Monday, November 10, 2008

Why I Oppose Government Health Care

As the father of a special-needs child -- my four-year-old son was born with Spina Bifida, requiring not only wheelchairs and physical therapy, but also considerable urological support (the greatest danger of paraplegia is kidney failure), potential orthopedic surgery, and emergency neurosurgery -- you might expect me to support government health care, at least for those with chronic conditions like my son's. Indeed, all of his health care so far has been paid for by the federal government, both because we have been too poor (as a grad student and a full-time mother) to afford any health insurance at all and because his health care has been extraordinarily expensive.

Readers of this blog will be aware of my general reason for opposing government health insurance: government is wasteful, because it makes prudential decisions far from the facts on the ground, and crooked, because politicians are more interested in looking good in the short term than in doing what's best in the long-term. Government health care would shovel lots of money into the pockets of special interests, while making it harder for the rest of us to get normal care.

Health care, however, is different from other issues, because the body is a more, um, personal concern than say the cost of fuel or even housing. You can ditch a broken car, and even go without; you can change your driving habits or downsize your house. But without health care, you lose your life. When the Founders enumerated life before liberty and the pursuit of happiness among the most central inalienable rights, their point was that without your body, nothing else in politics matters. The right to live is the most precious right of all. And yes, this includes the right to safety -- safety from war and crime -- just as much as the right not to be torn from your mother's womb. (Though when "seamless garment" types claim that war is a life issue too, they should realize that their argument cuts both ways: we are at war to try to prevent ourselves from being slaughtered on our way to work Tuesday morning; we pointed nukes at the USSR, not so we could kill, but as part of a strategy to keep them from nuking us; it did work.)

So securing good health care really is a central concern of government. But how?

A central part of the argument against government health care concerns rationing. In a market system (and we don't exactly have a health care market now, because of massive government intrusion and perverse incentives), rationing happens through price. At some point you say we just can't afford to keep this person going -- or you say that we will have to make other sacrifices, losing the house or working a second job. It is a great myth that government health care would elminate the need for rationing. Government resources are not infinite, and someone needs to decide what care is reasonable. Are we going to pay for nose jobs? Sex changes? Hair implants? Liposuction? If we do, the money -- that is, the resources to pay the doctors and all the people who support them, including the people who build lipo-suckers -- will have to come from somewhere. Government health care means we can coerce Peter to pay for Paul's vasectomy; it doesn't mean that the money comes from nowhere.

And government can use coercion to drive down prices, but if they're paying neurosurgeons less than neurosurgeons want to be payed for the joy of being woken at two in the morning to care for a six-month-old whose brain hardware is broken -- as we woke our neurosurgeon a few years ago -- then we're either going to have to give up neurosurgeons, or coerce them. Do we want a health care system in which our doctors are coerced to care for us?

At least there will be limits to the public's interest in coercion -- limits to how much money we want to pay for other people's new eyelids, limits to how much we want to be coerced to be doctors, or served by coerced doctors. The only other solution is rationing.

What will we ration? My son was born with Spina Bifida, the most common survivable birth defect. In the United States today, 90% of children like him are killed in utero; the same is true of Down's Syndrome kids. A neurosurgeon tells me that in Europe, there is no Spina Bifida: all such children are killed. Now, since these things strike more or less at random -- or at least, they're not caused by people's ideological commitments -- that means that 90% of this country would rather have an abortion than a kid with special needs. 90% of people in the United States -- one of the most pro-life countries in the developed world -- wouldn't even want to put such a child up for adoption. Of course, part of this is medical misinformation: people are not told what joy these kids can be.

But the point is, if we have government healthcare, are we going to find a political majority that is willing to pay for the kind of children that 90% would abort from their own wombs? Spina Bifida and Down's are expensive. If you would kill your own child, are you going to give up your nose job or vasectomy; are you going to choose to have coerced doctors; are you going to accept a tax hike that might keep you from shopping at Whole Foods, so that my son can have a wheelchair, regular urology consults, and emergency neurosurgery?

Maybe we kill these children because of medical misinformation. But is that misinformation going to change if we have government health care? Will there not be an even greater incentive to provide that misinformation, since my nose job -- or my good night's sleep, as a neurosurgeon -- depends on it? Why would my son not be the first one voted off the island?

By contrast, in a decentralized health industry, individuals can make the choice to put up that money. In fact, at present there exists an entire organization, the Shriners, who exist entirely to give health care, with private money, to kids with special needs. (The Shriners are Masons, and that makes me nervous, but that's beside the point.) Would the Shriners survive Obama's tax hikes on "the rich" -- that is, people who can afford to pay for my child's health care? (Their 22 hospitals are paid for by a $10.2 billion endowment; I'm guessing that didn't all come from circus tickets.) Would the Shriners survive a system in which all doctors are in the coercive employ of Uncle Sam -- and Uncle Sam is just a friendly euphemism for Nancy Pelosi?

I bring this up apropos of an article in The Australian. (The Australian, by the way, is the best-selling newspaper in Australia; this is not a kook fringe religious right scandal monger.)

THE Rudd Government is under pressure from all fronts, even Labor colleagues, to overturn a decision denying German doctor Bernhard Moeller permanent residency in Australia because his son Lukas has Down syndrome.

The Immigration Department this week rejected Dr Moeller's application for permanent residency, saying the potential cost to the taxpayer of 13-year-old Lukas's condition was too great.

. . .

"It is sad that in this modern day we are still viewing people with a disability, such as Dr Moeller's son, as a burden," Senator Bernardi said. "They can and do make significant contributions to our society."

More here.

I wonder who will decide whether my son, and children like him, makes a "significant contribution to our society." I wonder who makes that decision in Europe, where such children are not born. I wonder what would happen if the kid's dad wasn't viewed as "productive member of society." I wonder, if it comes down to it, whether American tax payers will choose a tax hike when told that kooky Christians want to bring children into the world with "massive genetic abnormalities." I wonder why they abort those children now.