Al Gore thinks he's found the solution for what ails his party --north of the 49th parallel. Last week, as part of the tour for his and Tipper's new pair of books, Gore announced to an audience in New York's Upper West Side that he has now "reluctantly" decided that single-payer health care is the way to go.
For non-wonks, ABC's The Note has a pretty good explanation of what that means. "Single payer" it turns out, is one of those euphemisms (like "affirmative action") meant to soothe, confuse and paint opponents in the worst possible light. Under a single payer regime, all money spent on medicine "is collected by some public agency or trust fund, which then pays for comprehensive coverage, delivered privately and publicly, for all citizens." Slate's Mickey Kaus headlined this "policy bombshell," "Gore moves to Canada."
Some have expressed shock over Gore's change of mind but they must not have been paying close attention. Gore was more cautious than the early Clintonites, whose enthusiasm for socialized health care got Newt Gingrich installed as Speaker of the House. However, during the 2000 election, the former vice president made no bones about wanting to expand the role of government in funding and regulating prescription drugs. He even went so far as to expound on the virtues of, yes, Canada's jury-rigged, highly regulated prescription drugs industry.
This frame of mind was not lost on the cast of Saturday Night Live. Near the end of their mock up of the first Bush-Gore match-up -- the infamous "lock box" debate -- Darrell Hammond (as Gore) held up a picture of 94-year-old widow Etta Munsen. This woman, Hammond explained, was a one-kidneyed Tennessean who suffered from "polio, spinal meningitis, lung, liver, and pancreatic cancer, an enlarged heart, diabetes, and a rare form of strychnic acne" and who was paralyzed by several strokes and "an unfortunate shark attack."
With prescription drugs bills of roughly "$113 million a day" ("staggering!"), Etta had to choose some weeks between food and "treating her Lyme Disease." The punch line was pretty good, even by SNL standards: "Now, under my plan, Etta's prescription drugs would be covered. Under my opponent's plan, her house would be burned to the ground. And that is wrong. That is just wrong!"
One hates to explain a joke but the reason that that caricature worked was that it had a counterpart in reality. Gore, like most congressional Democrats, really did believe that the problem with health care is that, without universal coverage, citizens are left to the ravages of cruel fate and/or greedy insurance companies.
To Gore and company, large numbers of uninsured or so-called "under insured" Americans are intolerable. These people are evidence that "the system" -- a somewhat free market in medicine -- has failed and needs to undergo drastic government-ordered repairs in order to meet basic standards of fairness. It is unsurprising that those who think the solution to medicine is more government would think that even more government will make for even better medicine.
Only a fool would argue that the American medical system is perfect, but its own admitted imperfection and incompleteness may be its greatest strength. No, the U.S. doesn't have a single medical system overseen by a national or provincial government. Instead, it has a patchwork of independent medical providers, insurance companies, charities, individuals and government subsidies that serve as an excellent safety net. (Members of my family, for instance, have been "under insured" for a few necessary procedures and the hospitals/doctors have always offered the right mix of discount and delayed repayment to see us through.)
The fairly unrestricted pricing of medical goods and services in the U.S. allows some people to get rich, but its more important contribution is the feedback loop generated by price signals. Procedures, equipment and drug usage are directed much more by the individual than by the state to a degree that occasionally shocks outsiders. In the U.S. you can always get another opinion, and another, and another. In Canada, that's a waste of taxpayer money.
While many Canadians are indeed happy with their health care -- or at least not so unhappy that they protest -- thousands flee across the border every year to receive life-saving medical treatment such as chemotherapy or surgery to remove cancer. Because Canadian medicine is ultimately driven by the government and not the demands of individuals, shortages of workers and materials are common and lead to rationing.
As things stand now, Canadians can crow about their egalitarian system while counting on U.S. health care to bail them out in a pinch. But one wonders where they would go if Al Gore ever became president.
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