August 30, 2009

Health Care Realities No One Wants to Face

No blogging for many weeks. Much going on and the seduction of "Facebook."

The healthcare debate is hardly a debate. It seems full of slogans and anecdotes, and no doubt will no be freighted with Kennedy nostalgia.

There are home truths about healthcare that no one wants to face. Fundamental is that people will want more healthcare than any system can provide. If you make it free or lower the cost of any procedure, demand will increase. It is not a case of a certain number of people who need vaccines and appendectomies, and if the state provides them that ends the matter. The demand is not self-limiting.

It follows that one way or another, any system will deny health care to some people at some times. The only question is the mechanism. As it stands, the poor and improvident get the shaft. If the government takes over, some political mechanism will decide, as it did when the AIDS lobby and the dialysis lobby got vocal.

Hence the "death panel" fear mongering, although demagogic, was not completely baseless. Sooner or later, if we have a public system, the government or some delegate of the government is going to decide who gets care, much as the anonymous nurse in New Hampshire now tells your insurance carrier whether to pay for your surgery. The fear of federal death angels is not far-fetched; it's happened before, and there are few moral barriers left.

Furthermore, once healthcare is nationalized, the Nanny State will have powerful arguments for intervening in the details of our lives. Just as Nanny Bloomberg banned trans-fats in restaurants, and Nanny school districts ban high-fructose sodas in vending machines, the pressure on the government to push people to live their lives in whatever the fashion of the day considers to be healthy will increase. Perhaps we won't have TSA agents search our pockets and purses for contraband Lifesavers, or ankle bracelets to shock us if we don't do our crunches, but the Nanny State will become more intrusive.

Finally, there's the deficit thing. Bush with his wars and his tax cuts destroyed the progress the country had made toward budget balance. In his waning days he further undermined fiscal sanity with the disastrous bank bailout. Obama has toed the Goldman, Sachs line. On the one hand, neither party can preach about the fiscal effects of healthcare spending, when they've wasted so much more on wars and bailouts for the rich. On the other, the country seems to have little stomach for more deficits.

What are we to do? Raise taxes in a recession? Hope that China and the Arabs continue to buy our increasingly questionable paper? Another question with no good answer.

Prediction. Either no reform or modest reforms this year. Republicans claw back a bit in 2009 and 2010 elections. Obama runs the risk of being a one-termer. Can anyone say "President Palin"? Oh noooooo . . .