I’m not going to pound on the fiasco that is the “socialist convention named” Affordable Care Act. (There is no affordable in the care act, just like there was no Democratic in the Deutshe Republic and there certainly is very little input from the people in China’s People Republic.)
I’m not going to pound on it, only examine why our reaction to the fiasco it is (and likely will continue being) is so immediate and in your face, when it is true that in most countries with centralized health care, people are fond/proud of it in some way.
Honestly, I think the left had convinced itself that even if it were a very rough start, as this is proving, we would swallow and go along, because other countries have/had. They thought we would grumble, and moan, but eventually we’d be happy to have that government-provided-health care and not mind too much that it’s not the best it could be, that innovation is stagnant or that it turns out to be very expensive indeed, and have strangers dictating what we could and could not have.
It might still turn out that way, but I don’t think so.
Remember the nineties, when HMOs were the worst thing evah, because some anonymous bureaucrat decided some treatment you thought you needed was too expensive/risky for you? Yeah, part of this was driven by the media-industrial complex and their continuous pounding on HMOs in service of promoting (then) Hilarycare. But part of it was that people also felt a certain amount of resentment towards the more restrictive portions of the service and the fact that someone else decided on the treatment. I think that they’re not going to feel any better towards something that is in essence a centralized HMO writ large and with the force of the government behind it.
It’s not just that it will have some problems, or whether those problems are massive or not…
I think it’s a matter of timing.
Look, over here we look at the problems of the NHS and other bureaucratized, centralized medical systems, and we shake our heads and go “Oh, that’s terrible” while over there (and occasionally on this blog) they go “yes, it has problems, but it’s good.”
But what I want you to keep in mind is what they have to compare it to. NHS was introduced just after WWII. If the books of the period are right, what existed before was patchy, not particularly good, and rural areas might have not particularly competent doctors. It wasn’t modern medicine. Modern medicine – and antibiotics – came in with the NHS. So what people retained was the idea of how much better it got.
It’s kind of like Communism in the USSR. It was awful and clamped down on society and took it on a poverty spiral, but what they compare it and contrast it to is not a free Western society but… feudalism. In comparison to THAT, communism, at least while its predatory empire could assimilate resource rich places like Cuba and Africa was an improvement.
In most other countries, socialized medicine in a form or another, was introduced around that time. Later in Africa and Australia, but then Australia has a massive interior which was probably as patchily served before as some parts of Africa.
What I’m trying to say is: what the people pushing for socialized medicine failed to comprehend is that it’s not the way of the future NOW. It was the way of the future fifty years ago. And if it had been introduced fifty years ago, it would probably have represented an improvement. If nothing else, the very fact that antibiotics were introduced then would have made a difference towards better outcomes.
While people aren’t blind to the bad outcomes, they also compare them, not to what free-market medicine would be now, but to what it was when socialized medicine came into being in their country. They compare it to patchy medical services and results, and they go “Well, it’s not wonderful, but—”
The problem from its advocates point of view is that, flawed and odd as the insurance market and therefore the medical market it distorts, is in the US, we have a system that’s better (or at least has more choice) than most socialized systems.
Oh, sure, if you don’t have insurance you can hesitate to go to the doctor sometimes with awful results. And if you don’t have insurance, you might use the emergency room as your physician (but not, most of the people who do this live at the margins of society. Most of the middle class who doesn’t have insurance goes to equivalents of emergicare, or as my friend Amanda calls them “doc in a box.” We did, for the most part, till our mid thirties, and we still go there if our regular doctor is closed.)
Again, the problem is that we’ve experienced this. All of us have some relatively bad experiences, but when it’s something really serious and really bad, we can usually get medical care. Yeah, it might be expensive, but it’s there, and you don’t have to wait for months and get approved, and have the opinion of some total stranger on whether you CAN have it or not. You can have the opinion of a stranger (insurance bureaucrat) on whether you have to pay for it or not, but that’s different from telling you you can’t have it.
All centralized systems end up restricting access to care, and the (UN)Affordable Care Act is not different, and I bet even if they can patch it (And frankly, they’d have stood a better chance of this if they’d introduced it in a time of great prosperity and money. Right now most of the people simply can’t afford the extra fees) Americans aren’t going to take any too well to being told their cancer has too little of a chance of remission. Go home and take pain killers. I don’t think we’ll take at all well to that. Because we won’t be comparing it to pre-WWII medicine. We’ll be comparing it to two years ago. And we’ll get mad. This whole idea that you’re helping the unfortunate have care is all very warm and fuzzy, but not when it’s your life on the line.
So, how can they have made such a miscalculation? Very easily. If you realize they are going from the idea that centralized statism is “progress” and that everything moves towards it. In other words, they’ve internalized this time table, where the state holds primacy and extends its power and hold over the individuals. The only difference between their vision and that of fascists and communists is that in their imagined future, the government is always benevolent.
But the time line is there in their heads. And when you measure progress not by better outcomes but by “is it being done by government with good intentions” the (U)ACA sounds like wild progress.
Only in real life people don’t judge you on your intentions or the time line in your head. And just like they couldn’t have imposed soviet-style communism in England, with its Free, Western society, but they could impose it in Russia where it involved the transition of one feudalism to another – in the same way imposing centralized medicine on a country that has had the experience of (however flawed) choice in medical care is going to be tough.
More importantly, it’s a challenge they never anticipated.
Which makes this moment so uniquely interesting in history.
Will people see the flaw in the statist version, and realize it’s a dream whose time has passed? Or will they forge ahead towards the future of the past – and the abyss?
The thing is, people don’t revolt against confiscatory tax systems even if you show them that — hypothetically — it has cost them colonies on Mars and vacations on the moon. But if they had all that, and you took it all away and shuttered it, in favor of a confiscatory tax system, I think the reaction would be completely different.
And, metaphorically speaking, that’s what we’re facing.
