American Consequences - September 2018


crowd out almost all other forms of social welfare or indeed, goods and services of any kind, and soon after, lead to bankruptcy. President Eisenhower warned of the military- industrial complex. But today, health care spending is more than five times the entire U.S. defense budget. It is a far greater fiscal danger to our country. And the health care industry will not surrender lightly... So-called “special interest groups” like health care providers, insurers, and pharmaceutical companies are likely to rouse enough popular support to derail any attempts to muzzle the current vast machine for the transfer of wealth to the health care sector. Spending on political lobbying by health care providers, insurers, and product manufacturers as a group far outpaced any other industry by $7.5 billion, a factor of more than three times from 1998 to 2017, according to Open Secrets .

To quote George Bernard Shaw: Nobody supposes that doctors are less virtuous than judges; but a judge whose salary and reputation depended on whether the verdict was for plaintiff or defendant, prosecutor or prisoner, would be as little trusted as a general in the pay of the enemy. Surgeons are paid to operate, so where does their natural incentive lie? American health care finds itself at a crossroads... Mere tinkering will no longer work and basic assumptions must change. Part of our cultural heritage seems to be an unbridled optimism in expanding frontiers, yet we can no longer predicate our national health care policy (if such a thing truly exists) on the expectation of and demand for unlimited medical progress, maximum choice, perfect health outcomes, and rising profits and income. A monochrome standard of care such as in single-provider, socialized-medicine countries is unlikely to solve or service the needs and demands of our diverse populace. Accepting this as the norm would not only radically alter the way that we think of health care, but also the way that we think of ourselves as Americans. We have come to think of health care as a right, and to the finest available as no less so. Extreme economic measures or even violence are not difficult to imagine from citizens denied access to privileges and benefits they formerly enjoyed. Yet extending the highest standard of care that our society is capable of providing would

Mere tinkering will no longer work and basic assumptions must change.

I am reminded of a scene from Hemingway’s The Sun Also Rises , in which a character is asked “How did you go broke?” and he replies, in “Two ways, gradually and then suddenly.” It doesn’t take a PhD in actuarial science to figure that we are heading for a demographic time bomb. By 2050 there will be more people over the age of 80 than under the age of five. If the U.S. nationalized the health care

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