I have avoided the subject mostly because I can't blog about everything - and others are doing it better. For the sake of the regulars though, I will tell you where I plant my flag.
I have seen the European health care systems up close. Notice "systems." That is the key. Each European country has its own system for providing care. Some are run much better than others - and all are accountable on a much more local level. There are a bit more than 5 million Danes. Their health care system is run by Danes - and you are always within an hour's drive of the guy who runs the whole thing.
Move up the scale, and you have 17 million Dutch. You are within 2 hours of the guy(s) house. The Dutch system is very different than the Danish - but even then in a nation like The Netherlands between the size of Maryland and West Virginia and a population between Florida and New York, their "responsive system" is expensive, clunky - and does not have the capabilities of the US system to provide fast service in critical specialties. When your right knee is bone on bone - getting a replacement in 2 months compared to 2 years, if at all - is what you are paying for.
Move up the scale more - and you have 61 million Brits - 62 million French - and 82 million Germans. Each have a different system. Each are accountable to a quasi local group - and generally speaking the larger they get - the less responsive they are, and the fewer options you have. Governments work that way.
The USA has a population well north of 300 million with a population as diverse as North Dakota to Mississippi, Maine to New Mexico. That is the key to the comparison. You cannot compare a system that serves 5 million to one that served 305 million.
The founding fathers - even when they only had 13 to deal with, much less 50, knew that in large nations, centrally dictated governments tend to be at first clunky, at middle inefficient, and at the end oppressive. The beauty of our system was that it allowed each state to experiment - figure out what worked best for them and their citizens. Other states could watch, and then benchmarking their sister states' efforts - improve those systems to meet the stated desires of their citizens. What worked best for Tennessee may or may not work well for Massachusetts. If Oregon's system turned out bad - they could adjust quickly and move on - if its citizens wanted to. The folks in South Carolina didn't care as long as they had a system that worked for their needs.
For those who feed off of power though - they don't like that system. You see, the closer you are to the citizens - as you are in Denmark, Tennessee, The Netherlands, or Massachusetts - the more accountable you are to the unwashed masses, and the harder the path to exercising power.
That is where we are for now. There is hope though. The Founding Fathers saw this tendency in governments throughout history. As a result, they built in checks and balances to let the system self-regulate against the fallen nature of man. Being that the Executive and Legislative Branches have taken this path - there is one hope left to preserve the Constitution - the Judiciary.
The States are planning to bring this to the Supreme Court - as are some private organizations. My hope is with the States - as this is the real fight. All can argue the need or want for government mandated health coverage - but it is hard to find a place in our Constitution that allows the Federal Government to force it. Let the fight go forward there. It will be interesting to watch. With the Executive and Legislative Branches already attacking the Judiciary at the SOTU - the pump is primed for our system of government to check itself in a nasty, noisy way - which is good.
If the States lose and we drift further into a post-Constitutional governement, then we can discuss tactical aspects that will manifest themselves in all sorts of nasty ways to mitigate the destruction of the world's best health care system. First of all, a if not the cost driver the last few decades WRT health has been the excesses of the Trial Lawyers. That has not been addressed in this bill and will not be addressed as long as the Democrats have the power to stop it. Health care costs are high in Europe - and they would be as high as ours if they had the same Trial Lawyer Bar as we have here. Forget all the cost extimates on this - it is much higher.
With that cost shifting to the government - the American public will need to be reminded of something. You voted for a Leftisit government - so you are going to get it good and hard. Taxes are already primed to go up a lot over the next few years. That won't be enough though - there will have to be other ways to get money to, shocker, give all these new goodies to the Baby Boomers in their high health care cost years.
If all is lost - you can at least have some comfort in this. As was well documented in the UK and Canada- once health care is socialized, you can live for 2-4 decades off the fat of the previous system. Care does not fall off the cliff, it just slowly fades like the pastel paint of a beach cottage. After 30-40 years - then it cracks and falls off to the point that even the elite, like Canadian Provincial Premeirs, have to go elsewhere to get their care.
Funny thing that - for the world's elite - those with the money - the USA had always been the place to go when you needed life saving care. For the best medical students - it was the place to practice once you became a Doctor. Well, as we bring our system down to the rest of the world's standard - remember you get what you pay for - then where will they and us go when we need care now - not after a 2-year wait or outright refusal?
