Monday, July 3, 2017

The American Way of Healthcare

Malcom Gladwell was on Meet the Press yesterday, talking about the healthcare system in Canada and opining about the lack of a healthcare system in the United States. He said the Canadians actually had a discussion about 60 years ago and they realized they could not have everything at once: Gleaming hospitals where the sheets had 500 thread count and healthcare for all. They decided they would provide the basics for everyone and they would accept that they might not have the Rolls Royce for every procedure, every medication, but they would have what was required for a reasonable effort.
Drawing by Pia Guerra

Of course, in this country, we have Rolls Royce care for the upper 1-10% and very limited health care or no health care for the rest.

Since the 1950's there have been vested interests which prevented a rational discussion--the American Medical Association acted as a vociferous trade group, bellowing that we were headed straight to Armageddon if we took even a single set toward government participation, which would lead directly to "socialized medicine" which was as unthinkable as "peace without honor" or other fates worse than death.

Since then, various groups have stood between Americans and really good health care, but for the past forty years, far as I can see, it's been the Republican Party, which has, in it's most unvarnished moments, simply said it's intolerable for rich people to have to pay for poor people's health care.  In the most revealing moment, Paul Ryan sputtered that under Obamacare, healthy people had to pay for the care of sick people and that is un-American and unfair and the road to Hell.

It was later pointed out to Mr. Ryan that's the way insurance works--a lot of people who are good drivers pay for all the wrecks those bad drivers cause, and people whose houses burn down get paid by insurance companies who collect premiums for years from all those well behaved people who do not allow their houses to burn down.

England, of course, has a two tiered system: You can fly economy class with the National Health System or you can fly first class with a coexisting private system which has its own upscale gleaming hospitals. Doctors can flit between the two systems, and the quality of care is comparable; both get you to your destination, but one gives you more leg room and a more comfortable ride.

It is on this crucible the real differences between the two parties becomes apparent for all to see: The Republicans really are a party for people who do not like the idea they may be giving their money so that others may benefit; the Democrats say they are willing to pay for others, as long as everyone gets a good deal in the end.

Doubtful the Donald Snowflake crowd sees it this way.

It used to be said there is no more virulent anti Semite than the disaffected Jew; now it is clear there is no more dedicated hater of the underclass than the lower middle class, the next step up on the ladder, the folks who see that with a turn of bad luck, an accident, an illness a lay off, they could slid right back down to that rung below them. 

One nation, under God, indeed.
E Pluribus Unum.

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