Adam Garfinkle, writing at The American Interest, debunks the egalitarian rhetoric used to promote federalizing health care.
[N]o one seems willing to call what is going on by its real name: class-based triage, or rationing, of medical care.
We can see this more clearly if we put these two data points together: We are slowly (or not-so-slowly) but surely moving toward a much more finely gradated class-based system of healthcare. Compared to where we were before Obamacare passed, the top is moving up and the bottom is moving down faster than ever, leaving a thinner middle where most Americans with employer-provided health insurance have typically been—somewhere in the murk between HMOs and PPOs of various descriptions. Now, those who can afford it will increasingly pay more and get more. Those who cannot afford it will pay less and get less.
Now, there is nothing surprising about this, and it’s what happens in most countries with some form of government-mandated universal health care. There are always private healthcare options in those countries, for people who can afford it, to detour around the public option. But it is not what Obamacare advertised.
Actually they will pay more and get less. When they do pay less, they will be paying more for less services. It may not be obvious to them, but the insurers will have done the math.
The problem is that triage of this sort is inevitable.
The market naturally rations products and services. There’s no way to get around that. Even in a totalitarian state with a planned economy, national health care and price controls, professionals will just go to the most rewarding fields.
And there’s always a class structure. Soviet academics lived much better than their colleagues lower down on the ladder. Meanwhile Soviet medicine was pretty terrible. The smart people were going into research and then not doing any research because the entire system was too far behind to catch up.
The more the system is tampered with, the more the middle, which is a product of the free market collapses, reverting everything back to the 99 percent and 1 percent model that the left pretends we have now. Except it’s really more like a 67%, 9% and 24% model.
ObamaCare forces more doctors to become completely inaccessible to anyone other than the wealthy. The process began with HMOs, that original ingenious plan to solve the health care problem, which instead made it more expensive and less rewarding for doctors to do business. Costs kept going up and so did health care.
This is just one of the final steps on the rung before we end up with no middle ground. This won’t just have an impact on the people in the middle, it will eventually destroy the quality of medicine in general.
There’s only so much room at the top. If the only way to really make money is by treating the rich, that requires far fewer doctors and that means there’s much less room in medicine.
Medical schools will turn out more mediocrities, Third World students who excel at rote memorization but have no interest in patient care, and the top tier of medicine will continue shrinking down. There will be some good people at the top, but their numbers will diminish with each generation.
And then American medicine will die. But you’ll always be able to go and see a Nurse Practitioner for some obesity counseling.
New Yale President Peter Salovey, in his address to incoming freshmen, described his own “modest upbringing”, admitted that there is inequality at Yale, but assured students they will wind up rich and happy anyway.
“You, Class of 2017, bring your different cultures, religions, ethnicities, and sexual orientations to this campus.” [link]
Yale president Peter Salovey delivered an address to incoming freshman about equality and the American dream. He spoke of his own immigrant grandparents and modest upbringing, and encouraged students to be open and open-minded about their own class (“one of the last taboos among Yale students”).
Estimated Yale tuition + room and board + books + personal expenses, according their website, is $60,900 for academic year 2013-2014.
Heartening: “Why did I choose to talk about Yale and the American Dream today? To assure you — especially those of you from families that are not affluent – that the dream is very much alive here at Yale. Ten years after they graduated, members of the Yale Class of 1998 reported impressive — and similar — average salaries and a high level of life satisfaction, regardless of whether they came from families whose standard of living was ‘far below average,’ ‘below average,’ ‘average,’ or ‘above average.’”
Worried about income inequality? Sheila Blair has a cure for the problem. Just make the federal government treat everybody the way it treats big banks.
Are you concerned about growing income inequality in America? Are you resentful of all that wealth concentrated in the 1 percent? I’ve got the perfect solution, a modest proposal that involves just a small adjustment in the Federal Reserve’s easy monetary policy. Best of all, it will mean that none of us have to work for a living anymore.
For several years now, the Fed has been making money available to the financial sector at near-zero interest rates. Big banks and hedge funds, among others, have taken this cheap money and invested it in securities with high yields. This type of profit-making, called the “carry trade,” has been enormously profitable for them.
So why not let everyone participate?
Under my plan, each American household could borrow $10 million from the Fed at zero interest. The more conservative among us can take that money and buy 10-year Treasury bonds. At the current 2 percent annual interest rate, we can pocket a nice $200,000 a year to live on. The more adventuresome can buy 10-year Greek debt at 21 percent, for an annual income of $2.1 million. Or if Greece is a little too risky for you, go with Portugal, at about 12 percent, or $1.2 million dollars a year. (No sense in getting greedy.)
Think of what we can do with all that money. We can pay off our underwater mortgages and replenish our retirement accounts without spending one day schlepping into the office. With a few quick keystrokes, we’ll be golden for the next 10 years.
The reviewer concedes that experience seems to show decisively that Wax’s contention that outside efforts, no matter how well-intentioned, cannot cure poverty is perfectly correct. Booker T. Washington was right all along in arguing that the African American race needed to concentrate its energies on uplifting itself, and that W.E.B. Du Bois was wrong in desiring to confront the rest of America demanding redress and compensation.
Wax is well aware that past discrimination created black-white disparities in education, wealth, and employment. Still, she argues that discrimination today is no longer the “brick wall” obstacle it once was, and that the main problems for poor and working-class blacks today are cultural ones that they alone can fix. Not that they alone should fix—Wax is making no moral argument—but that they alone can fix.
A typical take on race has no room for stories such as this one. In 1987, a rich philanthropist in Philadelphia “adopted” 112 inner-city sixth-graders, most of them from broken homes. He guaranteed them a fully-funded education through college if the kids would refrain from drugs, unwed parenthood, and crime. He even provided tutors, workshops, after-school programs, summer programs, and counselors when trouble arose. Forty-five of the kids never made it through high school. Thirteen years later, of the sixty-seven boys, nineteen were felons; the forty-five girls had sixty-three total children, and more than half had their babies before the age of eighteen. Crucially, this was not surprising: The reason was culture. These children had been nurtured in communities with different norms than those that reign in Scarsdale.
What this means, Wax points out, is that scrupulous recountings of the historical reasons for black problems are of no significant use in finding solutions. She notes:
The black family was far more stable 50 years ago, when conditions for blacks were far worse than they are today. Black out-of-wedlock births started to climb and marriage rates to fall around 1960, long after slavery was abolished and just as the civil rights movement gained momentum. Perhaps a more nuanced explanation for the recent deterioration is that the legacy of slavery made the black family more vulnerable to the cultural subversions of the 1960s. But what does this tell us that is useful today? The answer is: nothing.
One of the most sobering observations made by Wax comes in the form of a disarmingly simple calculus presented first by Isabel Sawhill and Christopher Jencks. If you finish high school and keep a job without having children before marriage, you will almost certainly not be poor. Period. I have repeatedly felt the air go out of the room upon putting this to black audiences. No one of any political stripe can deny it. It is human truth on view.