From today’s Wall Street Journal, Universal Health Care Makes Politics Sick by Joseph Sternberg:
Britain’s political class knows all too well the perils of a state-run health system. And I don’t mean the abysmal health outcomes the U.K.’s National Health Service delivers—cancer survival rates that lag far behind other European countries with more market-oriented health systems, winter crises, shortages of doctors and nurses, rationing and interminable waiting times.
Rather, it’s worth contemplating the ways state-run health care strangles a country’s politics like a python suffocating a pig. As soon as the government takes on full responsibility for health-care provision, health-care provision becomes political. And given the importance voters quite naturally place on their own health, health-care politics becomes the worst sort: emotionally fraught and inescapable. Consider three of the myriad ways this distorts British political life.
First, no amount of money is ever enough.
Second, when the government runs health care, every political question boils down to health care.
Third, and worst of all for a politician, to be the leader of a government that manages health care is to be personally responsible for every sick patient in the country. Every single one.
Nationalizing health care nationalizes bad outcomes, in every sense. Botched care—deadly cancers gone undetected, births gone wrong, autistic patients fatally mistreated—becomes national news because health care is national policy. Voters then expect to hold their politicians accountable for their doctors’ mistakes. Imagine one big rolling VA scandal coupled with the politicization of every instance of medical malpractice, and you get a flavor of what it’s like to read a British newspaper every morning.
America is a large diversified expanse of 50 semi sovereign states, several with economies larger than most European countries. Our politics are fraught with tradeoffs between national policy and Congressional representatives committed to bring home the bacon. A national will, a political fiction among progressives in America, is much more discernible in the far more homogenous European nations where even there, it rationalizes assaults on individual rights.
Imagine the compromises when 100 Senators and 435 Representatives bargain to get their piece of the health care allocation in an atmosphere where bitter partisanship rules every issue. In other words what seems to work in Europe is not easily transferable to a radically different political and economic environment. And the complete comparative picture is not as clear as we are led to believe. Maybe we spend more on health care because we want to.
If nationalized health care pollutes the politics of Europe it will damage ours much worse.
Secondly, we seek large systemic solutions because our severe partisanship makes the political cost of marginal changes too high. There are problems in our health care system that can be solved without the wholesale usurpation of the entire market, and without radical changes to existing programs. To think that we can centrally manage a complex market with millions of decisions made every day that comprises 17.9% of our economy without enormous adverse consequences is the epitome of Hayek’s fatal conceit.
We have never experienced a significant social program that did not far exceed its cost projections, and these programs were far more modest compared to the size and complexity of managing health care. What has changed that would give any confidence in the poorly thought out projections from the campaign trail?
Health care is one aspect of the cardinal sin of American politics; the desire to promise benefits without paying for them, hiding the costs in a maze of cross subsidies, mandates, proxies, regulations, and legislation. If the voters understood the true costs of nationalized health care it would be soundly rejected.