The Answer

This is fairly typical of those who would defend or at least seriously contemplate socialized medicine:

I have little direct experience of government work, but both my parents have worked in state and local government (in a state energy office and a city welfare program) and I saw them working hard, being frugal in their work, making a lot happen with a little, accounting for every expense.

No one has ever said . . . OK, no one who’s reasonable has ever said that government employees are evil. My experience has been that ineffecient, nasty and wasteful government employees are rare.

No, the problem is fundamental. We have an education system full of nice, dedicated, hard-working people that is a disaster. A post-office filled with decent people that is incredibly expensive. And a military filled with good people that wastes billions.

Hell, even most Congressmen aren’t bad people. But we’ve got $70 trillion in unfunded liabilities to show that it’s a bad idea to give them too much money and power.

Everyone who encountered a socialized medical system will tell you that the people within are nice. People tend to be when they’re spending other’s money. I’m sure many of the people who ran the Soviet farm program that starved millions to death were just trying to do their best. And I don’t know a public school teacher who doesn’t work her butt off.

No, the problem is not bad people. The problem is that collectivism doesn’t work and never has and never will. We hear excuse-makers using this all the time — the idea that good people will make the system work. And it fails to happen every single time.

My own brief experience in consulting was, by contrast, one of huge amounts of waste: high-priced plane tickets bought at the last minute for no reason other than laziness, luxury hotel rooms, excessive quantities of staff, lavishly paid for by giant corporations and all to give them messages they wouldn’t act on, but needed to have hired in to check a box or cover their asses.

Don’t get me started on consulting. But in many ways, this is precisely the point. One of the biggest problems with health care today is that the consumer is too far removed from the process. Most people have no idea how much their insurance is shelling out. Most people have no idea how much their insurance costs. So decisions on cost are made on the corporate level, not the consumer level.

The solution to this is not to get the consumer further removed from the process.

HMOs — and remember that Hillary in 1993 wanted all of us to be in HMOs — are the worst of all possible worlds. The consumer has no power at all. The business makes all the decisions. And people are forced by their employer to stick with their HMO, no matter how crappy they are. And so the HMO employees get, to quote this reader, luxury hotel rooms and first class tickets, while some poor shmuck with cancer suffers.

All this suggests to me that much of the difference between efficiency and inefficiency, or smart and dumb decisions, in any given sector is cultural, dependent on local group and individual choices, on access and accountability, rather than a necessary structural effect of the profit status of the enterprise.

So the solution is to impose a uniform culture on everyone? We’ve seen what happens when you do that to education (thank you, NCLB). Or farming. Or culture war issues.

With socialized medicine, we will get the worst of all possible worlds. Inefficiency? Medicare wanted us to discharge patients after a breast biopsy and bring them back weeks later for mastectomy, rather than doing both at the same time. Dumb decisions? I will never forget Medicare telling us that removing a bowel obstruction wasn’t medically necessary.

No one is going to claim that a privatized consumer-oriented healthcare system is going to be perfect. But we can’t let the perfect be the enemy of the good. You think healthcare is expensive and inefficient now? You just wait until it’s free.