One of my biggest problems with the health care debate is that most debaters make a category error when characterizing the problem. Let me explain what I mean by category error: in philosophy one makes a category error when one puts things in a category for which it cannot belong. In the case of health care, the category error being made is assuming that the 'health care problem' is a technical one, subject to a technical answer when in fact, the 'health care problem' is not a problem so much as a condition.
A technical problem typically has one or at most a few answers. For example if I wake up and my room is too hot, the technical problem might be that the thermostat is turned up too high and therefore the solution to the problem is that I go and turn it down. But if I wake up and conclude that the problem is that "the world is too hot", then I have placed my discomfort in a category that precludes my ability to solve it, at least with a technical solution.
Likewise with our health care 'system'. The system that we have has certain attributes, some good some bad. For example our system is expensive and creates access problems for people that don't have health insurance. However, it also delivers the best survival outcomes for people with cancer and heart disease and for most people, offers the greatest access and highest level of care in the world. It also supports most of the world's health innovation.
Choosing another health care system, say for argument sake, the Canadian system, would not 'solve' the health care 'problem'. Instead, it would simply deliver a different set of trade offs than the current one. For example in Canada, there is no problem with equality of access, but if one is seriously ill, there is far less access and poorer outcomes. The Canadian system is quite a bit cheaper than the US, but it also funds virtually no innovation, indeed relies on the US for new technologies. Depending upon your culture, values and circumstances, that might be a trade off worth making - clearly it has been for the Canadians - so long as we live next door, that is. But it would be inaccurate to say that Canada's choice 'solved' their health care 'crisis'.
Because it's not a 'crisis', it's a condition or state of nature that we humans have always struggled with: given limited resources, how to care for the weak and sick in our society? But there are some guidelines (or should be) for how to go about managing a 'condition' rather than solving a 'problem'.
Solving a problem is relatively straightforward: get the best minds in the area together and come up with a solution. If your house is on fire, there's one 'school' solution: get everyone out and then call the fire department. On that almost all experts agree. By contrast, there is no agreement on what type of house one should choose. That choice is governed by geography, culture, religion, economics, family size and other considerations. It would be unreasonable to attempt to dictate a technical solution to the question of what dwelling place you should live in. Consequently wise nations use markets to allocate housing and let the rules for them be defined locally so as to optimize the needs of widely varying local communities.
Health care should be treated the same way: whenever possible, health care funding and usage decisions should be made by individuals operating in markets, because only they can make the complex trade offs of culture, values and economics necessary to make the optimal choice. When the rules of the game need to be set for all, they should be set as locally as possible, to reflect the unique characteristics of those communities.
The benefits of this approach are obvious: first it maximizes consumer choice and freedom, something that Americans value greatly. Second, it enables innovation to flourish. Since we are suffering from a health care 'condition' and not problem, there is no one best answer, but there are likely 'better' answers. These 'better' answers are most likely to be found by consumers and governments experimenting and not by experts dictating a single solution from on high.
This is why there should be no 'national health care plan' in the US: it presumes a solution when there are only trade offs, it excludes much consumer choice and it guarantees that innovation will be stifled by bureaucracy and special interest politics. To make such a choice will be to freeze our dynamic health care system in Amber just as it is preparing to be transformed through biotechnology and health informatics.
A greater tragedy could not befall us. Well has befallen us. Sigh.
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