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The time has come, or so it seems. After more than fifty years of trying, it looks like the Democrats will finally enact in the United States what, as they remind us at every opportunity, all other rich nations have: a universal health care system that will provide medical services to all Americans regardless of their ability to pay for them.
Looked at from the 10,000-foot level, it does seem strange that the U.S. is the only industrialized country lacking this. Without exception, all of rich Europe and Asia have made arrangements for their citizens to see a doctor without being turned away on account of empty wallets; other lands don't see people forced into bankruptcy because of an unfortunately expensive medical need. As Timothy Noah wrote in Slate magazine, reviewing a book by T.R. Reid:
Most of the foreign medical professionals and politicians whom Reid interviews are well-aware of this and express horror at the mess the richest nation on earth has made of its health care system. Although no one comes out and says it, one senses that they wonder whether Americans place a lower value than they do on human life. [emphasis added]
That's absurd on its face - as everyone knows and complains about, America spends by far the most on per-person medical care. By that measure, Americans place a higher value on human life than do Europeans. In fact, one could say that Americans value human life twice as much as, say, England, and nearly three times as much as the Japanese - because that's how much more is spent per person on health care.
No, the problem isn't that Americans spend too little on health care. It's not that we spend too much, either. The issue that vexes our domestic left and our foreign critics is that we don't spend the same amount of money on everybody - or at least that we don't guarantee the same medical services to everybody should they need them.
The problem isn't that we value human life less, in general; it's that we don't value each human life as being worth exactly the same.
Which, of course, they are. Aren't they?
A glance at our nation's roads shows an astonishing variety of modes of transport. There are large SUVs and Mercedes limousines; tiny subcompacts and Smart cars; and of course, giant commercial tractor-trailer rigs. Any of these can be found in every condition from brand-spanking-new to rustbuckets shedding parts as they stagger along in a cloud of smoke.
These vehicles differ in reliability and in aesthetic appeal, but also in safety.
A significant reason that Americans love to drive big cars and SUVs, despite environmentalist whinging, is that they perceive them to be safer than small, high-mileage cars. Under most circumstances, it's perfectly true: if you're hit by a big rig, would you rather be in a Suburban or a Smart car?
Some years back, a heavy construction crane on a flatbed truck roaring down a Detroit highway turned out to be a little too tall for an overpass; the crane smashed into the bridge at 70mph, was catapulted from its carrier, and landed on a nearby SUV. The car was crushed, but the passengers escaped uninjured; occupants of a Mini would have been collected in spoons.
Then there's the President. Nothing so prosaic as even the biggest SUV for him, oh no - he tools around in a specially armored Cadillac nicknamed "The Tank," in convoy with hordes of police and Secret Service agents. What are the odds of him getting in a traffic accident? Pretty much nil.
We spend millions of dollars, and shut down city centers, freeways, and airports as needed, all for the goal of keeping one man safe from traffic accidents. Remember how all flights in and out of Los Angeles Airport were delayed while President Clinton had a haircut? Why don't we do that for you, or for everybody?
Let's face it: the lives of Barack Hussein Obama and William Jefferson Clinton are worth more to society than yours and anyone who says otherwise is not thinking straight.
Do we seriously believe, or expect, that the bum in the alley - or even you your own self - is likely to receive the same level of medical care as the President? Of course not.
How about as Bill Gates or Warren Buffett? Nope, not them either.
That's not the way it works in the U.S. - and it's not how it works under socialized health care either: neither England's Queen nor her Prime Minister would ever receive surgery in an operating room containing a dead rat, but the NHS thought the complaints of ordinary patients groundless. Why do you suppose so many Brits and Canadians, who in theory could get medical care at home for free, choose instead to come to the U.S. and pay out of their own pockets?
It's easy to say that everyone's life is worth exactly the same. Under the law, that's the way it ought to be - a rich man who murders a poor one should be punished just the same as when a poor man murders a rich one. But in every other way, people are not equal, nor are they of equal value.
If we're going to be concerned about health care equality, why restrict it to the United States? After all, we already spend more than $6,000 per head on average; the Congo spends but $15! The Congressional Budget Office's analysis of Mr. Obama's health care reform proposal says that it will cost $1 trillion over ten years while reducing the number of uninsured by 17 million; that's a bit less than the $6,000 apiece we already spend.
