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Megan McArdle on ObamaCare

John on July 30, 2009 at 9:52 am

She’s agin’ it:

I know, most of you have already figured out why I oppose national health care.  In a nutshell, I hate the poor and want them to die so that all my rich friends can use their bodies as mulch for their diamond ranches.  But y’all keep asking, so here goes the longer explanation.

Basically, for me, it all boils down to public choice theory.  Once we’ve got a comprehensive national health care plan, what are the government’s incentives?  I think they’re bad, for the same reason the TSA is bad.  I’m afraid that instead of Security Theater, we’ll get Health Care Theater, where the government goes to elaborate lengths to convince us that we’re getting the best possible health care, without actually providing it.

That’s not just verbal theatrics.  Agencies like Britain’s NICE are a case in point.  As long as people don’t know that there are cancer treatments they’re not getting, they’re happy.  Once they find out, satisfaction plunges.  But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.

So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure.  Innovation benefits future constituents who aren’t voting now.  Producing it is very expensive.  On the other hand, cutting costs pleases voters this instant.  This is, fundamentally, what cries to “use the government’s negotiating power” with drug companies is about.  Advocates of such a policy spend a lot of time arguing about whether pharmaceutical companies do, or do not, spend too much on marketing.  This is besides the point.  The government is not going to price to some unknowable socially optimal amount of pharma market power.  It is going to price to what the voters want, which is to spend as little as possible right now.

And I just love this line from a bit further on:

The one industry where the government is the sole buyer, defense, does not have an encouraging record of cost-effective, innovative procurement.

But Megan’s second reason for opposing it is even more compelling:

The other major reason that I am against national health care is the increasing license it gives elites to wrap their claws around every aspect of everyone’s life.  Look at the uptick in stories on obesity in the context of health care reform.  Fat people are a problem!  They’re killing themselves, and our budget!  We must stop them!…

Of course, the obese aren’t the only troublesome bunch.  The elderly are also wasting a lot of our hard earned money with their stupid “last six months” end-of-life care.  Eliminating this waste is almost entirely the concern of men under 45 or 50, and women under 25.  On the other hand, that describes a lot of the healthcare bureaucracy, especially in public health.

Once the government gets into the business of providing our health care, the government gets into the business of deciding whose life matters, and how much.  It gets into the business of deciding what we “really” want, where what we really want can never be a second chocolate eclair that might make us a size fourteen and raise the cost of treating us.

She concludes:

The real issue is the effect on future lives, and future freedom.  And in my opinion, they way in overwhelmingly on the side of stopping further government encroachments into health care provision.

At which point, feeling a bit breathless, I’ll just add…I think I’m in love.

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Category: Health & Education |

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