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.
This is a true story. It happened exactly as described.
It was around noon on election day, November 6, 2012. I was sitting in McDonalds. A group of old retired men were enthusiastically talking about the election. ...
A couple was waiting in line. They were a typical, mid-forties, white, middle class couple. They were listening to the old guys discussing the election and the state of the union in general.
One of the retired guys said something negative about “Obama-Care” and the middle-class white guy in line turned to him suddenly and said, “Oh yeah, well I’ll have you know that if it wasn’t for Obama’s healthcare plan, I wouldn’t have any health insurance right now.”
This silenced the old guys. He continued, appearing to speak to the room in general, “Obama made it possible for me to cut the cost of my insurance by over 80%, so I voted for him again.”
The entire room was silent. Nobody said a word. Before I knew what I was doing, I heard myself addressing him.
“You actually sound like you’re proud of that”, I said.
“You’re damn right I am,” he replied indignantly.
“In other words, you’re proud of the fact that instead of paying for your health insurance yourself, you and Obama have ganged up on ME and have forced me, at the point of a gun, to pay for part of your health insurance. You’re actually PROUD of the fact that you are mooching off of me and all those people working behind the counter in McDonald’s… that you’re part of a gang that is using the power of the government to FORCE us to pay for your healthcare. Instead of feeling ashamed… instead of bowing your head and cowering in front of all the people you are depending on to pay for your healthcare insurance… instead of meekly thanking them for the sacrifices they are being forced to make in order to benefit YOU… instead, you stand there claiming that you’re PROUD! What do you have to be PROUD of? Are you proud of the fact that you’re unable or unwilling to take care of yourself? Are you proud of the fact that you’re stealing part of their wages for your own personal greed? No… shame is what you should feel. Disgrace… embarassment… and gratitude… along with a strong dose of remorse… because YOU can’t or won’t take care of yourself and so you joined a mob of others who can’t or won’t take care of themselves… and together you’ve figured out how to force US to take care of you. Shame on you.”
Nobody said a word. The guy was stunned and his wife stood there mortified. The room was absolutely silent for a moment, then one of the retired guys started clapping… and within a few seconds, he was joined by another… then by someone across the restaurant… and pretty soon it sounded like the entire restaurant was applauding.
I had delivered my little sermon while still seated at my table. I remained seated and looked down at my meal… angry at myself for having lost my temper and butting in rather than minding my own damn business.
Within a minute or so, the room quieted down again and everyone went about their business, pretending nothing had happenned.
Then I heard the guy quietly say to the McDonald’s counter person, “Can I change my order… I’d like that, to-go please.”
Life in America gets more like living in an Ayn Rand novel every day.
A lot of reactionaries like myself have described Barack Obama as “a socialist,” “a Marxist,” and “a Communist.” How could we possibly have thought that about someone who, in his closing statement at the Second 2012 Presidential Debate, delivered this encomium to Capitalism and Free Enterprize:
I think a lot of this campaign, maybe over the last four years, has been devoted to this notion that I think government creates jobs, that that somehow is the answer.
That’s not what I believe. I believe that the free enterprise system is the greatest engine of prosperity the world’s ever known.
I believe in self-reliance and individual initiative and risk takers being rewarded. But I also believe that everybody should have a fair shot and everybody should do their fair share and everybody should play by the same rules, because that’s how our economy’s grown. That’s how we built the world’s greatest middle class. . . .
This sounds enough like Barry Goldwater to make poor Bill Ayers go out and commit seppuku in Grant Park. But that would assume that Barack Obama was expressing himself with sincerity. In reality, Barack Obama, in his closing statement at that Second Debate, was fraudulently trying to position himself as a mainstream centrist believer in the American system, which he really is not. In the statement above, he is not expressing his real position. He is blowing smoke in an effort to conceal it.
The real Barack Obama is the Barack Obama who tried to revive turn-of-the-last-century Progressivism in a speech delivered lat December in Osawatomie, Kansas:
[T]here’s been a certain crowd in Washington for the last few decades who respond to this economic challenge with the same old tune. The market will take care of everything,” they tell us. If we just cut more regulations and cut more taxes—especially for the wealthy—our economy will grow stronger. Sure, they say, there will be winners and losers. But if the winners do really well, then jobs and prosperity will eventually trickle down to everybody else. And, they argue, even if prosperity doesn’t trickle down, well, that’s the price of liberty.
