Any health care funding plan that is just, equitable, civilized, and humane must, must, redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition, redistribution. Britain, you chose well.
–Donald Berwick, President Obama’s nominee to head the Centers for Medicare & Medicaid Services
Let this be a reminder of what the health care policy debate is all about. It’s about ethics, not economics. In 1946 Ayn Rand wrote,
People are not embracing collectivism because they have accepted bad economics. They are accepting bad economics because they have embraced collectivism. …
More recently, Paul Hsieh, MD reminds us of the importance of defeating this moral narrative.
In many ways, the Harvard professor represents all that is wrong with the Obama White House’s approach to health-care reform. As an unabashed admirer of Britain’s National Health Service, he sees only one solution: a 10-point plan, with more micromanagement by clever elites.
Michael Tanner also reminds us of health care horrors in England. For example, “750,000 patients are awaiting admission to NHS hospitals. The government’s official target for diagnostic testing was a wait of no more than 18 weeks by 2008.” On Berwick, Tanner writes:
Dr. Berwick wants to bring NICE-style rationing to this country. “It’s not a question of whether we will ration care,” he said in a magazine interview for Biotechnology Healthcare, “It is whether we will ration with our eyes open.”
Dr. Berwick, a professor of health policy at Harvard, actually favors a single-payer system for the U.S. But what he considers absolutely essential to health care reform is government control over health care spending, not just for government programs but by patients themselves. “The hallmarks of proper financial management in a system,” he wrote, “are government policies, purchasing contracts, or market mechanisms that lead to a cap on total spending, with strictly limited year-on-year growth targets.” That way “rational collective action overrid[es] individual self-interest.”
Translation: Insurers and physicians won’t try to make money by providing products and services that you want, i.e., that serves your interest. They will serve political interests and mandates even more so than they do now.
To address some of Berwick’s claims:
- You can’t blame private enterprise and free markets on problems with U.S. health care, as I wrote in a previous post, the unfree market in health care.
- On equality, The Guardian (UK) reports that in England, “Generally speaking, the poorer you are, and the more socially deprived your area, the worse your care and access to it is likely to be.” The National Bureau of Economic Research concludes that “Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.”
- Health care is not a right.
- Even if you accept the premise that government should force one group of people to pay for the health care of an other group, it does not follow that government should function as a monopolistic health insurer. Alternatives include vouchers for insurance in a competitive market, or tax credits for charities. I address this in my Huffington Post article, Questioning Your Compassionate Politics.