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Dear Auntie Pinko,
I know the state of our health care here in America is a mess. We have 40 million people uninsured—more or less. The cost of health care is skyrocketing. I have read heartbreaking stories of people going bankrupt trying to pay enormous medical bills. I keep saying that there must be a better way.
To me universal health care is the answer but conservatives always scream that universal health care is "socialism" and that socialized medicine never works. I have heard right-wing talk show hosts denounce universal health care as a recipe for disaster and they always have someone call in who states that they once lived in Britain/Norway/Canada— (take your pick)—and that the socialized health care there is "horrible". They talk about how it takes "years" to have surgery done and that the people in those countries "hate" their health care system and come to America to get treatment.
So what is the real story? Are the people the people in places like Britain miserable because they can't get the surgery they need due to the long waits or is it all BS? I'd really like to know what the truth is.
Thanks
Rick Middletown Pa
Dear Rick
I am pretty sure that if talk radio hosts in a country that has “socialized medicine” were to discuss on the air the advantages of changing to a private-sector market-based health-care system, there would be plenty of people available to phone in and talk about having lived in America and how the health care here is “horrible.” And the horror stories they could tell would be as bad or worse than whatever you hear on American talk radio about “socialized medicine” countries. Truth, in a debate like this, depends on your perspective.
Auntie Pinko firmly supports a single-payer health care system regulated by government oversight, and universally available to everyone.
That said, it is a fact that such systems are neither as flexible, nor as responsive, nor even as successful, as the very highest level of America’s market-based private sector health care system. People do have to wait for some types of care that are instantly available here in America—if you can pay for them, or work the system to get them without the money up front and then go into bankruptcy or spend years in debt paying for them.
But irksome as those waiting lists may be, in “socialized medicine” countries, there are no waiting lists for emergency care your child needs when she experiences a painful, life-threatening asthma attack. And your mother need never choose between paying the heat bill and buying her life-sustaining medications. You may have to wait months, maybe even years, for that knee-joint replacement surgery, but if you fall down the stairs and break your leg, there will be no waiting to get the bone set, a cast applied, and pain medication dispensed—and no bill, either.
Those who worry about the implications of single-payer health care plans do have some valid points to make, and we should not dismiss them out of hand. There is less incentive for some kinds of medical research and development, and sometimes even a cost-based dis-incentive for the kinds of experimental processes and pilot studies that pioneer new treatments—sometimes life-saving ones. The systems are always costly, and they are often maddeningly bureaucratic and sometimes dangerously inefficient.
And there’s no other way to put it—they prioritize some types of care over others. The trade-offs can be agonizing for individuals, and their families who are denied some kinds of care—such as extreme life-extending and palliative care for increasingly fragile elderly parents and grandparents. A health care system funded by the public purse may have to make ugly choices about one more round of incredibly expensive cardiac repair for 75-year-old Grandpa, as opposed to an incredibly expensive corrective surgery for 2-year-old Baby, born with congenital bone abnormalities.
It’s much easier for us to leave that decision to a “market” that decides based on their ability to pay: If both are from wealthy households, both might get what they need. But if both are from poor households, neither is likely to get what they need. No one likes the thought of trusting the government to make such decisions.
But here’s the thing: We are the government, we control the government. If we want Grandpa and everyone like him to have free access to that life-extending expensive care, we can make that choice and raise our taxes to pay for it. At some point, we will have to have the wrenchingly painful public discussion of priorities and what we all, collectively, want to pay for—both for ourselves and our neighbors, since we are all in the same boat.
And that is why so many people don’t want to have the discussion. Those who benefit from a system where you can get anything you can pay for or go into bankruptcy or debt for, don’t like the idea of sharing a same system with those of us who cannot access such a system because we have neither the cash nor the credit required. Because the same limits, the same priorities, would apply to everyone.
Oh, the very wealthy would certainly be able to go somewhere and get whatever they wanted—money will still buy anything in this sad world. But the large number of people who imagine that, if they were really in a tight spot, they could make the system work for them somehow, are wary about accepting those limitations.
And we should be honest about how huge a sector of our economy is supported by people who are willing to pay for care that they don’t really need: Plastic surgery. Weight loss. Erectile dysfunction. Escaping the natural consequences of aging and unhealthy lifestyles. If a single-payer system were to prioritize those things very low, and have long waiting lists, no public subsidies for the technical specialists to train themselves, no public money poured into pharmaceutical research, there would be a major, if temporary, economic dislocation.
I like to think that in the long run, that economic dislocation would be alleviated by public investments in researching better preventive care, finding alternative therapies for chronic conditions that require costly extreme interventions, and the overall effects of having better health care easily accessible for everyone. But it would be a rough ride.
And that’s the truth. Thanks for asking Auntie Pinko, Rick!
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