per year die of the flu. If even 10% of these deaths are preventable, we've saved more lives in one year than were lost on 9/11. And that's just the flu; the number of preventable deaths from, well, everything doesn't have to be terribly high to make this a win. This may seem like an apples-and-oranges thing, but I'm not the one who forced the comparison. Oh, and speaking of terrorist attack: in the event of a bioterrorist outbreak, the performance of the current US system with the flu vaccine is not reassuring, is it? Anyway, the fact that being in charge of health care isn't sufficiently testosteriffic for Donald Rumsfeld shouldn't be a factor.

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