Now, it’s a simple theory. And we have to admit, it’s one that speaks to our rugged individualism and our healthy skepticism of too much government. That’s in America’s DNA. And that theory fits well on a bumper sticker. (Laughter.) But here’s the problem: It doesn’t work. It has never worked. (Applause.) It didn’t work when it was tried in the decade before the Great Depression. It’s not what led to the incredible postwar booms of the ‘50s and ‘60s. And it didn’t work when we tried it during the last decade. (Applause.) I mean, understand, it’s not as if we haven’t tried this theory. . . .
John Lott noticed the contradiction between exactly the same two Obama statements.
A Yale acquaintance was ranting just the other day on Facebook about the stupid rightwing narrative of success through hard work. College tuition prices have become so high, she said, that no one without means can possibly get ahead. I replied that I had met a fair number of people who had become wealthy and successful through perseverance and hard work, who had never attended an elite university at all. And she got angry, delivered a few ad hominems, and stormed off.
This political ad represents a perfect reply to her nonsense.
How long has it been since you heard somebody politely ask permission to do something (like light a cigarette) and heard the reply: “It’s a free country.” In my own experience, it’s been a long time.
Jerry has an excellent essay, reflecting on how far things have come, and just where America’s wound up.
This is not a nation where people are left alone anymore. This is a nation where they are hounded from the moment they are born until the moment they die by the arms of a regulatory state run by men and women weaned on Cleaver, Alinsky, Fourier, Marx, Wells and countless others. This is a nation where, accordingly, being left alone is the greatest of luxuries. ...
ObamaCare is one of the final declarations that there is no opting out. Even if you don’t drive, own a home, own a business, own a dog, or do one of the infinite things that bring you into mandatory contact with the apparatus of your local, semi-local, trans-local, national or global government, you are committed to a task from maturity to death. Your mission is to obtain health insurance, and, in a system in which you become the ward of the government as soon as you taste air, it is the price that you pay for being alive.
In a free country, you are not obligated to do things simply for the privilege of breathing oxygen north of the Rio Grande and south of Niagara Falls. But this isn’t a free country anymore; this is a country in which you get things for free. And there is a big difference between those two things.
We are a nation in which everyone is entitled to everything, except the right to opt out of all the entitlements and the cost of paying for them. We may not have the Bill of Rights anymore, but we have a hell of a bill to settle and, every year, the deficits keep making it bigger and bigger. Our forefathers passed on to us a Bill of Rights, and we shall pass on to our descendants a Bill. A tremendous Bill which can be unrolled from the mountains to the prairies to the oceans white with foam… and all the way across the ocean to China.
Dan Freedman has some data on the recent French election that most Americans had not realized.
This is from a friend in France:
Hello to my American friends,
As you know, the Socialist François Hollande won the presidential elections in France, last Sunday.
It is a catastrophe for France.
Hollande was elected by the Muslisms:
a survey (of 10,000 Muslims) shows that 93% of the Muslims voted for him.
As 2 million Muslims participated in this election, Hollande got 1,720,000 Muslim votes more than Sarkozy did: (0.93-0.07) x 2,000,000 = 1,720,000
But at the end, in the whole population, he got only 1,139,316 votes more than Sarkozy.
So, without the Muslims’ votes, Sarkozy would have been re-elected.
All the Muslim criminals feel now empowered.
Criminality is already on the rise (1,700 cars were burnt in France for the first night). Muslims are screaming anti-French and anti-Jews watchwords in our streets.
Veiled women, wearing the illegal burqa, are strolling in our streets.
And, as if this wasn’t enough, Hollande wants to give to all the foreigners the right to vote in our elections!!
France will face a very hard situation. We are heading for civil war in a few years.
That’s the last news from occupied France.
The dinosaur is wearing a “PS” (Parti socialiste) pin in his beret.
Tim Blair offers some quotations as commentary on the French election.
P.J. O’Rourke in 2008:
France is a treasure to mankind. French ideas, French beliefs, and French actions form a sort of loadstone for humanity. Because a moral compass needle needs a butt end. Whatever direction France is pointing in—toward Nazi collaboration, Communism, existentialism, Jerry Lewis movies, or President Sarkozy’s personal life—you can go the other way with a clear conscience.
French voters elected François Hollande as president on Sunday, giving the country a Socialist leader who has pledged to shift the burden of hardship to the rich and resolve the protracted euro-zone sovereign-debt crisis by softening the current prescription of austerity.
Time to haul right and stomp welfare. History is our guide.
UPDATE. Iowahawk: “If white people are so smart, then how do you explain Europe?”
