It's The Other People, Stupid

In this previous post, I said that there is a limit to the right a person has to decide their own future. In particular, I pointed out, when it comes to health care, your right of self-determination runs smack into, and is overridden by, my right not to be surrounded by sick people dying of preventable diseases whose treatment they can't afford.

Especially when you just know, like the mortgage lenders, they'll come crying to the rest of us: Hey! It's not my fault! I didn't know! Help me!

In this post I've got something else to say about health care and human psychology. Or, uh, American psychology, I should say.

In this editorial from the early part of November, Paul Krugman sums up what he takes to be the core argument for health care reform in the US. He writes,

"The United States spends far more on health care per person than any other nation. Yet we have lower life expectancy than most other rich countries. Furthermore, every other advanced country provides all its citizens with health insurance; only in America is a large fraction of the population uninsured or underinsured."

Krugman suggests that to any reasonable person these would be knock-down arguments for reform, and he goes on to offer some replies to counter-arguments in defense of this basic position.

These counter-arguments seem right to me; I haven't got anything to add there. But what I'm interested in is the reason there is reluctance to change the US healthcare system. I'm sure there are lots of reasons.

But one reason no one talks much about is this: most people having an opinion are actually getting very good health care. The Krugman argument talks about averages, totals, and the uninsured. Most people, I think, actually don't care much about averages, totals, and the uninsured.

Most middle-class and wealthy people probably think that if the health-care system changes in the direction of socialization that their care will become worse. In fact, I'm betting that for lots of people, the idea of socialized health care brings immediately to mind an image like the following: There they are, sick, sitting in a racially diverse room, with lots of poor people around, being told by some bureaucrat that there are 100 welfare queens ahead of them in line for the one MRI machine.

No one, I think, feels comfortable discussing this fear, so they find other things to say.

This fear is what we should discuss, for one reason: the fear is only relevant to the kind of socialized health care system no-one in the US is proposing anyway: a single-tier, no-private-doctors system.

In lots of European systems, there is socialized health care with nothing like this, because anyone has the choice to pay themselves, or get private insurance, and lots of people do, and they don't have to sit in any dark depressing rooms with people who don't play golf. They can do whatever they want.

Clearly any system anyone adopts in the US will have these options. The argument then is partly "this isn't such a change" -- in addition to the familiar "we have to change." And the argument should include an explicit injunction to take the cares of others into consideration.

Along a slightly different line of thought:
I'm an American living in Canada. Here in Canada we actually have a single-tier, no-private doctors system. It's interesting, because, you know, some of the things people say about it are true: there aren't enough machines, there are waiting times, places are understaffed and sometimes depressing and chaotic. And they're that way no matter who you are.

I've been here for a few years and so far the care I've gotten has been great. But more interestingly, I'd say, there are benefits to this system that you can't really imagine until you're here, but they're extraordinary.

Everyone gets the same health care. Duh. It's so simple, but it kind of transforms the way you interact with and feel about your fellow citizens. It gives everyone dignity. No one has to plead for help, and no one feels like a second-class citizen. If the system sucks, it sucks for everyone, so something gets done about it.

You're at the gym chatting with the cleaning lady. You're at McDonald's ordering a Big Mac. You're buying the papers at the weird convenience store.

All the people you see, you talk to, you're all in it together. You can look people in the eye, and not feel like shit. It's kind of awesome.

But this awesomeness isn't going to translate to the US. Whatever. Focus on getting it together for the people who need it, and let the people who can afford it do whatever they want. Don't tell people, "This will make it work for you." Tell them, "If you don't care about anyone else you're being overly selfish." Or fill in your own adjective.