The BHCSITW

One of the many disconnects in the ongoing health care debate (which is by no means over) lies between the Republican mantra that Democrats are destroying the Best Health Care System in the World and the prevailing view of the medical community. This view holds that the BHCSITW, although capable of providing world-class care, has nonetheless devolved into a ramshackle Frankenstein cum Rube Goldberg machine in a state of near collapse. According to this view, the BHCSITW

• relies on an insurance business that opens the system to the healthy and closes it to the sick, resulting in an ever increasing number of uninsured without access to care;
• shifts the cost burden onto patients and providers;
• rations care by denying coverage, limiting coverage, delaying payment, and establishing caps;
• is inefficient and burdened with administrative costs;
• shortsightedly discourages preventative care, creating long-term health problems and costs in interests of of short-term profit;
• discourages competition;
• prevents consumer knowledge and choice;
• discourages the tracking, recording, and dissemination of information about outcomes;
• impedes providers and patients from acting on such information in the few instances that it exists.

Now, I get that the Sarah Palins and Jim Demints and Cosgray families buy into the BHCSIW drivel. I even understand how a reactionary doctor like Tom Coburn could sincerely believe that it all comes down to physician compensation (even if he is being narrow, shortsighted, and inconsiderate of his patients). But intelligent politicians such as Eric Cantor, Mitch McConnell, and Olympia Snowe must know better.

One can only conclude that they are cynical, craven, and/or laboring under the illusion that the BHCSIW would be the BHCSIW if only they could Get Government Out of Health Care (GTGOOHC). But what does that mean? Literally, GTGOOHC means:

• repealing the Affordable Care Act
• privatizing Medicare/Medicaid
• privatizing the Veterans Administration
• ending the employer/employee tax exemption on health care expenses
• defunding the Center for Disease Control, the National Institute of Health, the Food and Drug Administration, and the Bureau of Alcohol, Tobacco, and Firearms
• curtailing or ending clean air and water regulations

One could argue that GTGOOHC goes so far as eliminating the 55-mph speed limit, removing warning labels from cigarette packaging, and no longer requiring cars to have seat belts. It sounds extreme, but I'm describing a classic libertarian position, and at least one classic libertarian is favored to become the next U. S. Senator from Kentucky.

Given that list, GTGOOHC is about as likely to happen in this country as a single payer system: There are too many special interests invested in the status quo to permit such a radical change, nor would the electorate stand for it. Instead we'll lumber along with the Only Health Care That Can Be Squeezed Out Of Our Broken Political System After Seventy-five Years Of Straining & Groaning (OHCTCBOOOBPSASYS&G).

In any case, the when the rightist politicians talk loftily of GTGOOHC, it's just that: Cheap talk. They don't have the guts to explain what it really means, nor do they have the evidence to make a serious case for it. Unless you count sloganeering and quotes from Ayn Rand as evidence...

John Galt Sez...

On my way into the bank this afternoon, I walked past a van with two bumper stickers. One read "Don't Tread On Me" and featured the familiar serpent. The other said

I swear by my life and my love of it, that I will never live for the sake of another man, nor ask another man to live for mine. -John Galt

My initial thought was to wonder what kind of fantasy world people like this live in, and I'm still wondering that.

In the first place, there is not and never has been a John Galt who swore on life, love, God, or anything else. He's a fiction -- a character in a novel who never actually risked anything, sacrificed anything, or did anything at all. He's an invention of Ayn Rand, a woman whose psychological well-being depended on acolytes who sat at her feet and nodded solemnly at every banal pronouncement she made.

Anyway, I wanted to tell the owner of this car, you live in something called a society, which by its very nature implies mutual interdependence. For example, you're depending on me not to punch you in the face because I don't like your stupid bumper sticker, and should I give you a right cross, you're dependent on societal good will to sanction me.

That van you're driving? It's safe because another man fought for safety standards.

Remember that first house you bought? In all likelihood, you purchased it through a government-sponsored lending program that limited your down payment, put a ceiling on your closing costs, and made a favorable interest rate available -- all enabling you to buy a better home in a nicer neighborhood than you would have otherwise.

Every day, poor people pay for the lifestyle you enjoy.

Do you have health insurance? Your co-payments are subsidized by the uninsured. Those nice suburban hospitals? You get to use them because health care is a zero-sum game, and the suburbs have modern, up-to-date facilities in part because inner city hospitals are falling apart.

Those clothes you're wearing? You couldn't afford them unless they were made by underpaid, exploited workers in a Chinese factory.

Same with the produce you eat: All harvested by underpaid, exploited migrant workers.

You like drinking and bathing in clean water? What about eating safe food? Or sleeping soundly at night? Other men and women serving as police officers, soldiers, and sailors protect you. What about your Constitutional rights? People have died so that you can fire your penis pistol at the local shooting range.

Do the world a favor: Grow up and stop the Nathan Hale wannabe thing. It's really quite pathetic.