My Long Awaited Healthcare Post (In the Form of a Book Notice) January 12, 2010
T. R. Reid, The Healing of America: a global quest for better, cheaper, and fairer health care. New York: The Penguin Press, 2009.
T. R. Reid is a correspondent for the Washington Post and a commentator on National Public Radio. One of his other books is The United States of Europe. In this work, The Healing of America, he goes to investigate specifically what the major health care systems outside the United States are like.
And what health care systems in the United States are like. On pages 20 and 21, Reid informs us of what countries our systems resemble.
“For most working people under sixty-five, we’re Germany, or France, or Japan….the worker and the employer share the premiums for a health insurance policy.”
“For Native Americans, military personnel, and veterans, we’re Britain, or Cuba.”
“For those over sixty-five, we’re Canada.”
“For the 45 million uninsured Americans, we’re Cambodia, or Burkina Faso, or rural India.”
The American system of health care is indeed a grab bag. Interestingly enough, in the end he picks as his favorite, or at least the system that can be adopted in the U S with the least trauma, not the British or Canadian systems which are likely to be best known to Americans, but the French system, with the German one closely behind. As it turns out, the Franco-German system, which he calls “Bismarckian” after its 19th century inventor, Chancellor Otto von Bismarck, is not quite as exactly like its American counterpart as his statement above might imply. In the Bismarckian system, the health insurance companies are all non-profit mutual benefit societies, and while the employer pays a portion of the premium for the employed, the government pays the premium for all those unemployed until they find a new job and may go with a new nonprofit insurance company. And, interestingly enough, the nonprofits and government health care systems, because they don’t have to hire a lot of employees to weed out “false” claims and look for excuses to drop clients from the rolls, are often more efficient than the American health care companies.
Everyone, of course, has to have health insurance. There have been a lot of protests concerning the new U. S. health plan, saying it’s unconstitutional and wrong to force people to buy insurance. Well, cry me a river. If these people win their point, I shall stop paying my Social Security taxes. I would remind you that one of the titles for Social Security is OASDI, which stands for nothing less than Old Age, Survivors, and Disability Insurance, and it is on that ground that the Amish religion won an exemption from Social Security taxes and benefits – because their religion forbids “insurance.”
I was never able to figure out what the “public option” fuss was about. In the Franco-Bismarckian system, there is no public option insurance company, but I suppose the welfare subsidy of paying premiums for the unemployed could be considered a “public option” of sorts.
This may be offensive to my conservative friends, but I favor the adoption of one of these systems, probably most likely the French, universally in the United States. The present system, unless you are having a boob job or some other form of plastic surgery, is hardly really capitalist. It seems to combine capitalist compassion and socialist efficiency. And, unless we are willing to let people die in the streets for lack of funds, it never will be totally capitalist.
And there is a legal reform I could suggest might be of benefit whether or not we adopt a new health care system. I do not favor price controls on health care, because all this will do is cause a scarcity of doctors, nurses, and facilities. But I wonder whether “imputed prices” might help. If I loan you money, under the assumption that you will pay interest, but the loan document says nothing about what the interest rate is, a government set rate called the “imputed rate” will apply. I can’t just after the fact tell you when you repay, “Oh, that’s also 20 per cent interest a year on top of your repayment of principal.” Now if I am providing other services, and no price was agreed to beforehand, the price is whatever I decide to charge you after the fact, because the law does not usually like to make me take less for my services than I would voluntarily accept. But I would suggest moving to an “imputed price” system for health care. The imputed price would apply only when a contract specifying another price, or specific list of prices, was not signed in advance. This might make people think a little bit about the price of health care.
While on that subject, some health care institutions that are a little bit more transparent about their rates than most doctors and hospitals are the burgeoning “urgent care clinics” that are found everywhere. I confess that I would like to see these “urgent care clinics” maintained under any new health care system we should adopt.
Finally, I do have one disagreement with Reid. He believes that we will not adopt a decent health care system unless we take the view that health care is a “human right.” I don’t think so. I do not believe that there can be any “human rights” to resources other than property rights to specific goods and contracted services that actually exist. That said, I am no longer, as I might have been in my wild youth, a total abolitionist of all government welfare. I just don’t believe that government welfare is a moral and ethical entitlement that can never be reduced or altered despite the fiscal needs of the state. And, Social Security and Medicare, though I do not favor abolishing them, are welfare, and what I say about welfare – that there is no moral and ethical entitlement to receive it – applies to Social Security and Medicare. If this offends anybody, tough. But even though I don’t think health care is a human right or an ethical entitlement, I still would like to see the U.S. adopt a saner health care system.