Tuesday, October 11, 2005

One Nation, Uninsured: A Review (Conclusion)

In Part 1 we learned about Prof Jill Quadagno’s new book setting forth the case for a national health insurance plan. The introductory chapters tended to focus on anecdotal “evidence,” which I do not find compelling. But the rest of the book follows a more rigorous argument, and at least makes an attempt to justify its conclusion.
Dr Q begins the actual meat of the book by laying out the history of medical care and cost at the beginning of the last century. She traces the evolution from private pay to corporate benefit – how we ended up with employer-based health insurance. By the 60’s, as our population continued to age (as folks started living longer and longer), Medicare and Medicaid became dominant forces in the health care delivery system. The Professor then discusses the genesis of national health insurance that began in the early 70’s, and sets up a sort of conflict between providers and legislators, lamenting the forces of the medical industry’s lobbyists. Of course, this fails to take into account the incredible power of the lobby of “care by government:” the legislature itself.
By the early 80’s, TEFRA ushered in HMO’s, based primarily on the tax breaks such entities would enjoy, thereby legitimizing what we lovingly call “managed care.” Dr Q argues (and I tend to agree) that this marked the beginning of a period of unimaginable premium growth. She seems to set up, however, a sort of tension between federal and state regulators; this particular argument left me unmoved.
The mid-80’s, Dr Q writes, brought us COBRA to “plug some of the holes.
And then there came HIPAA. The goal was, of course, admirable. But it contains so many provisions, some of which are only now becoming obvious (and onerous), that one wonders why this would be a good argument on which to base the need for national health insurance. It’s as if one built a brand new, 8 lane superhighway, but put barbed wire on the guardrails, and abruptly ended the road in the middle of a pit of quicksand. This makes no sense to me.
Her argument seems to be that the current system is “unfair.” I’ll even stipulate that she’s correct, that the system (as it is today) is unfair.
So what?
Where is the Constitutional prohibition against “unfairness?” Better yet, where is the Constitutional mandate for “fairness?” Because some people are not treated fairly, must everyone else be brought down to the lowest denominator? Wouldn’t it be more “fair” to make an effort to bring those less fortunate up to a better level? Nationalizing almost 15% of the economy in order to help a minority of the population seems pretty silly to me.
If one wishes to see a very real world example of what happens when the gummint nationalizes an industry, try taking a train. The passenger rail system, nationalized in 1971, is hardly a model of efficiency: it is expensive, inconvenient, and not well-known for its timeliness of service. Would we want those traits in a national health service?
I think not.
Is the current system perfect? Of course not. But we enjoy a level of care, as a society, that is unequalled in world history. There are a myriad of cost-effective ways to fix and improve the current system, which well serves over 85% of the (legal) population. Seems a shame to toss it out.
I would like to thank the Oxford University Press blog for the incredible opportunity, and the vote of confidence. And I also appreciate Dr Quadagno’s patience with me as I put together this review, as well as for the initial link that started this whole ball rolling. I certainly hope that I didn’t disappoint.
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