Dumped into sub-Saharan Africa, with its population of 800 million, the same trillion would give them each $1,250 - still pretty far from equality if we believe all human life is worth the same, but a big improvement on the medical care they get now. Is this what the "health care is a human right" crowd are after? If so, they're being pretty quiet about it; they are being dishonest either to the electorate or to their own principles and arguments.
It's transparently obvious that people do not, as a practical matter, value all lives the same. 3,000 Americans were murdered on 9-11, and we have spend several trillions pursuing the vengeance of the War on Terror with no end in sight. It's reported that the war in Sudan, often called genocidal, has killed between a half-million and a million innocent civilians; is it worth the lives of ten thousand American soldiers to put a stop to it? How about a thousand? A hundred? One? Apparently not.
The religious left has long argued that abortion is not the only issue that should be of concern to Christians; true Christians should care just as much about other areas of social justice, including health care equality. At least with the young, this point seems to have made headway in the last election; they voted overwhelmingly for Mr. Obama, who promoted renewed emphasis on welfare handouts and public provision of health care while defending abortion right up through the point of infanticide. Dean Inserra, a young evangelical, wrote:
Many younger evangelicals are asking if Christians should be willing to accept a lower quality of healthcare if it means people in need could have coverage. [emphasis added]
If an individual is willing to sacrifice their own comfort on behalf of someone else, that's noble. We honor such people as Mother Teresa for just that.
Are you willing, though, to sacrifice your children's health care so the uninsured won't have to pay? How about your mother's care, on behalf of illegal immigrants? If health care equality is the goal, that's precisely the demand: nobody should get better health care than anyone else, which necessarily means yours will get worse.
There are only so many doctors. There are only so many hospital beds. There are only so many pills, crutches, and livers available for transplant.
In theory, it would be possible to end hunger as was done in the US long ago because there is a maximum amount that any single person will eat before saying, "That's enough, I'm stuffed, thanks." There is no maximum consumption for health care - there is always one more test, one more ache or pain that can be looked at.
No matter the wealth or poverty of a society, there is only so much health care to go around. That amount can be increased by spending more on that than on other useful things, which is the choice America has been making for the past half-century. But it can never achieve total coverage of everything anyone could ever want.
The available care has to be rationed and parceled out somehow; the only question is, how and by whom?
If Bill Gates needed a liver transplant, and so did a homeless wino who'd ruined his liver by guzzling rotgut, and there was only one replacement liver available, who should get it? Which one of the two has contributed more to society, in the form of taxes paid, innovations produced, or employment created?
Which of the two is likely to contribute more if given additional years of life? More to the point, who do you want making that decision? Some government bureaucrat? Or the invisible but unbiased hand of the market?
Doctors don't like to talk about it, but the medical community has long acknowledged that care must be rationed and that not everybody deserves or can receive the same level of care at the same time. As we explored earlier, in the event of a flu pandemic the elderly, the sick, and very young won't be treated.
Is this monstrous? No, it's practical: there won't be enough doctors or Tamiflu to go around, and those sorts of people are, on average, more likely to die anyway.
If one vial of Tamiflu can cure three healthy adults with decades left in their lives or one octogenarian with one foot already in the grave, doesn't it make sense to save the three and not the one? Of course we'd rather save all four, but that isn't always possible.
Again, who should make that decision? Trying to deny that the decision need be made by saying all human lives are worth the same is a useless copout.
The fiction that all human lives are worth the same in every way is just that - a fiction. When it's used to drive public policy, that fiction becomes something far worse: a corrosive lie. The young evangelicals mentioned above have put their finger in the key point: to provide free health care for those who don't have as much as they'd like, or as much as other people think they should have, those who now have good care will have to sacrifice it.
Are you willing to tell your neighbor that his daughter's operation must wait so a welfare mom can be treated? What would you say if someone told you that about your daughter? The life of your mother may not be of particular concern to me, but it matters a great deal to you.
Why shouldn't you be allowed to pay whatever you believe it to be worth and obtain whatever care is in your power to get for her - and why should anyone else be forced to do so?
Until someone can come up with a good answer to that question - an answer which is compelling, convincing, and persuasive - the inhuman, impossible goal of health care equality will remain not a dream, but a nightmare of rights denied, destroying both liberty and lives.