April 22, 2009

Dr Pangloss, I Presume

"'I believe in the right of every American to choose the doctor, the hospital, the health plan of his or her choice,' Sen. Jon Kyl, R-Ariz., said before the [Sebelius confirmation] vote." (from a recent AP story).

I'll bet he also believes in Santa Claus and the Tooth Fairy. If there's one thing that the vast majority of Americans don't currently have — and, by design, would never have under most proposed extensions of current schemes — it's any real choice in things like health plans (or even the choice of having any health coverage at all).

There's an absolutely surreal air about American discussions about health care, a mixture of denial and an inability to understand that choices don't have to be as claustrophobically limited as they are here at the moment. Americans by and large seem dead set against medical services rationing, but ruthless rationing is at the heart of the current system (it just happens to be based on your income or financial state or past health record), and few Americans feel it's their duty to pay for any unrationed system. Health care insurance is one of the few things that unequivocally works best with social insurance (as opposed to individual insurance), where risk is spread across as many people as possible, but any mention of the word "social" or "socialised" brings out the pitchforks, and we get the current bizarre situation where you pay insurance for decades, only to be (quite legally) dropped from a plan as soon as you get seriously sick; at which point you face bankruptcy because no other insurance company will insure you. In effect, the current scheme is "insurance until you're sick; pay-as-you-go thereafter…". The worst of all possible worlds, in other words.

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