Apropos of the current consternation about “Obamacare,” we offer this reprint of an earlier article for discussion.
Most productive Americans hate the idea of socialized medicine since they think that they will pay more into it than they will get out of it, and they are right. Americans who take care of their health—i.e., exercise and avoid smoking, junk food, excessive drink, and recreational drugs—should also hate the idea of socialized medicine, since they will be paying for the cancer treatments of chain-smokers, the triple bypasses of lard-asses, the venereal diseases of the oversexed and impulsive, and the diabetes, cirrhosis, dialysis, obesity, etc. of the overfed and overindulgent.
Is it any wonder, then, that productive, health-conscious people prefer the present semi-private system to socialized healthcare? They would need mental healthcare if they thought otherwise.
But, crazy though it may sound, I want to argue that healthy, productive Americans should prefer a socialized healthcare system to what we have now.
First, they are already paying for socialized medicine without reaping any of the benefits, because we have a sneaky, hypocritical form of socialized medicine anyway.
Second, a socialized healthcare system need not exploit the health-conscious to coddle the sickly and self-destructive. One could also award health-conscious people certain benefits and penalize people who do not take care of their health appropriately, so perhaps they would take better care of themselves.
Before we go into the details, however, we have to confront honestly why we do not have a completely capitalist, free-market healthcare system. Such a system would mean that the only health care one could get would be what one can pay for by oneself (or persuade others to pay for).
Yes, there would be charity hospitals for the indigent in such a society, as long as some people did not completely embrace the libertarian ethic of selfishness. But there would be no “safety net”: no government guarantee that everyone who needs healthcare gets some care, no matter what.
In a completely capitalist system, there would be people who suffer and die of easily preventable diseases simply because they lack money (or the ability to persuade others to foot their bills). Not enough people want that sort of society, whether from religious conviction, altruistic sentiments, or simple rational self-interest (since anyone can have a run of bad luck). So we already have a form of socialized healthcare.
If you have private health insurance, you still pay taxes for Medicare and Medicaid and emergency room care for the indigent. And private health insurance is also a form of redistribution. The healthier you are, the less medical care you use. The people who really benefit from private insurance are those who have serious medical problems.
In the past, healthy people with private insurance could at least count on a modicum of protection from this because their insurers could turn away people with serious health problems or at least refuse to cover pre-existing conditions. But today, thanks to our government, they can’t. So the healthy are forced to contribute to the health care of smokers, fatties, drunks, druggies, AIDS patients, and others who can join your “private” health plans.
But it gets worse. Many health-conscious and responsible people pay such high premiums with high deductibles that they postpone visits to the doctor and important checkups and tests, while hypochondriacs clog the waiting rooms. This often leads to serious medical problems that could have been easily prevented if decent people were a little more inclined to be crybabies and mooches. Where is the justice in this?
In our current system of semi-socialized medicine by stealth, disproportionate benefits go to the improvident, undisciplined, and irresponsible—paid for by the productive, disciplined, and responsible. Given that, productive and health-conscious people might actually be better off with outright socialized healthcare.
Socialized healthcare is merely the logical extension of the commitment that our society has already made not to allow anybody to go without necessary care. I believe that commitment is fundamentally right.
But a socialized healthcare system need not be run by malevolent egalitarians out to penalize the healthy and responsible and coddle the sickly and irresponsible. Instead, one could have a set of incentives that reward healthy lifestyles and penalize unhealthy ones.
First of all, let’s divert all the monies raised from cigarette and liquor taxes to the healthcare system, so that people who smoke and drink subsidize their own care.
Second, let’s tax junk food for the same purpose. Let’s make corn syrup more expensive than caviar. Let’s return to a society where obesity is a rare sign of great wealth rather than a common sign of poverty, as it tends to be today.
Throw in hefty taxes on TV, golf carts, ride-on lawn mowers, leaf-blowers, drive-throughs, and everything else that promotes laziness and unhealthy living.
Conversely, give tax breaks for healthy lifestyle choices: joining gyms, taking yoga classes, quitting smoking and drinking, etc. Change zoning laws to mandate mixed-used development and walkable communities.
These are just a few suggestions, but they suffice to illustrate the basic idea. We need to create incentives to encourage healthy living and personal responsibility rather than penalize them.
But what about freedom? It’s overrated, but still a value to be preserved. Under my plan, nobody would be forced to do jumping jacks. Nobody would be prevented from eating Twinkies. (Well, maybe Twinkies.) I do not propose turning society into a vast boot camp or making fat farms mandatory.
But people who abuse their health will have to pay the full cost of it, since their little indulgences will be taxed to pay for treating the illnesses that follow from their lifestyle choices. (I do, however, think that individuals whose drug and alcohol problems prevent them from carrying out their personal and social responsibilities should be forcibly dried out.)
Should people have the freedom to opt out of a socialized healthcare system altogether? Yes and no.
No, people should not be able to opt out of paying for a basic healthcare system, even if they say that they are willing to suffer the consequences. First of all, most of them would come running to the emergency room anyway. But beyond that, some individual choices are foolish and should not be honored. A certain amount of paternalism is necessary in a decent society.
But although people should not be free to opt out of the standard healthcare package available to all citizens, they should be free to pursue additional healthcare if they can pay for it. The rich, after all, will always be with us, and as long as they can travel abroad, they will seek out whatever healthcare they can afford. So there is no reason to eliminate a private healthcare sector in addition to a socialized sector. Furthermore, it would probably be more efficient if most healthcare providers were private enterprises. The government would merely be the biggest customer.
Of course, the biggest barrier to socialized healthcare in America is not that people think it is immoral, impractical, or undesirable. The problem is a deep division and distrust within American society. Most white Americans correctly believe (1) that the left would end up administering any system of socialized medicine, and (2) that the American left is deeply hostile to the interests of white Americans.
There is also a racial dimension of this anxiety. Whites instinctively know that blacks and browns would take more from the system than they contribute, with whites paying the bills. Moreover, the old are disproportionately white, the young disproportionately non-white. Thus it makes political sense for the Democrats, as the party of non-whites, to want to bump off old white people to divert their healthcare dollars to the Democrats’ younger, non-white constituency.
As Harvard professor Robert Putnam’s studies have shown, racial and ethnic diversity are profoundly destructive of social solidarity and civic mindedness. Thus America will never have a Scandinavian-style welfare state unless and until we have the racial and ethnic homogeneity Scandinavia used to have. (Specifically, we would need a homogeneous society of intelligent, industrious, conscientious people.)
We’re never going to have a fully private healthcare system. The present semi-socialist system is immensely costly and inherently unjust. Maybe somewhere down the line, when the White Republic is established, we should consider replacing the socialism of the sick with the fascism of the healthy.