There are some things democracy, specifically Congress, doesn't handle well: monetary policy (so we gave it to the Federal Reserve Board), weapons procurement (does Congress know better than DOD which weapons are needed?) and healthcare.
Healthcare has to be rationed or a country goes broke. Cuba, Canada, the U.K. ration it by not funding all the doctors or procedures citizens want when they want them. Congress is unable to ration healthcare. Congress could never create a healthcare plan that denied a liver transplant to a 70 year old for whom the transplant would buy a year of life in favor of giving it to a 20 year old for whom it would buy 20 years. In our democracy, a government healthcare system would give them both liver transplants--and we'd go broke.
If Congress is going to provide healthcare for folks who aren't getting it, they have two choices: 1) set up and independent, unelected body to ration it, or 2) come at it the other direction: give away procedures and meds we can afford to fund, and that will make the biggest improvement in community health. E.g., it couldn't cost much and would be a huge savings in later healthcare costs, if we just gave away for free high-blood pressure meds, insulin, prenatal checkups, birth control, flu shots, childhood vaccinations, some orthodontics, a few free doctor visits per year.
So every year, Congress would vote on how much the taxpayers could afford to improve public health--and avoid later public health deterioration and costs. Then the many federal, state, and county health departments would figure out what 'low-hanging fruit' would make the biggest impact.
It doesn't make any sense to make HBP meds and insulin available only to those who can afford them--the cost of going without is enormous. It doesn't make sense for a person to forego a flu shot because they can't afford it, then go to work (because they can't afford not to) and infect ten other people. It doesn't make sense to let a person develop TMJ or lose teeth as an adult when a little orthodontics as a child would've prevented those.
Another option for Congress that doesn't require making those impossible rationing choices: loan tuition, room and board expenses for more med school students. Graduate M.D.'s can repay the loans by working at modest-salary jobs in government clinics.
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Kerry Lauerman
Joan Walsh
Salon.com
Comments
Other democracies somehow manage to ration and limit their costs.
but other countries with parliamentary oligarchy manage much better than the usa. i think it's the slavery heritage, there is a rage in the national character against the poor, especially if brown. certainly the poor are an 'out' group in my country tis of thee, like the gypsies and jews were in europe before the hitler regime tried to 'fix' it.
this is characterized succinctly by the notion of calling people 'losers' if they work for a wage, 'winners', if they game the stock market. in civilized societies, they are called citizens and crooks, respectively.
Al, I keep saying (FWIW) that "parliamentary oligarchy" is better than the American system - parliaments get things done (at least when there's not too many parties and one party can get power), whereas with your system, every congress person and rep goes his or her own way, no party loyalty (or enforced discipline), and also they're open to bribery and lobbying...