The U.S. system’s deep flaws make socialism more tempting
By Matt Welch
By now I’m accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care.
To put it plainly, when free marketers warn that Democratic health care initiatives will make us more “like France,” a big part of me says, “I wish.” It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it’s instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.
For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.
What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has “the best health care in the world.”
Don’t even get me started on the Kafkaesque ordeal of switching jobs without taking any time off, yet going uncovered by anything except COBRA for nearly two months even though both employers used the same health insurance provider. That incident alone cost me thousands of dollars I wouldn’t have paid if I had controlled my own insurance policy.
I’ve now reached the age where I will better appreciate the premium skill level of American doctors and their high-quality equipment and techniques. And in a very real way my family has voted with its feet when it comes to choosing between the two countries. One of France’s worst problems is the rigidity and expense that comes with an extensive welfare state.
But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? It’s a question I plan to ask my doctor this Christmas. In French.
(Matt Welch is Reason’s editor in chief.)
By Don McCanne, MD
Reason magazine is a publication of Reason Foundation, a libertarian organization advancing “free minds and free markets.” In this refreshing moment of candor, Reason’s editor in chief, Matt Welch, does not allow libertarian ideology to cloud the truth about the contrasts between our health care system in the United States and France’s system of social insurance.
He has not abandoned his libertarian ideology in that he seems to reject a single payer system for the United States, while suggesting that France’s “socialist system” can “sharpen the arguments for more capitalism at home.” Yet when he describes the superiority of the French system he is describing attributes of social insurance and not free market capitalism. Including these favorable attributes in the U.S. capitalist system would be impossible without significantly expanding the government role in health care.
He states the he opposes “ObamaCare,” yet for what reason? Although he may be wishing that a capitalistic free market in private health plans would accomplish what France’s social insurance program does, he provides evidence of the opposite. His opposition to the current proposal before Congress seems to be for the same reason that we oppose it. It falls far short of the goals of social insurance. It will not be universal, comprehensive, affordable, equitably funded, adequately risk-adjusted, efficiently administered, nor would it apply the principles of social solidarity that make all other systems more efficient and effective than ours.
Under the proposal, most of our health care system remains the same, with little fundamental change in either employer-sponsored coverage or in our public programs such as Medicare and Medicaid. One advantage for those who “can keep the insurance they have” was to have been removal of the cap on yearly medical costs, but even this promise seems to have been abandoned. Although reform will nominally provide coverage for a portion of the uninsured (falling far short of the goal of universality), it will compound the affordability problem for middle-income Americans though inadequate controls on cost escalation, higher taxes, and higher premiums and out-of-pocket expenses (the opposite of what we were promised).
The nation should listen when a prominent libertarian extolls the virtues of social insurance. Once we accept the principle of social insurance, then we can have a more rational debate over whether we want that to be a single-payer Medicare-type program or a European-style social insurance program using using private plans that are so tightly regulated that they almost function as a single payer system. Though PNHP will continue to advocate for the golden standard of a single payer system, that is the debate that we should be having.
Regardless, we need to dump the current proposal and immediately move on with a reform process that will establish a bona fide social insurance program within the United States. Otherwise Matt Welch will have to keep outsourcing his personal medical care to France.