09 February 2010

How About We Just Bite the Bullet and Make a Commitment?

When I read mean spirited and arrant nonsense like this column in the NYT by Ross Douthat (probably better yclept Ross Dontdothat), I am inspired to ask this simple question:

Are we truly not a wealthy enough, and a generous enough, society, that we will make a commitment to provide decent health care to all our citizens? 

If the answer, selon the GOP, and too many Democrats, is really going to be No, we can't afford it, then all I have to say is, for shame. We can afford Gulfstreams for the Morally Repugnant Elite but not a doctor for the children of coal miners in West Virginia and the elderly on fixed incomes everywhere in America? F--k that! I will never, ever accept that reasoning or settle for that kind of just plain rotten cheapness. These people should be deeply, deeply ashamed of themselves.

And as for the notion that health care will rise to 25% of the GDP, this is the most ridiculous nonsense of all. Yes, of course we have to raise taxes; the Bush tax cuts were outrageous gifts to the wealthiest Americans. In any case, long term predictions of future trends, including predictions of growth in spending, are always wrong. (Bank on it: they never take into account social and technological changes accurately, which effectively reform the value of goods and services generationally; this should be understood as a fundamental principle of economics. It's why you can't accurately say what 200 florins in Beethoven's time was worth in today's money... because there simply is no "equivalent purchasing power").

I mention Beethoven because I came across an anecdote in Marek's Beethoven biography to the effect that even with the huge economic disruptions caused by the devaluation of the Austrian currency and general depression in the aftermath of the Napoleonic invasion, if a person had a letter from a priest attesting poverty, doctors and hospitals were required by law to treat them for free. This in an autocratic society that recognized the absolute power of the Emperor. Of course, medical care was something very different then, but even in that time and that society, the right of people to the common decency of receiving health care when needed was acknowledged.

Moreover, if you look around the world, countries that do provide health care as a "right not a privilege" spend far less as a percentage of GDP on health care than we do, because they accept that government has a proper role in regulating health care costs, and, to a reasonable extent, health care expenditures as well. Of course it's rationing. But we ration now: the wealthy get it all, and the poorest get nothing. That's rationing. A decent form of rationing might not pay for every test, not every procedure, not every piece of expensive technology, not every drug. But reasonable care for all. We can afford it, and we are a lesser, more niggardly, and meaner people for not doing so now.

(I sent a much shortened version of this spiel to whitehouse.gov)

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