Thursday, August 13, 2009

Not the National Health

Thousands Line Up for Promise of Free Health Care - NYTimes.com:

Ana Maria Garcia, who works for Orange County, has health insurance that covers her husband and 3 ½-year-old daughter, but her dental deductibles are too high for them all to get care, she said...“Regardless if you are employed or not,” Ms. Garcia said, “everything in California is expensive, and so I can empathize with everyone here. Looking at this crowd, I think this is what people fear health care is going to be with reform. But to me it also shows the need."

Ms. Garcia nailed it. This is what Americans fear about "socialized medicine" and "socialized" anything else: a radical leveling down that will leave them much worse off.

The roots go deep into our national psyche. We believe that every normal person can and should take care of himself and his family, working hard, buying goods and services in the free market and for larger projects--barn-raisings and quilting bees--collaborating with neighbors on a voluntary basis. After all, if everyone did this, everyone would be ok and there would be no need for government and taxes--except of course to pay for cops, prisons and the military to protect us from Outsiders within and without: foreign powers intent on taking away our freedom, terrorists, and the criminal underclass. The government patrols the periphery and does not intrude; inside, we take care of ourselves.

Of course the poor will always be with us, and there will always be people who can't or won't take care of themselves. For those people there is private charity and, if necessarily, state run services which are public charities. We aren't heartless, after all. We don't want people dying in the streets or going without the basic necessities for minimal survival. But charity is only for the truly desperate and should only deliver the most basic services--only what is necessary to prevent death or great suffering.

As taxpayers we are stakeholders in the public charity system. We want to make sure that it screens charity cases so that only the truly desperate get benefits and doesn't use our hard-earned money to provide them with anything beyond the bare necessities. They don't deserve any more and we can't afford any more. If we have to pay any more in taxes then we will be forced to become charity cases ourselves, relying on public schools, public clinics and public transportation--government charities that provide bare-bones services for the underclass.

Socialism is a system which, in the interests of achieving equality, levels down, taxing citizens into destitution and forcing them to depend on the government for public charity. Comes the Revolution, impoverished by taxation, brainwashed by state propaganda and deprived of our firearms, we won't be able to fight back. We'll be enslaved by the government and forced to depend on it's largess for the kind of bare-bones services it now provides for the poor. Instead of making appointments and seeing doctors in offices we'll be queuing up for hours, or days, to get treated in sports stadiums like Ms. Garcia. Instead of driving to work, we'll packed into public transportation with smelly bums, spending hours on the bus for commutes that take 15 minutes by car. And our children will go to government run schools, like the ones we now maintain for the underclass, where drugs and violence are rife and kids are lucky if they manage to achieve basic literacy.

That is what, I believe, Americans on the right think and they deserve to be taken seriously. They aren't stupid, irrational or bigoted. They look around and see a two-tier system where the market provides decent services for the middle class--insurance and private health care, private schools and the like--and the government provides bare-bones services for those who can't afford to pay. So they infer, reasonably but mistakenly, that if the government "takes over" health care or other services they now buy in the market, that they will getting the inferior products that it now provides for the poor. The very phrase, "welfare state," conjures up for them a vision of everyone "on welfare," living in ghetto poverty. They, quite reasonably, don't want that for themselves.

How do you persuade them that this is just mistaken? You could point to other affluent countries that maintain welfare states which provide decent public services, including health care. But they won't believe it. Most don't realize that Western European countries are welfare states. They were brought up to see the world divided between the Communist Bloc and the "Free World": they think of Capitalism as the opposite of Communism and imagine that European countries maintain the same faux-laissez faire system as the US. Those who know that European countries provide much more by way of public services and social safety nets than the US are convinced that European welfare states are unsustainable and, in any case, that such systems wouldn't work in the US because, unlike Europe, we have a large, unproductive, criminal underclass.

How do you respond to this? They've got most of the facts right. What they've got wrong are the counterfactuals. Public services are lousy but that's not because government by its nature is inefficient or incapable of delivering anything better. It's precisely because they operate as public charities, providing bare-bones services for the poor. Middle class people don't use them and so won't support them, so that's all they can be.

As for this NYTimes article, describing how hordes of the uninsured and underinsured queued up for hours and slept in their cars waiting to see doctors and dentists volunteering their services in a sports stadium, I suspect many would have quite a different take from me, or from Ms. Garcia who sees this affair as showing a need. Most Americans will see it as a solution not a problem. They will see this arrangement as the way things should be: regular people with insurance making appointments to see private doctors and dentists in regular offices; those who can't afford it going to sports stadiums and charity clinics where doctors and dentists provide pro bono services.

If there's a "need," they think, what's needed is generousity: we need more doctors, dentists and other professionals volunteering, more churches providing social services, more charities. If everyone were generous we wouldn't need government (except for foreign and domestic defense): we would take care of ourselves and our families by our own efforts, and for the Other there would be charity clinics, soup kitchens and food pantries generously funded by us and staffed by volunteers.

Progressives need to address this. But first they need to get it, and that doesn't seem to be happening. The current system is lousy. It's not only humiliating to the recipients of these charities--it's unnecessarily risky for everyone and grossly inefficient. Private charity, individuals giving handouts to beggars ad hoc, evolved into organized charity which was both more humane and more efficient. Organized charity evolved into insurance schemes and ultimately into the welfare state, a public insurance scheme that was much more humane and efficient and made everyone better off.

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