Shortly before President Trump took office, I made a recommendation for how he could best proceed on a number of issues1. Notably, I did not include healthcare in my proposal. The exclusion of healthcare was not due to my general opposition to multi-issue or ‘omnibus’ legislation2, but rather due to a recognition that healthcare is such a complex and heated issue that it, essentially, must be addressed separately. I am not, however, going to advance a proposal for addressing our numerous and significant healthcare-related issues; undoubtedly, (some of) my colleagues will have already done so by the time this article is published. Instead, I shall be highlighting why all healthcare-related proposals (insofar as they seek to address systemic issues) are doomed to failure. In the interest of presenting more than just ‘doom and gloom’, I will also present a relatively minor (and very short) law that Congress can pass to immediately improve the lives of millions of Americans. Let us proceed.
Any and all proposals to ‘fix’ the American healthcare system are doomed to failure. One need look no further than Britain or Canada3 to see the inevitable future of any national healthcare system in the US. No, I am not advancing some sort of Libertarian claptrap4; rather, I am pointing out a simple, and inescapable, truth:
Demography is destiny.
National healthcare systems work. Let us dispense with any nonsense arguments to the contrary; they are unworthy of our time. The German healthcare system has, more or less, existed for over a century and survived a major depression, two world wars, partition, and reunification. To argue that an American system could not similarly5 survive is baseless. However, national healthcare systems in the Western world are currently under immense strain, and are, in fact, in danger of collapse in some countries. Both the UK and Canada pride themselves on their healthcare systems, but both are in the process of collapsing, and health outcomes will continue to fall. What was promoted as savior has become bane and will, soon, become destruction: In short, immigration is burdening national healthcare systems in the West beyond their ability to cope or to compensate. The collapse is already here.
Many picture a collapse as some sudden event, and that sense is, of course, built into the term as presumption6, but that is not what will happen with healthcare, what is, in fact, already happening with healthcare. Seldom are political or social collapses quick; they are not sudden affairs. We often speak of collapse in political science (and closely related fields), and it almost never fails to give people the wrong sense of things. Human systems virtually never collapse (in the sense of sudden failure); they decay.
For healthcare, the prospects are as simple to predict as they are dire. Healthcare systems can be organized in one of two ways: with insurance or without insurance. Without insurance, each individual pays all costs he incurs. In such a system, each man is gambling that he will not suffer a serious injury or illness. Where there is a serious injury or illness: The rich may pay and thus may survive; whereas the poor cannot pay and thus will almost certainly die. With insurance, each man is hoping that he will not suffer a serious injury or illness, but he may also rest secure in the fact that the insurance system will provide him with care should he require it. We concern ourselves, here, only with the latter system, as the former may always function, though with caveats7.
In an insurance-based healthcare system8, all (ideally) or many (more frequently) pay into a pool of funds. This is a risk pool. We are all liable to serious injury or illness9, and pooling our resources against such an outcome is optimal. However, this system works only so long as an equal or greater amount is paid into the system as it demanded out of it, and not all persons have an equal risk of serious injury or illness10.
Currently, the populations of Western nations are relatively fit and suffer relatively few serious injuries or illnesses; the same cannot be said of the populations being imported into the West. As general fitness declines and instances or serious injury or illness increase, healthcare system will be increasingly taxed. These systems are already overburdened, and demands will only increase in coming decades11. The inevitable decay is already rearing its ugly head. Have you been to an emergency room (particularly in the Southwest) in the last few years? If so, I need say no more. If not, look up the wait times.
Not only are the people flooding across the southern border less fit than the native American population, but they are also bringing in at least dozens of new diseases. In other words, not only are they themselves a burden, but they will also increase demands on the healthcare system from the native population. It is a recipe for utter disaster.
It is due the foregoing, and a number of other reasons, that I assess that any attempt to ‘fix’ the US healthcare system is doomed before it is begun. Without addressing the issue of immigration, there is no solution to many of the healthcare problems we face today. Consequently, I propose no overall solution, for to do so in the absence of immigration reform would be to attempt to teach a dog Latin, a task as thankless as it is pointless.
Of course, we cannot end on this note, as I promised not pure fatalism or doom and gloom, and so I offer the following healthcare-related measure that could significantly (and virtually immediately) improve the lives of millions of Americans12:
Any pharmaceutical company, or company offering products in the pharmaceutical category, operating in the US, or any territory or possession thereof, or which is subject to US law, must offer its products on a most-favored nation basis to US consumers and businesses.
I have been a proponent of this proposal [for some time]. I do not continue to advance it out of some sort of egotism, but rather because I firmly believe it would help millions of my fellow Americans. Many do not realize that US consumers subsidize prescription drug prices in many other parts of the world.13 This law would put an end to such subsidies.14
In summation: Whereas I do not believe that any nationalized15 healthcare system will work for any significant period of time in the US, I do firmly believe that the Federal Government and those Governments of the several States can take more modest steps that will yield considerable benefits for the American population. Other areas that can (and absolutely should) be addressed include drug addiction (particular opiates) and mental health. I believe we should be working on these measures, achieving concrete results, and not busying ourselves with designing systems doomed to failure.
We have problems enough; I suggest we not spend our time devising, designing, and implementing new ones.
- A longer form of that recommendation should appear on my personal blog sometime in the next few weeks. ↩
- I do, in fact, generally advocate for a single-issue requirement for legislation. ↩
- Or Germany, in a decade or two. ↩
- After all, I have more than two brain cells to rub one against the other ↩
- I do not, here, claim that an American system would necessarily be as resilient as the German one. ↩
- Granted, a collapse in this sense can be sudden or complete, and we are certainly gazing into the abyss of the latter. ↩
- e.g., we must interpret “function” in a very liberal sense. ↩
- And we shall include any form of nationalized care under the umbra of this term. ↩
- Though, of course, not in equal degree, and this is central to my overall contention. ↩
- If you read footnotes, this sentence may sound familiar. ↩
- For a number of reasons, chief among them an aging population in the West and the influx of unfit persons. ↩
- And, of course, earn the party that passes it significant political points. ↩
- And not all of them are ‘poor’ nations; for instance, we subsidize Switzerland. ↩
- And it should be noted that such subsidies have been ‘enacted’ in a most disingenuous and deceitful way. Very few people even know that these subsidies exist. ↩
- Or even State-based. ↩