As I have argued previously (see here, here, and here), the United States has been shaped by two great organizing models: capitalism and citizenship. Capitalism has provided the U.S. with one of the most dynamic economic engines in the world over the last century and more. Citizenship has made us a shining political beacon, a nation founded on equal rights and democratic self-government. In many ways these systems are complimentary. In other circumstances they provide necessary checks on one another, much as the various branches of the national government are intended to do.
From time to time it is necessary to evaluate whether certain services that might be handled by either model should be placed more firmly in one or the other system. For instance, I believe that our education system is tending a bit too much toward the capitalist model and away from the citizenship model in ways that will be detrimental to the nation in the long run. On the other hand, many state and local governments are experimenting with shifting services to a capitalist model, some of which does seem promising.
For health care, we can easily imagine either model taking precedence: We could adopt a ‘hands off my Medicare’ approach to the health care system and leave it all up to the market to set prices and distribute this scarce commodity. Or we could imagine a national system in which health care is taxpayer funded and distributed on an equal basis regardless of individual ability to pay. What we have know is a poor combination of both. Some parts (like the VA) are taxpayer funded and government run. Other parts (Medicare, Medicaid) are taxpayer funded through reimbursement to private providers. Still others parts are privately funded, usually through employers as the result of a complicated system of regulations, tax incentives, and union victories in the mid- to late-twentieth century. And this doesn’t even get into the complexities of state-by-state regulation, further complicating the balance between the capitalist and citizenship models in health care.
Recognizing that the current system is NOT a pure market system is the first step to realizing that federalizing it isn’t a socialist imposition. It is merely a decision about which of two existing directions to choose going forward. My own conclusion is that we would be better served with a federal, taxpayer-financed health care system.
This is the second post in a series explaining why I favor a national health care system. For the introduction to the series and a list of the posts, click here. Or, for all my health care related posts, see here.