If there is one topic guaranteed to split the Republicans in Congress and the Broad Right in the Nation, it is legislation concerning health care. Legislators would sooner steer clear of the issue, for it is both complicated and politically divisive, and there is no simple or popular solution. For those reasons, this website has also been reluctant to blog an opinion.
There are three basic facts that are almost always avoided by the various Broad Right factions, as well as all those in the political center and Left. Yet they are the starting points of any attempt to grapple with reality.
- No advanced urbanized Nation can afford to have seriously sick and dying people lying on the streets, especially if they have communicable diseases. There has to be a public health system that is tax-payer funded and it has to be at least somewhat pro-active. This means offering treatment for symptoms.
- No health care system, whether nationalized (as in Europe and Canada) or funded by private insurance, can hope to operate effectively, if a significant number of foreigners are admitted as residents and guaranteed medical help irrespective of financial contributions. Indeed, no system can function effectively and fairly if large numbers of new clients are introduced.
- Insuring against sickness and accidents is not the same as insuring a car or a house. Becoming ill with pancreatic cancer is far worse than writing off a car or house, and too obviously so to require an explanation here.
There is another basic fact not connected to these three but which has to be acknowledged before criticizing those who attempt to replace ObamaCare. It is that ObamaCare was ruthlessly rammed through Congress and the Supreme Court, not to solve the problems of health care, but to inexorably drive out the Insurance companies so that there would be no alternative to a Nationalized system and an expansion of the State’s role in society. Over several years it has wrought much damage to the medical insurance companies.
Its bonus points for Leftists included creating many new welfare dependents, some other winners, and a mess too complicated to enable a speedy return to the pre-Obama system. In passing it is worth noting that the pre-Obama system was only a partial free-market system and was also buckling under the strains of imperfection
I lived before Britain’s post-war National Health Service was introduced. I have lived under its subsequent deterioration, and I have lived under America’s imperfect private insurance system, so I have some experience as a consumer – and I am too mathematically-challenged to be an expert. I bow to Paul Ryan and his colleagues who are now attempting to do the near-impossible.
Here are some consumer comments on the UK’s system. The pre-Nationalization system prior to 1948 and Nye Bevan, meant that most working people died before retirement from work, TB flourished, war-time British soldiers were weedy compared to their American counterparts, the financial rewards for doctors were not sufficient to attract the able and ambitious, social status was the main reward, hospitals were clean but cruel, and working people who became sick were treated little better than workhouse residents.
The post 1948 Nationalized service brought many improvements for most working people, though doctors were gradually transformed into State employees. Over the years, the system, like all Government/taxpayer-funded systems, became more and more bureaucratized, wasteful and costly, and many people’s attitudes about personal responsibility for health deteriorated. The huge influx of immigrants from the late 1950’s onwards ensured that costs ballooned and waiting lists grew. Nurses, auxiliaries and other employees exhibited lower professional standards and were unionized.
The Thatcher reforms, aimed at introducing more market-based standards may have saved some money but did little to improve quality of care. The result is a service that cares adequately for children and mothers, has long waiting lists, poor communication, and seriously neglects the elderly. Private health care via insurance is mostly only for the very rich.
What public system can serve longtime taxpayers when an African with AIDS can get off a plane and receive instant medical care? Those citizens who have to seek medical help are treated as supplicants, not valued customers, and few Americans are aware of this huge change in status.
When I came to America and needed medical treatment I was shocked by the efficiency and availability of the American system. Being treated as a valued customer was an even bigger shock. But I am fortunate in that I benefit from an employer’s plan and can also afford to make large payments. Retirement, and the loss of an employer’s plan is not an option for me. The American system, even though it is deteriorating under the Obama burdens, is generally far superior to the UK’s National Health Service. And it is nobody’s business if Americans choose to spend more on their health than other Nations. No-one complains that Americans spend more on their dogs!
Those on the doctrinaire Right who demand that Ryan and Trump sweep away ObamaCare in one move, and let the free market work, are not people who will have to face the voters in 2018. Trump has said that a new system will take three steps. We should be patient and support a Ryan plan that has Trump’s support.