Sunday, August 27, 2006

Interesting pro-National Health Care Argument

Don Boudreaux at Cafe Hayek posts a critique of Malcolm Gladwell's New Yorker article on universal health insurance. A good post, but nothing shockingly new. But Tom West in the comments has a nuanced and interesting defense of a Canadian-style system that I'd not heard before:
I think you misunderstand the advantages of a national health-care scheme. If the Canadian model is any indication, you can get about 90% of the health outcomes for close to 50% of the costs.

Two things, however. National health-care works because it *is* rationing. Anybody who thinks they can get the advantages of national health-care (much lower costs) without the downside (somewhat lower health outcomes) is completely fooling themselves.

Frankly, unless Americans are willing to accept this trade-off, (and I don't think they are) it isn't possible to gain the primary benefits from a national health care system...It's easy to be told "there's nothing we can do for Grandpa any more". That doesn't work when next door somebody
is doing something (mostly fruitlessly spending dollars, but there will be *some* successes) for their Grandpa.)

...(A better analogy instead of steel is cars. People are currently buying BMWs, but if the government centralized it, we'd all be riding Toyota Corolla's. A *lot* cheaper, but not quite the same thing.)

I believe I've run across parts of this before, but Tom is the first person who's laid it out this clearly. National health care saves money because it forbids expensive, low-benefit treatments. It gives you a way to feel you've done everything possible without actually spending money on all the things that are possible. If no one can get these treatments—say, because private healthcare is outlawed—you can't feel bad about not spending barrels of money to extend Grandma's life another six months. Thus the scheme is dependant on outright forbidding many treatments, and insuring that there's no superior private option availalble. (Tom notes that the US provides a last-resort outlet, which lets off some pressure but isn't terribly visible and so doesn't bother most Canadians.)

Tom is right that this will save a lot of money (though moving to a Canadian system in America removes Canada's outlet, and ensures that we don't have one either). But this plan also means that you aren't allowed to get healthcare that could save your life. I find this thoroughly repugnant. That's a moral argument, not an economic one, and I can't prove its objective truth. But I can't buy into Tom's scheme; and I doubt that most Americans, were the plan presented to them clearly, would either.


Post a Comment

<< Home