Friday, December 5, 2008

Health Care Kerfuffle

An interesting thread of conversation came up between Ezra Klein, Andrew Sullivan, and Gershom Gorenberg about the merits and drawbacks of socialized healthcare.

One of the commenters in Ezra Klein's blog referred to the Andrew Sullivan post I linked to above and said that Andrew Sullivan was comparing "the US healthcare system as experienced by Andrew Sullivan to the UK healthcare system as experienced by Andrew Sullivan." To a certain extent, both Andrew Sullivan and Gershom Gorenberg are speaking about their own personal experiences, and how it has affected their opinions toward socialization of healthcare; Sullivan is responding to the UK, and Gorenberg is responding to Israel.

But in Sullivan's other post on the subject, he does point out that Ezra Klein's opinion polls aren't necessarily a better indicator of whether British-style healthcare is better for us than US-style medical industry (I refuse to call it "healthcare" but it is a medical industry). He's right that different countries respond to different systems differently.

But I disagree that Americans living under the NHS would have a revolution instantly. Certainly, I know many Americans who would be extremely frustrated with the healthcare system; that is because I know many people who can afford healthcare under the current system. But for those people who I know who can't afford the healthcare system, the choice between a nationalized healthcare system and no health care at all can't even really be called a choice. It was summed up for me when John McCain said, when asked about his skin cancer, that like most Americans he consulted with his oncologist about the issue. There are many Americans (I don't know if it's a majority or not) don't even have their own GP--they get a doctor when it is direly important, because they can't afford anything else.

But I do agree with you that the NHS is not what we should be looking for. In Ezra's post "The Canada/England Fallacy" he lays out a pretty good argument for not pursuing the British Model: because we shouldn't have a system that disallows those who can seek better health-care to do so. You, Andrew, probably have enough money to get better healthcare for your family than that which the NHS provided you. And so you should. But those who can't afford any healthcare at all--and whose privatized healthcare, if they could afford it, would probably treat them equally as poorly--should have something.

The state of postage in the United States (and other nations in the world) is similar. A government-run entity (USPS) is good for non-urgent mail, and can send registered mail and packages if you want it to. But other private companies (UPS and FedEx) compete with the government-run entity. If the USPS completely failed to provide any worthwhile service, it would eventually collapse--but I use the USPS all the time for letters, and for packages I tend to use UPS.

I'm aware of the pitfalls of socialized medicine. I was born in Israel, where my parents had lived for many years, and it has its own socialized medicine. My parents are ambivalent about socialized medicine; when they were young and poor, they got healthcare that they might not have gotten without its existence. But my oldest brother was born while my mother was not anaesthetized, because the nursing staff at the hospital attempted to give her the run-around because the anaesthesiologist had taken the day off. My grandfather had many troubles with his heart, and spending time waiting for cardiologists to have the time to address him was difficult.

Still, at the end of the day, this issue should be decided on economic models, on a more scientific approach to addressing what methods are most effective for the most amount of people. We want people with a lot of resources to have the best healthcare possible, and people with no resources to have the most healthcare possible. The top should be unfettered; the bottom should be supported.