Why has there been such antagonism to the idea of Universal Healthcare here?

[anvi]

I understand all the arguments of opponents to universal health care in the United States.  Their are constitutional arguments, suspicion-of-government arguments, economic arguments, innovation arguments, "negative-rights" based arguments, ect. ect.  I also think I understand the motivations on the part of opponents to resist it.  Some arguments have a greater hold on facts than others, but I understand them.

But, at the same time, I have very strong feelings about this issue.  I personally find the rejection of the very idea of universal healthcare morally disgraceful.  We don't have it because, living in a democracy as we do, large portions of the electorate don't want it.  If we did want it, we could figure out a way, and there are numerous different ways available, to make it workable, as many, many other countries have done with, while not perfect (nothing human can ever be perfect) appreciable success.  But, on the most basic level, if ideological doctrines about government, making profits or saving money are more important to people than human life, no amount of persuasion will being them to the table.  If people don't even care about the health or well-being of their fellow citizens just because those citizens happen not to have means, then I have no inclination to give any credence to either their professed patriotism or religious values.  

[anvi]

Zarn and Cannonia,

I don't reject thoughtful analysis at all.  I said I understand the arguments against universal health care, I didn't say I agree with them.

As far as the constitutional arguments against the current legislation are concerned, I have my own view of the matter, but they will be decided by the courts.  Even if the current approach does not work, as I mentioned, there are other ways to craft a framework for universal health care that would not have to breech any constitutional provisions.  (I can't resist the temptation to point out that the 94 Republican Senate bill that countered Clinton's health care plan had mandates.  So, even Republicans apparently change their own minds about what the Constitution permits and does not permit fairly often.  That's not an idictment of them, by the way; I'm just pointing it out to show that the constitutional issues here are probably much more complex than most of us are led to believe.)

I reject the blanket "anti-government" arguments because, while there certainly are such things as inefficiency and corruption in government, these things also exist in the private market.  And, if the government can take things away, as president Ford so famously quipped, so can the market.  Whether a program is well-crafted or not, or whether the market is performing well in a given industry, depends on the specifics of the case, not on some a priori maxim.  The U.S. government is not doing a good job of dealing with our health care situation now, but neither is the private health insurance industry.

I reject economic arguments because there are plenty of countries with universal health care frameworks that are plenty economically robust (how is the Japanese technological industry doing in the world, or the Swiss banking industry, or the German automotive industry?).  Indeed, I would make precisely the opposite argument, namely that reducing the amount of GDP spent on health care, which universal health care systems help do (they sure don't do all of that work), helps free up economic resources for other sectors.

I reject "anti-innovation" arguments because I have lived in Germany and Japan for extended periods of time, and I found nothing wanting in the treatment I received there when it was needed.  I have spent a good amount of time in Canada too, and anyone who wants to dump all over the scientific research environment in Canada without knowing anything about it ought to visit and look into what a robust field they have made out of developmental biology.  That worry about American medical innovation if we change our insurance coverage system is a paper tiger.

I don't want to go on too long with this, these are just some of the conclusions I've come to.  I am hardly anti-analytical, and I've not only had lots of personal experience with different health care systems, but have read a lot of literature about it, from all perspectives.  But, if you want to accuse me of being sentimental about it, to that I don't mind pleading guilty.  The United States, which has on the one hand arguably the most enviable health care research environment and delivery system of any country, at the same time is stuck on a health insurance coverage system that rations millions and millions of people (as opposed to procedures) out of coverage, and watches some 22,000 of its own citizens die every year for no other reason than they can't get coverage for their illnesses.  22,000 is almost the entirety of the population of my hometown.  To my mind, these latter consequences are cruel and barbaric and fundamentally unjust, and we should as a nation feel morally obligated to fix them.  If you feel differently, then, like I said, you feel differently, and nothing I can say would change that, would it?

p.s.  Thanks much, Torie and Opebo.

[anvi]

Milhouse,

I drafted a much longer reply earlier, but decided to scrap it in favor of something more concise.

There are different models of universal coverage in the world, not just "single payer," with differing degrees of centralization and taxpayer burden.  I personally am a bigger fan of the Bismarck model of universal coverage (Germany, Japan, Switzerland) than I am of "single payer" (Canada) or the Beveridge model (U.K.).  I don't believe the U.S. will ever adopt any of those systems.  But I do think the differences in the models demonstrate that how much a universal coverage system relies on government centralization and how much it directly costs the taxpayers depends on how it's crafted.  I actually think the way the U.S. government is directly involved in coverage now is quite counterproductive.  It covers way too many people directly (27% of the populous), and while it lowers prices for those it insures, it has no mechanisms to hold down health care costs overall, and so effectively bids up health care prices for everyone else.  Bismarck models insure far fewer people directly, leaving this to private but non-profit insurance companies (which do cover costs of capital but are not publicly traded), but empower government to hold down overall costs for everyone. While that leads, admittedly, to some reduction in quality (many of which are negligible in real treatment), it saves lots of money.

But here is my own personal bottom line.  It surely is the case that a homegrown American universal, or near-universal, coverage system will raise total health care utilization costs and will require various, hopefully rational and hopefully even more transparent, kinds of care-rationing.  But, I would much prefer to ration various kinds of procedures in different circumstances to what we do now, namely ration millions and millions of people entirely out of coverage.  So long as we're going to end up spending 20% or more of our GDP on health care anyway, whether we have universal coverage or not, I would prefer covering as many people as possible. 

[anvi]

John,  I see your point of course, and I do think it applies rather evenly internationally in terms of medicines developed in the U.S.  But in Japan, for example, there is a price schedule for procedures that is annually negotiated between the government, providers and citizens, which means that a Japanese physician can only charge so much for an MRI scan.  That makes the purchase of MRI scanners produced in the U.S. prohibitively expensive, so they have to produce their own.  Fortunately, Japan is a technologically innovative country, and companies that sell lots of different kinds of electronics, like Toshiba, also produce lower-cost but still reliable MRI equipment for the Japanese market.  And since other countries in the region, in east and south Asia, also need low-cost medical equipment, the Japanese medical tech products also have good markets there.  Their universal coverage model has not hurt their medical tech industry.

Now in the U.S., pharma gets lots of tax breaks, credits and expensing deals from the government, and medical technology companies will not stop competing, which means they will not stop innovating.  But, just as you and others here quite correctly point out, it all depends on how you craft the coverage system.

[anvi]

Gweithwr,

I agree that the notion of healthcare "models" is a useful abstraction at best and that one can never just import one model tout court, especially in the States where we so often regularly assume that our habits and acquired expectations = the only correct way to do things.  On the other hand, in the mid-'90's, Taiwan did a major study of different ways nations handle health care coverage and developed a hybrid approach for itself.  Models may be useful fictions, but we can still learn from them in crafting improvements.

Torie,

Every major study I'm aware of confirms with what you are saying about price controls.  As mentioned, I neither believe that the U.S will ever adopt some of the major elements of other health care systems nor that it's a good idea to de-incentivize pharmaceutical R&D in the U.S by imposing price controls on that industry here. I have not studied this aspect very much, but at least at first glance, I do think the fix you have in mind for prices for medicines makes sense.