Wednesday, June 24, 2009

Public medicine looks a lot like public school

With our son approaching school age, my wife and I are considering a variety of options: charter, private, homeschooling. Just about the only option not on the list, even though we're forced to pay for it anyway, are public schools. We're not only unimpressed with the results achieved by local public schools, but we also don't like their one-size-fits-all structure. As things stand, we're concerned that, a few years from now, we'll face a similar situation with health care, forcing us to pay for coverage that we don't want in addition to care that we actually choose.

That's the big problem with government-sponsored versions of anything. No matter the quality of the ultimate product, everybody has to pay for it, even if it doesn't suit their personal needs and preferences. Just imagine if dining out was a state-provided service. Given popular preferences, at best, we'd end up with reasonably decent steak and burger joints from sea to shining sea -- and that's it. Good luck to vegetarians and fanciers of exotic ethnic foods.

Of course, at worst, you'd be forced to pay for the food quality of a high school cafeteria mixed with the service you've come to love at the Department of Motor Vehicles.

That worst-case scenario came to pass in Canada, where the country's Supreme Court ruled in 2005 that the quality of medical care provided by the state system in Quebec was so terrible that the province's law against private health insurance couldn't be allowed to stand. While the ruling doesn't apply elsewhere, private -- and arguably illegal -- clinics are springing up around the country to provide care to people who'd rather pay for medicine twice than accept the government's prescription.

Private medicine is legal in the United Kingdom, where about 11.5% of Britons (up from 5% in 1980) carry private insurance in addition to the taxes they pay for the National Health Service. Government-provided dentistry is such a shambles that people have fled the system, and dentists now make more from private-pay patients than from the state system.

But if other country's medical systems have troubles, so does the American system. After all, The World Health Organization gave America's health care a miserable 37th-place ranking out of 191 countries, right?

Well ... not so much. Actually, when economist Glen Whitman looked at WHO's rankings, he concluded:

The WHO rankings depend crucially on a number of underlying assumptions—some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares.

The analysts behind the WHO rankings express the hope that their framework "will lay the basis for a shift from ideological discourse on health policy to a more empirical one." Yet the WHO rankings themselves have a strong ideological component. They include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance.

Basically, WHO front-loaded its ratings with criteria that guaranteed high rankings to tax-supported systems, and low rankings to systems where people pay for their own care. Said Whitman, "To use the existing WHO rankings to justify more government involvement in health care--such as via a single-payer health care system--is therefore to engage in circular reasoning because the rankings are designed in a manner that favors greater government involvement."

Plenty of people share WHO's biases -- many Canadians and Europeans are happy with what they get, and lots of Americans say they want the same thing. But plenty of people don't share WHO's biases. If you implement a state-sponsored health care system, everybody gets drafted into the one-size-fits-all scheme, without consideration for their personal preferences.

Actually, "draft" is the right word. Since state-supported schemes are supported by taxes picked from all our pockets, they're basically conscription with limited -- or expensive -- opportunities for conscientious objectors (and sayonara to voluntary alternatives). That's true of public schools, and it may soon be true of health care.

Right now, President Obama and his allies in Congress say they have no plans to displace private medicine, only to create a public plan that would compete with and "discipline" private insurers.

Right. What do you think would happen to Burger King if McDonald's not only ran its own restaurants, but also had the power to charge everybody for Big Macs whether they ate under the golden arches or not, and could regulate all fast-food joints? That's the sort of "discipline" you get from a government plan.

I expect that, in years to come, my wife and I will be looking at our options for escaping not just public education, but also public medicine. And, as it already is for Britons and Canadians, that choice will be expensive and limited by a government that doesn't put a lot of value on personal choice.



Anonymous Anonymous said...

My wife and I are putting our daughter in a private school next year, our son adjusted fine to High School, our daughter who is a freshman just hasn't thrived in the one size fits all public school system and her grades, attendance and attitude have plummetted.

I'm with you, whatever the government thinks it can do good, is typically not anywhere close and i can see federal manadated screeenings etc. And I for one don't want the state to provide anything for me.

June 25, 2009 9:10 AM  

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