I lived in England for twenty five years and lived with the National Health Service. The argument for the National Health Service was simple: through taxes the state provides basic health care for the whole population. I hear my right wing American friends grumbling about yesterday’s Supreme Court decision and raising their voices about the coming wave of socialism, but I’m not sure everyone has thought it through.
All of us already pay taxes and receive certain services for the whole community which we take advantage of when we need them. Nobody bleats about socialism when they pay taxes to pay for the police, the national guard, the armed forces, the judicial system, the prisons, and fire fighters. Nobody complains too much that we pay taxes and receive education for our children, libraries, museums and city, state and national parks to enjoy. I don’t hear people complaining when they get their social security check in old age or their elderly parents get medicaid and medicare. I don’t see people campaigning to close the food welfare banks or calling for all welfare payments to cease.
The fact of the matter is that we already live in a mixed economy in the US. Our system is part socialistic and part capitalistic. In my opinion this is actually a healthy and civilized solution. Complete and consistent capitalism does not have adequate systems to put in place and maintain proper public services. Complete and consistent socialism quashes enterprise, hard work, initiative and proper reward.
The question therefore is not, “Shall we have government services paid for by taxes?” but “Shall we add a national health service to the existing services the government provides?” My experience of a national health service in Britain was both good and bad. Everybody paid a tax which was called “National Insurance”. Because everyone paid the National Insurance contribution, individual contributions were generally lower than what we pay for health insurance here. Like all insurance plans, because we were healthy we paid more than we used. It’s the same with all insurance plans and taxes. I pay for the fire department, but they’ve never come to my house. It’s part of living in society.
When we needed the National Health Service in England it was there, and although there were grumbles, in my experience the whole thing worked pretty well. The advantages were that everyone had a huge burden of concern lifted from them. Basic health care was available for all. Taxes seemed much higher than in the US, but if an American added his health insurance payments to his tax bill it would be roughly the same.
The problems with the National Health Service, however, are the same problems of Health Care here. The health services are full of dedicated, hard working, honest, caring and giving people. However, the health and insurance industry is also full of corrupt, venal, greedy and lazy people. The National Health Service in Britain is a notoriously over blown and expensive industry. The British NHS is the world’s third largest employer after the Red Army and the Indian National Railway. The bureaucracy is huge. There is a huge amount of waste, graft, kickbacks and inefficiency. Because there is no competition there are insufficient checks and balances in regards to costs and salaries. Critics say it is one huge gravy train.
Furthermore, in my limited personal experience of health care in the USA–for all the bragging we do about how excellent it is, I have found it to be hugely expensive, health insurance to be expensive and getting worse, and the actual care provided to often be poor and at times scandalously poor. My fellow Americans may not like to hear me say it, but on balance I think the National Health Service has the edge.
If I were in charge what would I do? I am personally in favor of a government provided health service just like I’m in favor of other tax funded services which benefit the whole community–rich and poor alike. However, to avoid the overblown bureaucracy why couldn’t we have a health insurance tax which operates on the local level like school districts? Hospitals could still be self governing, but health insurance would be handled through the local government structure. If the health insurance was provided on a local level there would be more local oversight by elected officials who could lose their job if there were corruption and inefficiency. Local officials would be responsible to local voters.
This solution has the advantage of keeping power and responsibility at a local level. It also has the advantage of built in competition–which helps keep costs down and efficiency levels up. So, for example, my local health insurance district would pay for my treatment, but I still get to choose what doctor or hospital I go to. This also has the advantage of taking health insurance out of the hands of the big insurance companies–who are out to make a profit–and put it into the hands of local, elected authorities who are providing a service–not running a business.
With power in the hands of local people they could also decide the important subsidiary issues. The local voters will decide if their health insurance district pays for abortions, sterilizations etc. The local voters would elect officials who would decide whether or not certain treatments would be covered. Local hospitals would also have the freedom to provide certain controversial procedures and policies and let market forces decide whether they do or not.
So write me in for president whydontcha?