Probably every President since John Adams has looked for a way to make government more efficient, and there’s a good chance that Washington was thinking along those lines in his second term.
The trouble is, every agency, every advisory council, was created for a reason. It may not have been a good reason – very likely there are dozens of government agencies created in return for a vote in the Senate, and designed to give a job to some senator’s nephew so that he could afford his own apartment, but that’s still a reason.
What we have is a conflict between a desire for small government and the desire to solve all social problems. In President Obama’s 2011 State of the Union message he said “we do big things,” but we don’t. We do small things, but we do an awful lot of them.
Nothing illustrates this better than our healthcare system which was designed by a committee using Lego bricks. We have Medicare for the old, SCHIP for the young, Medicaid for the poor, the Veteran’s Administration hospitals and clinics for veterans, military health services for active duty personnel, Tricare for military families, the Indian Health Service for Native Americans, prison hospital services, the National Hansen’s Disease Clinical Center for people with leprosy, and Obamacare for everybody else except 30 million people who don’t fit into any of the above.
This is a reflection of the inner American guilt trip. We want to think of ourselves as fiercely independent, self reliant, small government types, but we’re also a bunch of softies at heart. In the Sept. 12, 2011, Republican debate, when Ron Paul was asked about the fate of an uninsured man who encountered a serious medical condition, he first spoke about taking responsibility for your own actions, and then said that in a case like the one described, charity would step in. That’s us – a bunch of creampuffs at heart, which is why we keep developing health systems for a few people at a time, instead of admitting that we want a universal healthcare system, because that would be big government.
Meanwhile, we’re faced with a deficit problem. It’s not an acute problem – cutting expenses too quickly, before the economy picks up and can run on its own is likely to throw us back into a recession – but sooner of later we have to face it, and the cost of health care is a major problem in long term projections, Our population is growing older, and our medical care is growing more sophisticated. When Sue Lowden, a Republican candidate for the Senate from Nevada suggested paying the doctor with chickens, she was going back a century. Individual physicians might be amenable to a barter system, but Alexion Pharmaceuticals, which makes Solaris, a treatment for paroxysymal nocturnal hemoglobinuria that sells for $409,500 per year, might not be amenable to bartering. There are 8,000 people in the United States who need Solaris. Radiology has made major advances, but at a price. A CAT scanner will run from about $200,000 to $300,000. If we’re going to have a modern healthcare system, we have to have modern financing, and not rely on empty soda bottles by the cash register of the local deli.
We’re known for a long time that a single-payer health program was both less costly and more effective than the slumgullion that has been foisted on us as “the best healthcare system in the world.” Unfortunately, between politics and self delusion, the public option was omitted from Obamacare, and when Congress was faced with the fiscal cliff, all anybody suggested was raising the eligibility age for Medicare.
Rep, Paul Ryan (R-Wis.), chairman of the House Budget Committee, proposed replacing Medicare with a voucher system, apparently without calculating what a policy would cost for somebody whose drug bills alone would run over $100,000. We’re going to have to bite the bullet sooner or later and say that we want universal single-payer care, because we can’t afford anything else. A good place to start would be to consolidate all the bits and pieces that we have now into a single National Health Service. It would have a single administrative hierarchy and a single purchasing department which would have incredible leverage when it came to price negotiations. It would also get us used to the idea of an NHS, and demonstrate once and for all the efficiency of a single payer plan.
Once that’s done we could begin folding more people into the system until the American system of healthcare financing came into the 21st century. We really can reduce the deficit and cut the cost of health care, we just have to stop pretending we want small government. We just have to stop watching old John Wayne movies and look in the mirror.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y. Email firstname.lastname@example.org.
From The Progressive Populist, February 1, 2013
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