US Political Scene A right of center view of American politics

The State and Future of U.S. Health Care

Many people support socialistic ideals by an appeal to pathos. Here is a rough prototypical and salient argument: Recently divorced Ann is a middle-aged woman with 3 kids. She has two part-time jobs and no health insurance. She has a medical emergency, which results in massive health care costs. She ends up losing her home and has to move into a friend’s home with her two children who are still at home. She loses so much because of not having health insurance. If only there was a nationalized health care system in place, she would not have lost her home and all of her savings, which were small already.

This or similar experiences seem to be commonly used as arguments for nationalized health care and/or health insurance. However, using an appeal to emotion (a pathos story) is a logical fallacy; it is a weak argument at best and misleading at worst. Sure, it makes you feel badly and it is sad, but should it be the foundation for an argument in support of socialist policies? No. Such a story could be used appropriately and as support for an argument, but it should not be the central theme of an argument. Yet, appeals to pathos in support of nationalized health care are rampant.

Here is an example from Pres. Obama’s most recent address on health care. This is, of course, not his entire speech but this entire selection is nothing more than an appeal to emotion [again, appeals to emotion are okay as long as they do not comprise the bulk of an argument]:

“Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or too expensive to cover.

“We are the only democracy — the only advanced democracy on Earth — the only wealthy nation — that allows such hardship for millions of its people. There are now more than 30 million American citizens who cannot get coverage. In just a two-year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone. But the problem that plagues the health care system is not just a problem for the uninsured. Those who do have insurance have never had less security and stability than they do today.  More and more Americans worry that if you move, lose your job, or change your job, you’ll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care. It happens every day.

“One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn’t reported gallstones that he didn’t even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer had more than doubled in size. That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.”

An additional argument in favor of nationalized health care is that the “U.S. system is broken. Look at Sweden or Canada or any number of other countries that provide health insurance to all their citizens without ‘breaking the bank’. It is unethical for the U.S. to not provide for its citizens [as an aside, ethics have largely replaced morals in our world; instead of talking about what is moral or not we talk about what is ethical or even legal or not].” There are a number of problems with this argument.

1. It assumes that nationalized health insurance is a good solution, or at least better than our current system and that the cost is justified. We do not know that it is better than what we have. Many assume that it will be – or at least that it will be “fairer” – but we cannot really know it will be better unless we implement it. The problem is that it is a really expensive experiment. Additionally, is it really the role of the United States government to provide for the health care of its citizens?
2. It assumes that the U.S. is or should be like other countries. The U.S. Constitution is not the constitution of other countries and what was enumerated as the role of the government in the Constitution is different than in other countries.
3. It ignores that socialized health insurance plans are one of the main reasons of high health care costs! To be accurate, all insurance is socialistic in nature (although historically, insurance has been based on risk – those at higher risk have higher premiums; that is a capitalistic modification of insurance {however, there are many within our country who want to level the playing field and make everyone pay the same amount}). In any case, insurance in and of itself is socialistic (I’m not saying that necessarily as a negative, I’m just pointing out philosophical underpinnings of our health care system). Additionally, most of the insurance plans in the U.S. are company funded. This means that our health care system is not based on free market principles. There are hints and allegations of free market economics but there is little real competition. The health care industry is based on insurance – everything revolves around it. It is also heavily regulated by the government. There is a striking correlation between the cost of health care and the rise of company-paid insurance. As the industry became more dependent on insurance and more regulated, costs increased. Health care costs in recent years have far outpaced inflation. In the free market this would likely result from an increase in demand. As demand increases, prices increase. However, our system is not a free market – it is not capitalistic. Demand has increased, which increase can account for some of the increase in health care costs, but due to the nature of the system, the dramatic rise in health care costs is likely due to governmental intervention and socialistic-type policies, such as employer-paid health insurance (and even insurance in general).  For more on this topic please read David Goldhill’s article in The Atlantic (Goldhill is a Democrat). Governments are notoriously poor at reducing costs.
4. This argument also ignores the fact that most countries who have nationalized health care have recently started to privatize because the governments are finding the model to be unsustainable. If the government run systems work so well, why the need for privatization? The answer is that they are not sustainable, especially not in a world that devalues family and family size (meaning that there is a decreasing number of people supporting an increasing number of people).
5. The demographics of the United States are different from most other countries. The United States has many immigrants. We allow a number of legal immigrants in every year; also at least tens of thousands of illegal immigrants enter each year. Should illegal immigrants be covered by nationalized health insurance? How many other countries with nationalized plans are similarly affected by demographic factors like the U.S. is? [That is not a rhetorical question - I do not know. I could guess that very few are].
6. Is a nationalized plan really sustainable with the aging population? We have more and more older adults due to numerous factors (decreases in infant mortality, better health care, more medicines, and so forth) and fewer younger adults (and not just per capita). People are having smaller families than they used to – the declines in average family size have not been dramatic within the past 100 years but they have been steady. This means we have a decreasing number of workers supporting an increasing number of people. People will be able to work longer – in theory – than they have in the past so this problem may not become as severe as it could be but we also have an increasing number of people with chronic health problems who are not able to work or who can only work part-time. The irony is that socialism, which is ostensibly about “the people” and requires masses of people to function, devalues people and leads to reductions in the number of people, which reduction undermines socialism! Look at the average family size in countries with stronger socialist influence (e.g., much of “Old Europe” or China) compared to the United States.
7. Many health problems are related to unhealthy life choices. Obesity, hypertension, hyperlipidemia, and diabetes are all mainly related to lack of exercise and over-eating (and unhealthy eating). These problems lead to heart problems, higher rates of cancer, long-term disability, higher dementia rates, more strokes, etc. I have seen estimates that greater than 66% of health care spending is for largely preventable problems. Granted, some people have genetic propensities that contribute to these problems but genes only account for a minority of the variance. This means that lifestyle, not genes or biology, is responsible for much of our health care spending. I am not ignoring the fact that other things like corn food subsidies lead to an increase in use of high fructose corn syrup, which is very unhealthy. I am also not ignoring the fact that unhealthy food often is less expensive than healthier food; however, ceteris paribus (i.e., all other things being equal), lifestyle is the greatest contributor to health care costs. This means that in order to reduce health care spending, we have to change our lifestyles! Given that the government is not good at reducing costs (the free {or slightly regulated} market is much better), is it appropriate that “the government” pays for poor lifestyle choices of so many people? Is it appropriate that through socialized health care a person who makes good lifestyle choices be forced to directly subsidize someone who does not? Some may argue that we are already doing that and by nationalizing health care we can further diffuse the costs, which might even reduce costs generally. This may be true in the short-term but it is not sustainable. As mentioned earlier, the government is not good at reducing costs. Costs will continue to rise and in the end, the whole system will be worse than before. Nationalizing health care and insurance does not fix the problems in health care in our country. It is a bit like adding bandaids when what we really need is a transplant. There is an additional problem to diffusing costs in this manner.

