Thursday, August 27, 2009
Understanding the American health care debate from abroad has been rendered difficult, if not impossible, by the cretinous, Palinesque rhetoric which now seems to be the preferred discourse of the Republican Party. There will be, according to these knuckle-draggers, government death panels and the whole Obama scheme is either Nazist or socialist or both. In fact, what the current health insurers get up to seems to be far worse than anything imaginable in any state scheme and, besides, America's position as the only wealthy country not to look after the health of all its citizens does look increasingly weird as the years go by.
This is not to defend the NHS, which needs very radical reform indeed, but it is to say that American suspicion of any government involvement in health insurance and the resulting denial of medical care to millions of its citizens needs more explaining than I have yet seen.
Part of the answer, I think, is the deep American conviction that failure should be punished so that success can be rewarded. This is seen both as a moral and an economic imperative. In this context, failure involves the loss of health insurance. If this penalty is removed then there will be less incentive to be successful. The three big flaws in this are: a)rampant and demonstrable private sector abuse of the system b) the fact that very little failure is actually deserved and, even if it were, death or serious illness must be an excessive punishment and, therefore, the moral aspect of the imperative drops out of the equation and the only justification becomes economic. But this too is weakened by the fact that c) the current US system is not very effective in that life expectancy is not that high, it encourage massive over-medication to the point where iatrogenesis is the third biggest killer and it is fantastically inefficient and expensive.
Health would seem to be a perfectly legitimate extension of the state to correct market failures. Nevertheless, I understand the need to reward success and punish failure in the context of the American imagination. The potency of the idea is what makes the US so different from Europe. Unfortunately, to stir up the knuckle-draggers and damage Obama, the Republicans have decided to exploit and debauch this idea. American individualism thus becomes American savagery and true conservatism withers.
Posted by Bryan Appleyard at 6:32 am