OK, now that I got that off my chest, here is today’s post. A bright student of mine was telling me why he believes as a normative matter that “we” should have health reform:
The whole debate about health care centers around whether or not you consider health care to be a privilege (something you earn and buy as a commodity) or whether you think universal care is something that a society should provide for its members if possible. It is my opinion that this is a case in which we as a society should be willing to accept a loss in efficiency for a gain in equality. … But I think this is a case where we should be willing to sacrifice efficiency for equality – and we are not that efficient anyway in our current “system”.
He raises very many interesting points, but I’ve dealt with all of them at various points on this site. Indeed, almost all of us want health reform – but that does not mean universal health care or health insurance. Today I want to focus on one simple idea – that in government, and for people who think government is the solution to all of our problems, the word tradeoff simply does not exist. It cannot. Let’s see why.
Implicit in the arguments that “we have a duty” to make sure the sick and infirm are not dying in the streets is that we are so damn rich that it would be a moral outrage to allow that to happen while other families have 6 cars and 12 televisions and take quarterly sojourns to the beaches of Hawaii. I agree! I happen to think that people care enough that the poor and infirm would be taken care of without government in the way. But suppose I am wrong.
If people truly cared about the poor and the permanently infirm being taken care of, I would not be as ascerbic as I am. I don’t believe for a second that the majority of people who argue for health reform really give a damn about the poor or infirm – it just makes them feel good to say it, or be more acceptable in the company of others. Why do I say this so strongly? Because providing even a very generous level of support to the poor and the infirm is so easily within our reach that it is laughable to suggest otherwise. Instead, “we” use the poor and infirm as pawns in a corporatist game, in a middle-class entitlement game, special-interest game, political-nanny-statism game, and no one is willing to admit it.
Look at it this way. You want to argue that the world’s richest economy could easily sacrifice a little income to make sure people do not die (early, unnaturally, due to the poverty that used to kill people) because of income or for the seriously infirm to go without care. I agree. If you add up all of the annual expenditures by local governments, state governments, and the federal government in the United States, you would get a figure around $6 trillion. That would make the US government the world’s single largest economy, and by a factor of 20%.
For a federal government to spend $3.5 trillion per year and still find itself with this health care crisis is so much more inexcusable than arguing that “society is so rich that we should trade off some efficiency for some equity.” What the heck are we doing with $3.5 trillion (or $6 trillion if you add all levels of government)? The US government (all levels) has 20% more resources itself than the next largest economy in the world does yet it cannot take care of health care for the poor and chronically infirm? Where on the list of priorities must this really be? Is it ahead of mohair subsidies, sugar subsidies, windmill subsidies, funding for education schools, and so on? What kind of bizarre world am I living in? And I am being asked to sacrifice a little more just to see that we’ll get it right this time?
Or think of it this way. Some very serious and intelligent people believe that we could fund very important and basic functions of the federal government for $1 trillion per year. Suppose we cut the federal budget in half as well. That would still leave us with $1 trillion to dedicate to health care for the poor and the infirm. There is no conceivable way that this number would exceed 60 million Americans, that is explicitly exaggerated to make my point. How much money would be available to take care of the health care for 60 million people if $1 trillion in funds were dedicated to them? How about $16,667 per person. That means for a poor family of 4, the federal government would have almost $67,000 per year to help out with health care expenses. For a poor family of 8, there would be $133,000 of funds. Even with the world’s least efficient health care system, that is far beyond the level of support that we would need to provide world class care to all of the poor and infirm.
So be proud of yourselves for voting for Team Nike or Team Reebok today. Swill back the cool refreshing elixir of campaign and political success, and enjoy the moment of smugness that comes with the “now our guys will come in and clean some house” moment of an electoral victory, or the delight you take in the Team Reebok concession speeches and the political commentary about the party being in shambles and suffering from a leadership and confidence crisis. And remember that both Team Nike and Team Reebok have been and continue to be the “board of directors” of the richest “country” in human history, and cannot even scratch the surface of a problem that they blithely exclaim is the most serious one facing our country. Show me a real company that would still exist with that kind of track record? Show me a real company that would get a single soul to show up for its annual picnic on the first Tuesday of November and I will show you a dystopian novel written by the most miserable person who ever lived.
Update: “next” was omitted to 3rd paragraph from end in original post, and has since been corrected.