Psychologists have shown an interesting phenomenon that people in the presence of others accept less personal responsibility. In the face of need, an individual within a social situation is both less likely to help and slower when he does help. We think someone else will pick up the tab. We think that someone who is more capable will act. The problem is that responsibility is diffused enough that fewer act. This is called the bystander effect or diffusion of responsibility. It has been replicated numerous times (see for example, Darley & Latane’s article Bystander intervention in emergencies in the Journal of Personality and Social Psychology, 1968). Those in larger groups are less likely to help someone in need. Now, any given individual might be likely to help, but based on averages and group studies, those in larger groups (”larger” typically shown to be comprised of 4 or more individuals) are much less likely to help someone in need, even if it is an emergency and the person could be in serious danger. The classic example of this is Kitty Genovese, who was raped and murdered but no one intervened to help her (someone eventually called the police but it was too late). There are many reasons why no one did but the important thing is the research that grew out of this attack and similar ones too. The more people present, the more diffuse our perceived personal responsibility becomes.

Socialism is the same. Because “the government” takes care of the people, why should anyone help another person? Why should we reduce costs by losing weight if someone else is paying for our health care? I’m not saying these are conscious decisions to not accept personal responsibility for actions, it is just that the nature of socialism leads to less personal responsibility. There is no individual in the collective we of socialism. Without at least some focus on the individual (I’m not implying or supporting anything like Ayn Rand’s Objectivism – her extreme humanism of selfishness), there is little to no desire for accepting personal responsibility for actions, in fact, personal responsibility is eschewed. Without this responsibility in health care, costs will continue to skyrocket. Socialist systems are not the solution. Our health care system is already largely socialist (although maybe not what we think of as “typical socialism”) through Medicare and employer-sponsored plans. More socialism will not work, we need less governmental intrusion and more free market enterprise.

Is capitalism better for health care? Maybe. My bias is to say, “Yes” but others will disagree. Are all socialistic ideas bad? No, but they are not necessarily the best answer. Is pure capitalism the best? Likely it is not. I have not addressed most of the philosophies of socialism, instead I have focused mainly on the health care debate, which merely touches one part of economic socialism. There are many other aspects of socialism to which I am opposed, including the devaluation of the family unit and the distrust and denial of religion. I also did not address how socialism interferes with the correct practice of free will, which is a topic for future discussion.

In summary, I believe socialist policies (including lack of competition, government and employer-sponsored health insurance, etc.) are largely responsible for our enormous and growing health care costs. Some may counter by stating that “more socialist” nations have lower health care costs as percents of their GDPs – that may be – but our health care system is anything but capitalistic. As we shift towards socialism, “socialist” nations shift away. Our system is unsustainable as are “more socialist” systems. The solution is not to increase the government’s role in health care but to reduce it by reducing the artificial barriers against free market principles.

I do not have all the answers and maybe I do not have any of the answers, but I do know that socialism is not the best solution. It is a worse solution than what we have now. We need to increase personal responsibility, not take it away even more than it already is by moving in a socialistic direction. If we want to fix our health care system, we need to encourage healthy behaviors. I will not suggest how we might do that – that is a post by itself – but it will go a long way in reducing our health care costs. Further, increasing dependence on the government to solve our problems reduces our dependence on ourselves, our families, our friends, our neighbors, and our communities.

Please comment to add suggestions or correct any errors I might have in my post. I welcome and respect all viewpoints as long as comments remain civil.