Friday, May 12, 2017

Health Care: The View from the Inside

A couple days ago I got an email from a physician, giving me the inside word on the problems of the health care system from his 40 years of experience. He'd read my American Thinker piece, "The Meaning of Kinda-sorta Obamacare Repeal and Replace." His analysis was deep and penetrating.

But who cares? Right now we have a health care system that is riddled with political corruption. I don't mean this in the sense of politicians and crony capitalists milking the system, although I am sure there is plenty of that.

No, I am talking about the bigger issue, the fact that down the years the politicians have offered free stuff to the voters, and the voters have only ever asked: "does that come with sprinkles on top?"

To keep the free stuff coming, the health care system has become horribly distorted, quite apart from the fact that it is administered and regulated by the administrative and regulatory state, which means, according to settled science, that it will be a dysfunctional mess.

And it won't get any better. That's because Rule One of government spending is that the politicians dare not cut spending, ever. President Trump proposed spending cuts of $50 billion (in a $4 trillion budget) and the media couldn't believe it. The end of Meals on Wheels! Oh no!

(I know! Why doesn't George Soros pick up Meals on Wheels. How about it George?)

Or, as my physician emailer put it:
How is this to be done when people become more devoted to free stuff than to the free market?
My line on this is that it all depends on what you are prepared to surrender to. Because you must be willing to surrender to something. That is the basic meaning of social animals and social cooperation.

On my reductive Three Peoples theory there are obviously three ways to surrender.

The People of the Subordinate Self surrender to their liege lord. He could be the village Big Man; he could be the lord of the manor; he could be the local politician. The subordinate worker or peasant surrenders to his lord in exchange for free stuff. Of course, the People of the Subordinate Self are not perfect. They are inclined to resent their lord when he doesn't deliver the free stuff as promised. Sometimes they form a head of rebellion complete with peasants with pitchforks, or they strike their employer.

The People of the Responsible Self surrender to the market. They are saying, in effect, that they agree to serve their fellow men and women by doing something useful for which people are prepared to pay. You can see that this is to aim higher than the People of the Subordinate Self, who just surrender to the local big cheese, and then wait for orders. I do not think we give this surrender option enough credit, for if you ask me it is a noble and selfless thing to abjure violence and the strong arm, and just say that you will accept the verdict of the market on your efforts to wive and thrive in this world. Of course, the People of the Responsible Self are not perfect. They are inclined to look to government for a bit of help when the market goes against them and revalues their contribution to the world downwards. Sometimes they get politicians to give them subsidies, and carve-outs.

The People of the Creative Self surrender to the verdict of history. It is not enough for them just to serve their fellow men and women by being useful. They aim higher than that. They aim to do something original and transformative: in business, in art, in literature, in religion, in politics. It is not enough just to do something useful, it must be special. Of course, the People of the Creative Self are not perfect. They are inclined to force their creations on the rest of us, whether we like it or not, in art, in politics, and the rest. And since the People of the Creative Self are now the ruling class, it means that they use government to force the rest of us to be the chorus of jolly peasants on the stage of their creative projects.

You can see the problem when you apply this theory to health care. The People of the Subordinate Self expect their liege lords to provide for them. The People of the Creative Self have all kinds of creative plans for health care from Health Maintance Organizations (Ted Kennedy's wizard wheeze) to "single payer." So it is only the People of the Responsible Self that are prepared to willingly surrender themselves to whatever the health-care market delivers.

But who cares what we think?

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