The debate about healthcare reform in the United States didn’t begin in 2009. It has been going on for more than 70 years. Although it’s forgotten by most Harry Truman’s Fair Deal included a provision for universal healthcare. That didn’t go much of anywhere and the discussion really began to heat up in the 1960s.
When the debates that culminated in the establishing of Medicaid and Medicare were going on, I supported something quite different, a system of clinics, run by the federal government, that would provide healthcare to needy seniors. Something else that has been forgotten is that before Medicare there were a lot of destitute or near-destitute seniors. I suspect that was a leftover from the Great Depression. Some areas of the country, particularly in the South, didn’t recover for a generation and the seniors of the 1960s had been adults in the 1930s and their lives had been blighted by the Depression.
There was a very simple reason for my preference. The United States had no experience in running a system like Medicare or Medicaid in which tax money was transferred in the billions to private providers but it did have experience in running a much more modest plan which seemed to be working and controlling costs at the same time: the VA system. Also, that plan wouldn’t have the spillover effects that Medicare has and which were obvious from its inception fifty years ago.
Such a system didn’t satisfy the ambitions of the progressives of the time (we called them “liberals” then) who really wanted British National Health. For reasons that have never been clear to me it was anathema to conservatives and libertarians of 50 years ago as well. A system of clinics to provide healthcare to qualifying seniors was “socialized medicine” but the VA hospital system wasn’t? The idea is beyond absurd.
In the 1970s I had the opportunity to live and work in Germany briefly, visiting France, Belgium, and the Netherlands. While there I learned that their systems didn’t lead inevitably to those countries becoming Soviet hellholes as most Americans seemed to believe and many believe still. For decades thereafter I supported a single payer system something on the order of France’s. That got nowhere and when Hillary Clinton bungled her opportunity to reform the U. S. healthcare system the door was once again closed on any sort of U. S. healthcare reform for another 15 years.
Shortly after the Congress began its annual exercise in kicking the can down the road called the “doc fixes” I abandoned my support for a single payer system. I have now concluded that the federal government is simply unwilling and incapable of controlling costs and any system in which costs are not controlled will inevitably collapse of its own weight. The present system, which I still find disrespectful to call “Obamacare”, is no exception. I think it will collapse for all of the reasons its critics have predicted but it’s still early days. By the time it collapses healthcare will comprise about 20% of the economy and the dislocation that collapse will produce is truly awful to consider.
So now I’m in despair. It’s far too late for a modest program capable of addressing the actual problems. Healthcare costs, inflated by Medicare, are simply too high. The U. S. is pretty obviously incapable of running a nationwide single payer system.
I suspect that workable reform must take place at the state level, as is the case in Canada and Australia, which will mean that some states will have state healthcare systems, some will have have state-based single payer systems, and some won’t have either one. Such an outcome is so unacceptable to both political parties that I don’t expect to see our system seriously reformed in my lifetime. The deadweight loss of our healthcare system will continue to grow, stunting economic growth in the other sectors of the economy, for the foreseeable future.