Friday, September 18, 2009

Healthcare Reform

I saw Howard Dean speak at a Barnes and Noble back in July.  A former doctor himself, he stressed that no matter how many disagreeable provisions were sure to be included in any medical reform bill that passes through two legislative chambers, the sine qua non of the entire effort is the public option.  Then he batted softballs from admirers.  

Until an Ayn Rand-colyte got up: "Will I have the choice not to pay for the public option?  If I can't opt out of getting taxed for it, even if I don't want it, then how is it an option?"


This baffled the five-term governor (note: gubenatorial terms are only two years in Vermont).  The easy answer is that it's just as much an option as public schooling.  Everyone's property taxes fund schools, even if they have no children.  Those who do, have the option to enroll them in a system of taxpayer funded public education, to pay a premium for private schooling, or to do it themselves.  I did not post this analogy at the time, and it is so obvious as to be no longer remotely original.    


However, many such complaints (though not most) aren't misguided.  Any government driven healthcare reform will, and like all entitlements will irrevocably, increase the size of a growing federal government.  It will replace some cubicled claims auditors with cubicled bureaucrats.  It will be flawed.  It will be expensive.  A profit-driven firm can't compete with an entity able to sell trillions of dollars worth of bonds to fund its short and medium-term insolvency (which is why every plausible reform plan puts major restrictions on just who is eligible to enroll in the sure-to-be-cheaper public option).  A public option for health care, like social security, medicare, the federal reserve system, the medicare prescription drugs plan, progressive taxation, corporate welfare, and public schooling, is inherently socialistic.  That doesn't make it the logical first step to gulags in the Dakotas.


Not a single independent observer ranks our current system as much above average.  In bang-for-your-buck terms we inspire all manner of unflattering metaphors.  Dr. Dean cited medicaid's overhead at 4% of costs, compared with a typical insurer's 20%.  He maintains that the marketplace is incapable of supplying two sectors: defense and healthcare.  I'm inclined to agree...until I hear a proposal to shift money out of the type of "Cadillac" insurance plan my NYC Department of Education-employed fiancee enjoys.  

I supported Barack Obama last year because I believed he was a political son-of-a-bitch in sheep's clothing.  If anything meaningful is accomplished on the healthcare front, I say it vindicates that analysis.

1 comment:

  1. I love it when people make arguments about wanting to opt-out of plans like that. I always want to ask them if they've ever called the police, or fire department, or had their kids go to school or fill out a FAFSA or drive someplace on a highway or fly somewhere from an airport or, as you say, sent their kids to public schools...oh, or mailed a letter, or cashes a social security check, or not been invaded by North Korea because of a bunch of subs in the pacific, etc.

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