Americans and Healthcare

The painting is of The Shipwreck by Claude-Joseph Vernet, and is discussed here.


Barack Obama has been, almost from the beginning, in danger of being 'Carterized'. I thought that last year, on the basis that the manifesto on which he was elected could not begin to grip the problems that America had in a way that coincided with the electoral cycle.

I also thought that stagflation was a fair bet for 2010, if depression did not set in in 2009--and that either was potentially fatal to the 'change' administration. David Dinkins is another comparison I've made--a decent man, giving way to a much tougher Republican after his city fell apart under him. I also think that populist right and libertarian groups are far stronger than the weakened and ridiculous state of the Republican Party would lead a person to believe.

There are five major causes of the extreme expense and poor coverage of American healthcare;

(i) Doctors are required to run their vocation as a business, both by their professional bodies and the law, but precluded from anti-competitive practices by Supreme Court decisions;

(ii) Doctors' costs are massively inflated by a requirement to take out insurance against, and to occasionally fund, cases from tort lawyers (though that is changing in the states);

(iii) Doctors are encouraged to work in elective specialities rather than general primary care, and to bilk private insurance companies for expensive technological treatments rather than the normal treatments the companies won't pay for;

(iv) Twenty per cent and counting of hospitals are owned by investors, and have been since the Reagan era, and have to make a profit;

(v) Insurance companies quite cheerfully admit to denying coverage, recissing agreements, and dumping agreed costs onto the sick, or employers, or the state.

The Administration chose to tackle these problems in three ways. President Obama, noting the failure and alienation that arose from President Clinton's effort, left Congress to sort out a plan. The Congress has two year terms for a reason, similar to that which explains why the Keystone Kops appeared in short films. They have, predictably, messed up, and are now suggesting the introduction of VAT--as if that improves anything.

Secondly, the Administration trumpeted computer improvements, more subsidy, and salaried, regional centres of medical provision. Either these things have been incorporated into the stimulus bill, or they won't deliver.

Thirdly, it called for costs to be cut, and asked the $500 billion healthcare industry to make nice. Perhaps they could send a free apple pie with their bills.

But--no federal proposals to limit tort lawyers. And no real acceptance that either you have a national health system that pays for capped insurance, and which has a soviet-style approach to treatment, or you pretend to pay for limited private insurance and co-ops that ration care, or you go full out to control costs. Removing all employer taxes and allowing people to use the money they save to buy state or federal policies, or to top-up a federal option paid for with a tax that could not be easily raised, would also be defensible.

The present messy system though, is not a runner. I also suspect that most of the options I suggest would run into trouble because Americans tend to believe in risk, in responsibility, and personal accountability and, in the mass of small towns, they can also rely on the community enough not to look to the state.

As for the rich and the middle classes, you can talk all you want about the evils of poor coverage, or the costs of healthcare--but, as with slavery in the 1840s, until some disaster overcomes the basically comfortable system they enjoy, they won't support radical change. It was ever thus with human beings anywhere.

I think that the administration may well be on a highway to nothing. Worse, I think that, with the 2010 electoral cycle now beginning to break across Washington, time to fix the escalating costs of healthcare has slipped away.

An administration adrift at a time of debt, deficit, and foreign threat means more desperate foreign policy, more crisis, and more anger from those who are now economically inactive, or being violated by banks and utilities, or facing the loss of their future.

Given how the federal government, and for that matter the media-political class have been deligitimated by their own acts in recent decades, that combination is potent and potentially toxic. 'Healthcare'--not a mad objective--may become the rock on which not just Obama's ship was first dashed, but on which the failure of the fourth republic of the United States was revealed.

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