Michael Pacher, Der Heilige Wolfgang und der Teufel [St. Wolfgang and the Devil], c. 1473, Alte Pinakothek, Munich
Paul Rahe explains that the American Roman Catholic hierarchy ought not to be surprised to find Barack Obama’s Leviathan state now demanding the surrender of the church’s conscience and soul. They made a deal with Statist Socialism decades ago and ultimately in these kinds of deals payment does come due.
The principle articulated in canon law —the only law common to all of Western Europe… was lifted from the Roman law dealing with the governance of waterways: “Quod omnes tangit,” it read, “ab omnibus tractari debeat: That which touches all should be dealt with by all.” In pagan antiquity, this meant that those upstream could not take all of the water and that those downstream had a say in its allocation. It was this principle that the clergymen who served as royal admnistrators insinuated into the laws of the kingdoms and petty republics of Europe. It was used to justify communal self-government. It was used to justify the calling of parliaments. And it was used to justify the provisions for self-governance contained within the corporate charters issued to cities, boroughs, and, in time, colonies. ...
The quod omnes tangit principle was not the foundation of modern liberty, but it was its antecedent. And had there been no such antecedent, had kings not been hemmed in by the Church and its allies in this fashion, I very much doubt that there ever would have been a regime of limited government. In fact, had there not been a distinction both in theory and in fact between the secular and the spiritual authority, limited government would have been inconceivable.
The Reformation weakened the Church. In Protestant lands, it tended to strengthen the secular power and to promote a monarchical absolutism unknown to the Middle Ages. Lutheranism and Anglicanism were, in effect, Caesaro-Papist. In Catholic lands, it caused the spiritual power to shelter itself behind the secular power and become, in many cases, an appendage of that power. But the Reformation and the religious strife to which it gave rise also posed to the secular power an almost insuperable problem – how to secure peace and domestic tranquility in a world marked by sectarian competition. Limited government – i. e., a government limited in its scope – was the solution ultimately found, and John Locke was its proponent.
In the nascent American republic, this principle was codified in its purest form in the First Amendment to the Constitution. But it had additional ramifications as well – for the government’s scope was limited also in other ways. There were other amendments that made up what we now call the Bill of Rights, and many of the states prefaced their constitutions with bills of rights or added them as appendices. These were all intended to limit the scope of the government. They were all designed to protect the right of individuals to life, liberty, the acquisition and possession of property, and the pursuit of happiness as these individuals understood happiness. Put simply, liberty of conscience was part of a larger package.
This is what the hierarchy of the Roman Catholic Church forgot. In the 1930s, the majority of the bishops, priests, and nuns sold their souls to the devil, and they did so with the best of intentions. In their concern for the suffering of those out of work and destitute, they wholeheartedly embraced the New Deal. They gloried in the fact that Franklin Delano Roosevelt made Frances Perkins – a devout Anglo-Catholic laywoman who belonged to the Episcopalian Church but retreated on occasion to a Catholic convent – Secretary of Labor and the first member of her sex to be awarded a cabinet post. And they welcomed Social Security – which was her handiwork. They did not stop to ponder whether public provision in this regard would subvert the moral principle that children are responsible for the well-being of their parents. They did not stop to consider whether this measure would reduce the incentives for procreation and nourish the temptation to think of sexual intercourse as an indoor sport. They did not stop to think.
In the process, the leaders of the American Catholic Church fell prey to a conceit that had long before ensnared a great many mainstream Protestants in the United States – the notion that public provision is somehow akin to charity – and so they fostered state paternalism and undermined what they professed to teach: that charity is an individual responsibility and that it is appropriate that the laity join together under the leadership of the Church to alleviate the suffering of the poor. In its place, they helped establish the Machiavellian principle that underpins modern liberalism – the notion that it is our Christian duty to confiscate other people’s money and redistribute it.
At every turn in American politics since that time, you will find the hierarchy assisting the Democratic Party and promoting the growth of the administrative entitlements state. At no point have its members evidenced any concern for sustaining limited government and protecting the rights of individuals. It did not cross the minds of these prelates that the liberty of conscience which they had grown to cherish is part of a larger package – that the paternalistic state, which recognizes no legitimate limits on its power and scope, that they had embraced would someday turn on the Church and seek to dictate whom it chose to teach its doctrines and how, more generally, it would conduct its affairs.
I would submit that the bishops, nuns, and priests now screaming bloody murder have gotten what they asked for. The weapon that Barack Obama has directed at the Church was fashioned to a considerable degree by Catholic churchmen. They welcomed Obamacare. They encouraged Senators and Congressmen who professed to be Catholics to vote for it.
After all, whoever heard of religious freedom surviving under Socialism?