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Is federalizing the cost of health care tantamount to "creeping" socialism?  When you listen to the rightwing commentators on television, and this includes virtually all of the "main stream media" people "reading" and eyebrow-arching the news, you get the distinct impression that the ox being prodded, if not actually gored, is their own.  It seems to me that three different kinds of ideas are contributing to this "media affect," despite the nearly overwhelming feeling in our society that no one should be without necessary care.

First let me dismiss that small number of people who believe that those without the financial means to protect and maintain their own health are dispensible, parasitic trash fully worthy of the bad end they will come to.  You people who have so little respect for human life that you would consign another human being to illness and incapacity because "they have not earned their health" seriously misunderstand this world and science and ethics.  You do not understand nutrition, epidemiology, psychology, or compassion.  You have seriously flawed psyches, personalities that did not mature to sociability, you are closet sociopaths.  Fortunately there are not many of you.

Basic health is not a commodity to be manipulated—bought and sold—in a "free market." By its nature health care rises above market considerations and ideologies. It is a public imperative, ever more so in this age of rapid and ubiquitous transportation of foodstuffs and persons and the ever increasing risks all that entails.  The basic health of individuals is the tangible, discrete and concrete element of public health for which we have a long and reasonably proud tradition of taking responsibility.  Basic health care is a public imperative no less important than providing for the common defense and national security.  It is of the same category,  for public health programs affects not only the individual and his family, but the neighborhood and the economy.  Public health is private personal health and it is a community concern a national imperative.

But, there are those who believe that nationalized medicine will be inferior, that they as patients will be put into situations where they have to rub elbows and IV's with the hoi polloi, people of different races and stations of life.  No.  If you have the money you will be able to buy whatever level of medical service you can afford.  The very rich will get more intensive care and perhaps more attention, although it is not clear that the medicine will be as much as an order of magnitude better.  The surroundings will be more plush, that's all.  Private medicine will always be available, but its costs will not be allowed to dictate the costs of public health.  Medical personnel will not be able to gravitate to high cost care in significant numbers because the basic system will absorb them and incentives to relieve MD's of their college debt will keep them in the public sector for significant periods.  You will be able to choose your care providers as the French and other European citizens do. 

The federalization of medical care will essentially remove the parasitic insurance business from the system and give back to doctors the right to diagnose ... and to stand behind their practice.  Those who err will go on notice and those who err frequently will lose their licences.  Removal of insurance companies will remove a huge burden of cost from the health care system.  If you own part of an insurance company your ox will be gored; it's about time!

The third problem people see is that elective medicine will drive up costs, especially when the definition of what counts as elective (rather than an "urgent") care is hard to agree upon.  The system will be fluid around these problems for a decade, perhaps slightly more, but it will iron itself out.

Chronic care and invalid care are problems akin to elective medicine.  Chronic care is not optional or elective, but the notion that these people would die off naturally without this care is a pernicious an idea as euthanasia.  Clearly not every person requiring constant care is a Stephen Hawking, but every person has a human right to care and with this decision firmly in place you will be surprised how the profiteers will abandon the scene when their prices are slashed and their care rigorously and frequently inspected.  It will take time to drive out the bad, but it will be done.

The weakest point of any federal program is the dependence of the organizations that implement and regulate it on the politicians.  The Republicans have shown that they can let welfare systems created by Democratic majorities run off their rails by providing slovenly leadership and disincentives to honesty among the bureaucrats and the clientele.  They destroyed the Great Society programs of welfare through their deliberate maladministration.  The American health care system of the future must be independent of Congress and the Executive in the same way that the Federal Reserve system is.

The essential lesson of the Constitution is that there is a way to control the baser instincts of man by checks and balances.  The new American health care system must employ those very same principles and, after they are installed, we must be eternally vigilant that the system stays on track.



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James R. Brett, Ph.D. taught Russian History before (and during) a long stint as an academic administrator in faculty research administration. His academic interests are the modern period of Russian History since Peter the Great, Chinese (more...)

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