Monday, June 29, 2009

Taking Care of Our Unlimited Wants

In a recent post, I criticized conservative pundits who've portrayed the administration’s health care reform proposal as a move toward "socialized medicine." Opponents of the so-called "public option" seem to be among the most eager to frame these reforms as a wholesale government takeover of the health care industry.

As I've said, I believe this is a false argument. But underneath this bit of conservative sophistry is a fundamental truth about the nature of our health care dilemma.

The debate over national heath care is really a debate over social priorities. For many opponents of the Obama plan – most of whom legitimately fear that the public option is a backdoor to single-payer – the central question in this debate is whether those who have health insurance should be compelled through the tax system to financially support those who lack insurance. Progressives tend to see this as a no-brainer – health care is, after all, a "basic right" – but the issue becomes increasingly complicated when we begin to consider expensive medical innovations that are available to only the wealthiest citizens.

If every American is entitled to health care, what level of care should be provided to each American? Should every citizen be afforded access to the most cutting edge medical technology? I think most progressives would agree that we cannot provide every citizen with the best possible care – the cost would be far too high. So how do we decide which illnesses should take precedence, and which procedures should be funded?

The Obama administration’s push to address these difficult questions through comparative effectiveness research not only oversimplifies an extremely complex problem – it also ignores the moral dimensions of the problem. Those who criticize the inequity and inefficiency of the market must describe what they believe are the best – and most ethical – ways to prioritize treatment through the government.

These are not simply scientific questions; they are questions that involve serious moral judgment. We live in a country with limited resources and unlimited wants – this is the fundamental economic problem that all societies face. If the market is no longer rationing health care resources, the government must. But so far, those who advocate broader government control of the health care industry have been hesitant to acknowledge this point – or to explain their moral priorities.

It’s true that the government will not be taking over the health care system, but if we do move toward single-payer – as many progressives would like – the government may be purchasing most people's care. Even with their enormous bargaining power, the feds simply cannot afford to fund our unlimited wants.

There will have to be tradeoffs, and those who support a single-payer system should be honest about those tradeoffs.


Emily said...

This is a great post- as were your previous ones on health care. I've been reading so much about this lately, but it doesn't seem like there is one great option. And I think that Amercians have a very, very different view of what they "deserve" when it comes to their health care than people in other countries. I don't think there will be a perfect answer, and to be honest, I don't even know how successful our government will be in making significant change. Between the amount of lobbyists and the amount of money health insurance companies have given politicians over the years- can Congress really pull off a comprehensive, affordable and effective health care solution? It's going to be a bloodly battle, and I'm skeptical.

I agree that Republicans need to stop their bickering and get together some type of workable plan themselves so at least there can be an honest debate between the parties. Something has to be done, we can all agree on that.

Also, what did you think about Walmart backing employer mandated plans?

mikhailbakunin said...

Thanks for the props! I totally agree with you. Health care is a really difficult issue for me – it’s just so complicated. There are so many philosophical, moral, and financial concerns.
The international comparisons strike me as unreliable for the exact same reasons – Americans have such different views on social responsibility and entitlement. We also have a very different political culture. Our system of government is great in some ways, but it’s often less accountable and more easily corruptible.

On the issue of Wal-Mart, Megan McArdle had an interesting post yesterday on the latest announcement. I think she’s right. Wal-Mart probably had many different reasons for supporting an employer mandate – some good, some bad – but I think that the higher-ups at Wal-Mart are powerfully aware of the fact that an employer mandate will increase fixed costs and possibly price smaller companies out of the market. Wal-Mart can absorb rising health care expenses; smaller businesses probably can’t.

There’s a myth that big companies don’t like government mandates. In reality, it seems to depend on how those mandates affect the overall competitiveness in the market.