Back before she became a vice-presidential candidate, Sarah Palin proclaimed a "Healthcare Decisions Day" in Alaska, when Alaskans would be encouraged to discuss end-of-life care with their physicians. Just last month Newt Gingrich wrote an editorial for the Washington Post praising "community-wide advance care planning".They're faking it, of course. It's just another alternative truth; the post-modern politics package is what they do.
But I wondered: what is the special impact of maintaining a system that wastes about a trillion a year, compared to the cost of the same performance elsewhere? Even if there's $80bn of profit in there, surely any system or elite that was even minimally sane couldn't accept something the size of the war-swollen budget deficit going down the toilet every year.
As far as I can see, there are a couple of ideological/aesthetic effects of the healthcare system that may explain (or expalin - freudian!) it. The first one is something which I've noticed thanks to the blogosphere: Americans talk about health insurance the way drug people talk about drugs. Indeed, it's the drugs that vary. It's all about waiting for this, trying to get that, coming up with schemes to get hold of that despite not having such-and-such - a combination of dependency and fascination, on the one hand, and bitter, whining resentment on the other. The system is so complex, and its motivations so mean, that the good ol' fundamental attribution error makes it impossible to avoid imputing will and whim to it; I'm waiting for my man, indeed.
British conservatives tend not to get this bit, the degree of insecurity it provides; they imagine that you pay a bill every month and it just works. This is of course because of the NHS; if your employer stuck to the premiums, you're still covered anyway, and the private healthcare biz is limited in how far it can go in "medical loss management" because of the system's existence.
And insecurity is deeply political - whilst you're desperately trying to score the next month, what aren't you thinking about?
The second: The desperate insufficiency of negative liberty. Another thing which always comes up - sticking to some crappy job to get health insurance. This raises an interesting point. What kind of a huge X-inefficiency must that be? Further, if you believe in liberty, what kind of an infringement of it is this? One of the great achievements of the NHS is that you never need to think about it, or rather, that you can think about it in rational, public terms rather than under constant personal and private insecurity.
This is a crucial point about libertarian ideas of liberty - if, as they usually maintain, we need freedom in order to be creative, innovative, and enterprising, why does this usually get delivered in the form of making it as dangerous as possible to be any of those things? It's almost as if...there was a complete disjuncture between the top layer of ideology and the operational code that makes it all happen!
And thirdly, the flip side of being obsessed with health insurance is being obsessed with health (self, quackery, etc).
No wonder they're so keen.
Which reminds me; while the transatlantic bit of the whole palaver played out, my grandfather was waiting for the results of an NHS case conference as to whether they could carry out a procedure to place a rather special stent at the very top of his throat, in order to re-open it, without the tumour interfering with his breathing. He's over eighty, he's been ill for some time, he's already had several rounds of radiotherapy. And, of course, he's not Stephen Hawking, but an old sailor and former GEC Marconi electronics engineer, an orphan who was a communist from the Depression until he got to know Yugoslavia in 1945. The procedure is complicated; they need the respiratory specialist to be present at the same time.
They provisionally scheduled it for Friday after next.
The NHS is perhaps the definitive creation of democratic socialism in Britain...