Slapping the Camel's Nose

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When I wrote the other week about why I am opposed to national health care, a number of people angrily demanded to know why I was writing about something that "no one is proposing".  Now, this is clearly a lunatic statement.  I was writing about something that many people were proposing.  I just wasn't writing about the nebulous bills currently wending their way through various committees.

I hadn't intended to.  I was writing about my deeper opposition to the entire project of providing, paying for, or otherwise guaranteeing health care.  Since for most people on the left, this is akin to declaring that I would like to take up killing orphans in my spare time, I outlined why I think that this is morally correct even if you take the liberal set of initial values, and don't place any moral weight on taxation or other coercive action by the state.  I have voiced my various practical objections to the particular options on the table at various moments.  But the main thing is that I don't want to give the government a greater role in health care markets.  Nay, not even if all the other countries . . . well, all the cool countries, anyway . . . are doing it.  To the liberals proclaiming that, unlike those of us in the conservative or libertarian camps, they are practical people just seeking the best way to make us all better off, I say:  I think your utilitarian calculus is badly wrong.

Now, I felt this was relevant, because in fact, no one I know who is interested in national health care views these bills as the final iteration of American Healthcare 3.0.  Everyone agrees that these bills are very bad, fix few-to-none of the underlying problems with the American healthcare system (cost inflation, the tax break for employer-provided insurance, etc.)  But we have to do this because we can't just do nothing, now.  So we'll do this now, add a whacking great new line-item to the budget, and then fix it later.  The implied fix is things like cost controls on pharmaceuticals, comparative effectiveness treatment to decide which treatments "work" (and by extension, which ones shouldn't be provided), and an ever-expanding role for government treatment mandates.  The goal of everyone, to a first approximation, on the "pro" side of these health care reforms is a European-style system where the government basically runs the whole show.  Maybe they contract out the billing services to insurance companies, which you may choose between (though you can't choose covered services, etc).  Maybe there's a safety valve in the form of a private system that the very affluent can buy into.  But for 95% of the population, the government dictates what treatments are covered, and usually, how much should be paid for them.

I mean, pardon me if I've been totally fooled by all the people saying yes, these bills suck, but they're better than nothing, and they'll open the way for all sorts of government awesomeness later.  But assuming that they aren't funning me, why on earth would I confine my discussion to what's on the table right now?

I think most of the people demanding that I discuss nothing but current legislation understand this very well.  That's because they feel exactly the same way about pro-lifers advocating for bans on partial-birth abortion, various sorts of counseling, waiting periods, and parental consent.

The fact is, leaving aside partial-birth/late-term abortion (I will not here dive into the debates over whether the health of the mother includes mental health, or whether late-term abortions are or are not performed upon women who simply decided they'd rather not have a baby), these restrictions do not strike very many people as unreasonable.  They recognize that outside of the pro-choice movement, most Americans think that having an abortion is a Really Big Deal, and gently discouraging it by asking women to think the thing through is not crazy. 

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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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