Thursday, March 29, 2012

Brief Thoughts (But No Solutions) to Healthcare

There's been an awful lot written on the US healthcare system this week, largely because of the Supreme Court case. Trying to guess how justices will vote by listening to their questions is a bit like trying to infer Soviet policy in the old days by seeing who stands next to who at the May Day Parade. I have no idea what the Court will do - we'll find out in a few months.

There is one core observation that is both obvious and, to my eye, vastly under-reported. There are a lot of arguments about "Obamacare" and "individual mandates" and insurance and all sorts of other technical details. There are even arguments about whether universal health care should be a goal or not. But in one sense, we've already answered that last one. The moment we made it the law that anybody who walks into a hospital gets treated, regardless of their ability to pay, we essentially made health care universal - sometimes lousy, but universal.

I worry about government power as much as the next guy (and more than many). But on this issue, I think the horse has long since left the barn. We are ALL paying for everybody's health care, especially the poor - it's just a question of how. So long as we stick, as a matter of public policy, to the requirement that hospitals treat everyone - and I haven't heard even the most strident anti-Obamacare Republicans calling for a repeal of THAT law - all we're really arguing about is who should pay for it, and how to make the system more efficient. Political scare tactics aside, we have already socialized medicine - we've just done it badly.

We can all appreciate the irony of Republicans attacking a Democratic President for doing something that Republicans themselves once championed as an alternative to a different Democratic President. But then, most politicians of both parties are happy to use the old political Etch-a-Sketch when it suits their purposes.

I don't know if I like the particular solution that the Obama administration has come up with or not. There are some parts of it that everybody likes - like the inability to exclude for preexisting conditions, which has a serious drain on mobility in the labor market (you'd think free-market Republicans would care about that). I'm not keen on the government telling me to buy something, except in this case it's something I (and over 90% of the country) already have. Maybe there's a better way to do this. I'm certainly open to ideas.

But for all those who are simply opposed to this particular health care bill because, well, it's The Other Team - let's stop replaying Monty Python's Argument Sketch in public. If you think something else would work better, say so. And if you really mean it when you say you want to "get government out of health care" - try to repeal EMTALA first, and see where that gets you.

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