Now, even middle class people from Canada and Europe can come to the USA to get treatment if they have the money. Once our superior infrastructure and higher quality care are gone in a few decades - then it will only be the rich that will have that option. Costa Rica is a very nice place, thank you.
They rest of us? Suck it up - you will get the guv'ment you voted for. If you give up your freedom for the promise of "more affordable" health care - you will neither get nor receive either.
Wait - let me do some more generational warfare for you. If history tells up that you can go 30-40 years feeding off the previous system with just slowly declining care before there are significant, unrecoverable cracks that can't be ignored ... what happens in 30-40 years. Oh, that's right - most all the Baby Boomers will be dead.
Let's see. The Boomers are mostly past their prime earning years. The first cohort of Boomers are already retired. They will, by and large, miss the higher taxes. Nice - they will suck the younger generations dry even more - and then leave the nation with a worse health care system than the one they inherited. Of course.
Another note - there are national security issues. We will have four years of taxes before any of the new system takes root - the I would guess another five until we get a better picture of the exploding costs ... that leads us to when Salamander readers - you got it - the "Terrible '20s" and the shipbuilding budget train-wreck.
Opening the aperture though - I think Mark Steyn put it best over at The Corner.
Even though you can expect a fighting retreat in DC - the Democrats have the power to make this happen at the Federal level. The battle moves to the States and the Courts. The Democrats own this monstrosity - so don't let them forget it. Thank your local Republican Representative - and the few Democrats - that voted "no," but you need to shift your efforts to your home state. Get in touch with your Governor, State Attorney General, and State Representative/Delegate/Senator and let them know how you feel and ask them what they plan to do.
Well, it seems to be in the bag now. I try to be a sunny the-glass-is-one-sixteenth-full kinda guy, but it's hard to overestimate the magnitude of what the Democrats have accomplished. Whatever is in the bill is an intermediate stage: As the graph posted earlier shows, the governmentalization of health care will accelerate, private insurers will no longer be free to be "insurers" in any meaningful sense of that term (ie, evaluators of risk), and once that's clear we'll be on the fast track to Obama's desired destination of single payer as a fait accomplis.
If Barack Obama does nothing else in his term in office, this will make him one of the most consequential presidents in history. It's a huge transformative event in Americans' view of themselves and of the role of government. You can say, oh, well, the polls show most people opposed to it, but, if that mattered, the Dems wouldn't be doing what they're doing. Their bet is that it can't be undone, and that over time, as I've been saying for years now, governmentalized health care not only changes the relationship of the citizen to the state but the very character of the people. As I wrote in NR recently, there's plenty of evidence to support that from Britain, Canada, and elsewhere.
More prosaically, it's also unaffordable. That's why one of the first things that middle-rank powers abandon once they go down this road is a global military capability. If you take the view that the U.S. is an imperialist aggressor, congratulations: You can cease worrying. But, if you think that America has been the ultimate guarantor of the post-war global order, it's less cheery. Five years from now, just as in Canada and Europe two generations ago, we'll be getting used to announcements of defense cuts to prop up the unsustainable costs of big government at home. And, as the superpower retrenches, America's enemies will be quick to scent opportunity.
Longer wait times, fewer doctors, more bureaucracy, massive IRS expansion, explosive debt, the end of the Pax Americana, and global Armageddon. Must try to look on the bright side . . .
Virginia seems to be leading - Sic Semper Tyrannis.
UPDATE From a friend in Germany - a view of where you are going, IF, you get a system as good as the German one. Look at the cars - that should give you an idea.
As someone who has lived in Germany as a civilian on the economy for 20 years, let me tell you what you're in for.
Of course, I always get an appointment, and I get very good care. Ah... but even with all that, pre-exisiting conditions are not covered. Enjoy!
- My income is taxed at 52%.
- I pay $8 / gallon for gasoline, most of which is tax.
- 18% VAT on almost everything.
- I pay $1000 / month for my private health insurance policy.
- Whenever I call a new doctor for an appointment, the first question is, "do you have private or government health insurance?"