Jeff Miller quotes an ABC News Forum article, Prescription for America Questions for the President to suggest that Obama doesn’t have individuals best interests in mind.
“President Obama struggled to explain today whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people — like the president himself — wouldn’t face.”
I hadn’t expected Mr. Miller to come around to such an egalitarian approach to healthcare so quickly—but I’m pleasantly surprised. The article quotes somebody as arguing that the wealthier portion of America has tried to ensure healthcare options that allow them to get the absolute most for their money, even if it means others won’t get the care they need. We’re upset when people don’t have access to routine care. But we’re horrified at the thought that buy the best or most experimental care, even long after it makes sense. In other words, if we have limited healthcare resources, we still want to make sure we can buy as much as we want.
Obama was questioned on this. He was asked to commit not to use his money to seek extraordinary care outside the scope of his nationwide proposals if something horrible happened to somebody in his family. In other words, he was asked to restrict his family to the level of care he was able to provide for everybody. Of course he said no. If something happened to Sasha or Malia, he’s not going to compromise his efforts to help them for political reasons. Most of us wouldn’t want him to.
But Comrade Miller faults the President for refusing to sublimate his children’s future to the greater good. Obama won’t rule out using his money and influence to gain benefits not available to the least of the citizens. He doesn’t want to ration healthcare and ensure that money can’t buy an advantage. Obama’s proposal is predominantly capitalist in nature.
Of course, I’m being a bit unfair to Comrade Miller. He’s actually a libertarian—and I think his point is that even the best leaders are self-interested. When the chips are down, Obama will put the health of his children before the health of your children, just as you would put the health of your children before the health of his. You 1) know your interests and 2) will fight harder for them than the government. This is an important point.
But I’m a bit concerned about it. I agree that 300 million people have access to more information than even the most talented system organizer. In a realm like medicine, where there’s a lot of misinformation out there and most people have trouble knowing who to trust, it’s less clear cut. And, as medicine is a science with things like peer review, the best information may be fairly centralized. Still, when we have atypical cases, individual doctors and patients are probably better at problemsolving than a massive system. The information issue could go either way. But it’s hard to see a disadvantage to at least gathering the best information in a widely distributed place. We should at least make sure our doctors have the best tools.
But the more concerning part is that individuals will fight much harder for their health than a government will. Don’t get me wrong—I think it’s a healthy thing to do. But if we have finite medical resources, who gets to be in charge of distributing them? Are there cases where we have to make tough medical choices and say that some things are and some are not covered? Are there times when we could say enough is enough, we can’t dedicate millions and millions to prolong somebody’s life by a month or two while others don’t have access to affordable coverage.
I’m reminded of the trolley problem. One person is (presumably glued) on one branch of the track. Five people are (again, somehow stuck) on the track in the other direction. A guy a ways a way must operate the switch to chooose between the death of the one and the death of the five. Normally the question is what should that guy do—and almost everybody says he should go with the death of the one. But suppose we move the switch? If we allow the one guy, who’s usually doomed, to make the choice, he’s quite likely to choose his own survival. While we might call him a coward, we can’t blame him too much, because we aren’t certain what we would do in the same situation. So where is the best place to put the switch? I’m fairly comfortable saying we want the uninvolved guy with the most objectivity making the choice.
So, sure, we treat decisions about our own health differently than we treat decisions about the health of others. This doesn’t necessarily mean we make better decisions about our own health—or, rather, that we make decisions that are best for society. If we’re simply in a trolley problem, perhaps healthcare’s not a bad place for a command economy.
But we’re not in a trolley problem. Or if we are, there’s a third track we could send the train down where it would plow into a bunch of inefficient waste somebody had dumped there. We might eventually get to a spot where we simply don’t have enough doctors for all the life-saving treatment we want. But before we start making life tradeoffs, we can simply remove a lot of ineffciency. In some cases, this means changing incentives. In some cases, this means distributing information. In some cases, this means providing inexpensive preventative care rather than expensive emergency care. And maybe it focussing our best doctors and best specialists on places where less brilliant or less trained individuals cannot do the same job just as well.
Do we need to choose between a capitalist system where those with the most money get the best care and the others are left with asprin and shot gun and a government rationed system where you can’t get certain treatments, even if you can pay for them? Not now. Probably not ever. The choice we’re willing to pay an upfront cost so the poor can have lasting access to healthcare.
