dijous, 29 d’octubre de 2009

La reforma sanitària als EUA (per Publius, de Washington DC)



Una visió no Obamista del tema:


United States newspapers are not going the country any favors with their coverage of the healthcare debate.  What sells newspapers is describing every catfight, walkout, procedural vote, and committee chairman throat clear as being the defining moment in the healthcare debate.  A bit of perspective is in order.
 
First, there is no question that the stakes in this issue are simply enormous, both in quantity and in kind.  Despite reassuring and soothing descriptions like, "a healthcare overhaul" and "a healthcare reform," what is actually being proposed is a "healthcare reconceptualization," or --as various conservative pundits have accurately called it-- a redefinition of the American middle class' relationship with its government.  This is not change on the margin.
 
Right now, most Americans that are not enrolled in Medicare (the joint federal-state healthcare program for the elderly) get their medical care through some kind of insurance program.  Most people that are employed pay into an insurance pool of some kind which, in turn, pays for most of their care, including routine, predictable primary care (annual check-ups, pediatrician visits, care of chronic illnesses, etc.).  Others (though far fewer) have traditional "catastrophic care" insurance policies that only cover "one-off" events such as a broken leg or appendicitis.
 
Although the details President Obama's and the Congress' plan are still being nailed down, there is little question that Congressional leaders and Mr. Obama want as much government control of and involvement in healthcare as possible.  The dream --the passion!!-- of the American hard left is to have government-run and -financed healthcare modeled on the UK or France.  When the government gets into the business of providing something as essential and basic as healthcare, the American middle class will have ceded an enormous amount of its income (through taxes) and its autonomy (through allowing government boards and the like to make decisions about what care is available, who gets it, and when), making beggars and supplicants of the heart of the American body politic.
 
Readers of this blog are surely familiar with the arguments for and against welfare states (and, if I wasn't clear above, an Obama victory would be the final step in the United States' journey down that road) so let me make another observation that may be less familiar. 
 
In The Road to Serfdom, F. A. Hayek made the the trenchant observation that, as the power and scope of the state grows, so, too, does the amount that people and interest groups stand to win and lose by winning elections.  Healthcare legislation will pick winners and losers.  Who gets cancer treatment?  People with breast cancer or people with prostate cancer?  Who gets organ transplants?  More to the point, what will the decision making criteria be and who gets to choose them?  When the decider is the government (a single actor, rather than a variety of actors such as many hospitals and physicians) the opportunities for corruption increase and the intensity of partisanship increases, as well.  Higher stakes and a broader scope of authority worsen tendencies that are already innate to government and steadily corrode civil society.
 
Which brings me back to why the media coverage is so misleading.  The stakes are huge...but do not imagine that any one angry outburst, "no" vote, "yes" vote, or promise means much of anything just yet.  Start paying attention after reconciliation, the series of meetings during which the bills passed by the upper and lower houses of Congress are combined into one (a process that makes sausage making look good).  After that one bill is created, there will be a series of procedural votes and then a handful of "yes / no" votes which will determine the American people's relationship with its government. 
 
It's fun to watch the fur fly but what counts is watching the votes.
 
-Publius