Health Care Wha?

by lbej

Americans are funny about government.  I understand that we were once a people into frontiering and mountaineering and engineering and all sorts of eerings, but now we’re mostly into the sitting and the staring and the eating.  In the past we didn’t need so many things taken care of for us but now we do.  Civilization is also very complicated now.  You could treat your own bear-inflicted wound in 1810, but you’re not very well going to give yourself a heart bypass in 2010.  The health care debate has been bothering me, because I think it’s silly.  I hear something to the effect of “I want to make my own decisions about health care.”  Really?  Do you really?  Then it’s a good thing you have all that medical training and oh yes the finance and statistics knowledge that helps you to weigh costs against benefits.  It’s also a good thing that 300 million people can make uncoordinated, arbitrary and contrary decisions about health care and force the consequences into a single system that then doesn’t fail catastrophically.  Otherwise you’d need people with actual knowledge to administer the system.

So the first choice is do you want an orderly system that works most of the time or a chaotic system that never works?  You choose the first option or you go sit in the corner and put on the dunce hat.  The next choice is do you want the system run for your benefit or the benefit of the shareholders of medical companies?  If you are one of the shareholders, maybe you pick choice number two.  If not, you really should pick number one, otherwise you’re being silly.

So now we have the problem of government.  Nobody likes it.  This is because it does many things and invariably each person will resent one of those things to the neglect of the other things it does that aren’t so terrible.  That’s fine, you don’t have to like the government.  The awesome thing is that you get to vote to change it.  If you don’t think elections matter, how do you explain the enormous amount of money corporations and unions and other groups spend financing them?  The alternative is that corporate boards and corporate executives make the decisions.  They will do what they’re supposed to do, which is preserve and enhance revenue streams and control costs.  This does not make corporations bad.  Let me repeat that they are doing what they are supposed to do, what they are created to do: make money for the shareholders.  People are being deliberately naive and or disingenuous if they argue that corporations should do something different.  If a manager has to make a decision and one choice helps you and another helps the company, which choice will she make?  Which choice should she make?  You’re not being honest if you say she should help you.  I understand that a stark choice like that isn’t always necessary, and that doing right by customers is often good for business, but it’s not so important when you have a monopoly and an inelastic demand curve.

I think of health care like national defense.  We need it and we can’t provide it for ourselves.  It’s expensive and you don’t use it all the time, so you’d like it if you could just pay for the little bit you need at the moment you need it.  Also you’d like to pay a little bit even if you need a lot.  But if you don’t pay for it now it won’t be there when you do need it.  And you can’t deny it to others if you want it for yourself, not unless you plan to start turning critically ill people away when they show up in the ER.  Maybe you want to do that, but please say so if that’s the case.  So it’s a public good in economic parlance (free riders can’t be entirely eliminated).  The issue is not whether the government should provide health care or not.  Of course it should not.  Look at the people you know who work for the government–do you want those people giving you a colonoscopy?  Private companies and individuals should provide health care, just as they provide the products and services that are necessary for national defense.  The difference is that in the case of national defense, elected officials tell the private companies what the people need, whereas in the case of health care, boards of directors are making those decisions.  Yes, I know shareholders vote for corporate directors, but are you a shareholder, you personally?  If so, fine.  But probably you aren’t.  You have to pay for that right to vote, which we call a poll tax.

The point is I want the government to make health care decisions so I can vote yay or nay without owning stock in every company from which I might ever require medical services.  If you don’t want that, I think you should explain to everyone what you do want.

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