I have written very little about the healthcare debate because I do not consider myself sufficiently informed to add much value. However, I’ve seen others make some valuable contributions, which are worth sharing. In last weekend’s NY Times, bio-ethicist Pete Singer brings some honesty to the debate, in his opinion piece, “Why We Must Ration Health Care” (free registration may be required). The thought that more patients could be served at lower cost without rationing is simply beyond belief to me — there simply aren’t enough inefficiencies to wring out of the system, and if there are, political intervention usually isn’t a very effective means of eliminating them. This is just common sense. Reducing health costs will involve rationing, but this is not necessarily a bad thing, just a realistic assessment. The question really is how that rationing should occur, and whether this should be done by government, private business sector or individual choice.
The appropriate role for government is at least partially dependent on whether health care should be regarded as a right. This blog has many European readers who may take for granted that health care is a universal right. However, this is by no means a consensus opinion in the United States. A good friend in California city government told me about battles over cable television access in his town — many residents regarded affordable cable as a “right.” In some ways, health care seems closer to the right to cable than, say, rights like freedom of speech or freedom of religion. After all, rights to healthcare ultimately mean rights to someone else’s time, money or expertise… not exactly “unalienable rights.” I came across an opinion piece from Congressman John Campbell, a Republican out of California that attempts to wrestle with some of these issues; yes, it’s a political piece, and I know nothing about Campbell and his other views, but I think he tackles these issues in a common-sense, intelligent way.
None of this is to negate the need for an intelligent U.S. healthcare policy. As medical technology continues to improve, it’s likely that we’ll see more applications that provide limited returns for large costs — some kind of rationing, led my government effort, may well be desirable. Whether healthcare is a right, a critical part of a social safety net, a middle class entitlement, or none of these, is all a matter of debate as well. The key word here is “debate.” These are weighty issues that deserve more thought, time and public input than we’ve given. The argument that, “if we don’t act quickly, we won’t ever have a solution” is highly unsatisfactory. It may be that we’ve had no solution in the past because either there is no real consensus on the tradeoffs, or the proposed policies are worse than the current realities. I, for one, am happy to see the healthcare debate move along a slower path.