Reverse engineering will be disastrous

Michael Kinsley is a smart man, which is why it’s so stunning to read drivel about empathy in his recent editorial on healthcare.

What is the most ridiculous thing about the American health care system? Is it that 45 million Americans don’t have health insurance? That is the most embarrassing thing, but it’s not beyond all rational explanation. It’s a failure of empathy. We — the majority of Americans who are lucky enough to be covered — apparently don’t care enough to do something about the minority who aren’t.

As a blanket statement, that’s bad enough. That’s liberal nonsense thrown out to lead to the inevitable conclusion that the government must provide healthcare. And if you disagree, you hate poor people. Or something stupid along that line, which the rest of the editorial virtually assumes without actually saying it.

But why? Only the most cold-hearted individual wants to see people without the means to purchase healthcare live a lower-quality life (or die) because of his situation. It’s reasonable to assume that government might not be the solution, though. Mr. Kinsley seems to understand that with this paragraph:

… There is a real moral dilemma here about what happens after you have defined and achieved the goal of decent care for everybody. In fact, this issue more than anything is what tripped up Hillary Clinton back in the early ’90s. Her health care reform plan purposely made it difficult — not impossible, but difficult — for people to go outside the system to get a higher standard of care. The reason is obvious: If a superior level of care is available, the care being guaranteed to everybody is inferior. In other words, you are rationing — denying people useful, if not vital, health care to save money. Worse, you are letting people buy their way out of the rationing if they can afford it — the way affluent young men were allowed to buy their way out of the Civil War draft.

Pretty much. We need only look at the state of public housing in most communities. This is a public good, supposedly, and the government can do it best, supposedly. So why have so many people chosen to not pursue expansion of public housing to include any and all people? Is it possible that those who can afford to buy their way out of that deal have shown exactly what they want? I see no vote for rationing, other than those votes coming from the policy wonks hell-bent on imposing a centrally-planned, socialist healthcare system. In other words, I can’t comprehend Mr. Kinsley following that paragraph with this one:

At the moment we don’t guarantee anyone any level of health care, so this moral dilemma can be saved for another day. And in the end, the answer will have to be that of course the standard of care the government promises everybody will not be based on the principle of “money is no object” and of course people will be allowed to do better for themselves if they wish. What sense would there be in telling people that they can spend their money on anything they want except their own health?

I don’t recall reading of a national healthcare initiative passing Congress, so I hope it’s too early to be saying “the answer” and “government promises” in the same sentence. And Mr. Kinsley’s right, there is no sense in telling people they can spend their money on anything they want except their own health. Yet, with a presumption of government-provided care, you’re telling me that I have to spend my money, through taxes, on everyone’s health. Smoking bans and trans fat hysteria and soda restrictions are bad enough. The health police will be a nightmare once the public coffers must pay for the consequences of an individual’s decision, for which he will never again be responsible. Bottom line: don’t start with the solution (government) and work back to the problem (non-universal coverage risk-protection). Work with methodology (principles) instead.

But what is most ridiculous [ed. note: isn’t it a failure of empathy?] about the current American health care system is that we have no idea, very often, whether even the most expensive treatments do any good. Business Week had a cover story last month touting what is called “evidence-based” medicine: that is, basing treatments on whether they work. You might say, “As opposed to what?” The article has some tendentious, newsmagazinish statistics about how most medical treatments (two-thirds? three-quarters?) are based on hunch or habit or a doctor’s finances or anything except solid evidence that they actually are good for patients.

Based on the primary pseudo-medical topic I write about, you know where I stand on this. Changing to government-provided healthcare will not change people’s attitude on this. (Disclaimer: children’s rights, and all that) If an individual must pay for what’s done to him, he’s more likely to question the treatment in search of alternatives. And if he doesn’t? It’s his money.