The best “argument” I hear for a new government involvement in the medical system in America is that, “the poor cannot afford health care” and that even if, as a technical matter, they can afford to purchase moderately priced insurance policies, they incur serious tradeoffs when doing so that richer people do not have to face.
Everything is costlier to the poor. Does this fact excuse “the poor” (or non-poor) from having to prioritize wants and needs? Many adherents to “we have a duty to do something to help the poor obtain health care” idea clearly are not thinking through the implications of this belief. If you are daring to claim that it is a societal duty that is so important, so important that you justify confiscating my property at the point of a gun, then you must imply that health care is right up there with food, shelter and clothing.If this is the case, it is not clear to me why the focus of the conversation has to be on the duties of the non-poor and not on the duties of the poor themselves.
Why is the mandate not on the poor themselves to buy coverage if they can afford it? Why not send the czars and police to the homes of the poor to see if they are making wise choices? After all, people are claiming that the affluent Wintercows of the world (many who have struggled mightily to get where they are) are too selfish to make the socially correct charitable contributions – and thus you are willing to send the police after Wintercow to check my “consumption basket” to make sure the right amount ends up in the hands of the poor (for example, since they “see” that I am not making charitable contributions to health care organizations for the poor, they “choose” that consumption item for me before allowing me to take that much desired trip to Yellowstone or Acadia). At the same time, you are not willing to do that very same thing to the people who are the focus of your concern? That is injustice exactly the way Aristotle would have defined it.
Which brings me back to the point of the post. Don’t we have Medicaid? Medicaid was part of the massive government overhaul of health care in the 1960s. It is also wildly expensive, bankrupting many states, and not ensuring that those who are covered under Medicaid actually get care (e.g. reimbursements to doctors in some cases are so low that they refuse to treat Medicaid patients at all). It was sold to us on the same grounds that health reform is going today. And it has failed. Where does the burden of proof have to be for folks like me?
Then the argument turns to, “well, other countries give everyone free health care for half the cost and better outcomes.” Then, it seems to me that this argument has nothing to do with the poor at all, and it has everything to do with having the government run a national health care system. I’m happy to have that debate, but not if every time we discuss a point the topic gets changed yet again, as it seems to have been when we are talking about the poor and access to medical care.
In future posts I will address what we know about differential outcomes across countries and where the US “system” fits into all of this.