Friday, March 19, 2010

Room for Reason on Health Care?

It’s sad, in a way.

Yesterday I posted an article on my Facebook page about the rate at which mothers die giving birth in the US. Several organizations had ranked the US 41st in the world (at the bottom of industrialized nations) in terms of death rates for women in childbirth. I prefaced the link with a comment that I was a) unsure that the current health care proposals are the right answer, and b) hoping that someone from the Republican/Libertarian side would offer a better, more market-driven solution.

The responses confirmed my worst fears about the way this issue is being discussed, and highlighted how difficult it is to be a dissenting conservative these days. In all the reaction (and let’s be honest, overreaction) to the idea of a government-run health care system, not one of the responses mentioned the tragedy of the mothers who are dying. Think about that. Most of the respondents, but not all, were parents. Most of the parents were men with daughters. None, not one, mentioned the real lives behind the statistics—the ones that represented kids growing up without their birth moms, husbands raising children without wives, or, at least as likely, orphans placed in foster care. Think about that, too.

Now before anyone pushes the nuclear response button (seriously, haven’t you had enough of that already?), let me say a few things that require some nuance to communicate (and understand) fully.

First, I’m not in favor of a radical re-vamping of the US health care system. It takes a thoroughgoing misunderstanding of American culture and values to think that replacing the current system with an entirely new one isn't a fool’s errand at best. But, we spend 16% of our GDP on a health care industry that doesn’t provide basic services to all of our residents, and that clearly isn’t working either. (For all the reasonable and unreasonable fears about the British National Health Service, it’s still a fact that everyone here has good—not great—medical coverage, and it costs 8.4% of GDP.)

Second, I do believe that there is a profitable solution to be had, one that offers basic coverage to everyone, but it is being subverted by the intransigence of the two dominant political parties. One of the qualities that makes America such a great place—and such a great economic engine—is that it encourages and delivers solutions to problems that a) meet the needs of the public, and b) turn a profit for employees, shareholders and, through taxation, our public sector. To say that this is not possible is to redefine America into something it has never been—a place devoid of the ideas and acumen we cherish as a pillar of our national culture.

Even Britain—and pay attention here if you’ve only seen a caricature of the health care picture here—even Britain’s marketplace offers a broad range of private insurance options that kick in if the NHS can’t provide what you need. And they’re not just for the rich. How do I know that? First, because I have that insurance myself. My church generously provides me and my family with a basic private insurance overlay which costs about £2000 per year, and includes vacation coverage in that amount. (That means that when we visit the US, where we no longer have insurance, we’re still fully covered.)

But I can also argue that private health care isn’t limited to the rich by analyzing where it is advertised. Most of you will know that advertising is targeted so that specific ads will reach the greatest number of potential customers. Toys are marketed during Saturday morning cartoons, feminine products are pushed on the Lifetime channel, sports events are soaked in beer commercials, and luxury items can be found in high-end magazines. Advertising is placed where it will reach the highest proportion of people likely to buy what is being advertised.

Here in London, private health insurance is advertised in the Underground and on buses.

Companies selling private health policies in the UK, after considering where they might get the most bang for their advertising buck, have chosen users of public transportation as their primary audience. If you separate the tourists from the equation, then the expectation is that commuters—not rich people, but people with jobs—are likely to want and to be able to afford private health insurance. Oddly enough, and this is one of my areas of serious dissent from the current president’s plan, there is more choice in health care in Britain than we find being proposed in the US. I’ll say again that this is a complete and utter misunderstanding of American culture and values.

But getting back to the article in my original link, I never thought I’d see Americans of any political stripe roll over and tolerate being 41st in the world at anything. Even if, as some suggested, the left-leaning orientation of the article’s sources (the World Health Organization, Amnesty International and the Guardian newspaper) exaggerated the details to smear Americans—even if they inflated US stats by 10 places or so in the rankings, I wasn’t raised in a country that would have been happy being ranked 30th in any important table. The competitive juices would have flowed, the partnership between government and private enterprise would have kicked into gear (with all the necessary tensions there), and somewhere, somehow, some American would have figured out a way to do it better, cheaper and in more colors.

The responses I hear to the health crisis tell me that spirit is dead.

It wasn’t killed by the government. It wasn’t killed by illegal immigrants. It was killed by the very people who would have found a solution just a generation ago—it was killed by pro-business, pro-private enterprise, pro-innovation conservatives who spend more time talking about what’s wrong with the other side than they do proposing a better way to solve the problem.

For the first time in my adult life, the right seems less culturally American than the left.

So what do we do? I want you to hear this in the refreshing spirit in which mean it:

I don’t know.

This is a huge problem for us to solve, and I don't pretend (as some will) to have the answer. The way our provision of health care has evolved over the last century has left us with a system that is, on the one hand, amazing in its life-enhancing creativity and excellence, while on the other, unattainable for too many of our neighbors. The solution to this problem will come when advocacy for independence and profitability is tempered by advocacy for justice and universal access. If that seems like too much coded language, let me say it a different way: As trite as it may sound, we won’t find our way out of this until the two sides with important vested interests can work together.

In the meantime, and to get back to the shocking details (even if only true by half) in the story I linked to yesterday—in the meantime people are still dying unnecessarily. People at the bottom of the economic ladder, but who will (as past generations have) contribute to the growth and profitability of our nation in years to come, need the rest of us to come up with a solution in the same way we did for polio, illiteracy and Hitler.

That’s what I was trying to say.


  1. Lauren Cobb8:36 AM

    Thank you, John.

  2. Not sure that your survey was quite valid, John. Posting an article on Facebook and then positing the challenge for your ordinary conservative friends to post a solution to a massively complex problem we're only marginally familiar with, then a day later declaring that they are somehow not "culturally American" is a bit quick on the draw, don't you think? ;)I realize that there was a degree of disagreeability about some of the posts in response, but it's hardly a representative sample of the American "right".

  3. Dave Rogers11:04 AM

    John, an outstanding insight into the loss of the American spirit. Right on target. Also "Left" on target! Both sides are responsible.


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