Explaining the health care debate

Every time I try to explain the health care debate to Dutch people I am faced with the same wrinkled-brow, gaping-mouth, puzzled expression that the Japanese president’s wife, Miyuki Hatoyama, must confront when she starts talking about her latest jaunt to Venus.

a box of kleenex, a cup of tea with lemon juice and honey, and cough drops
Cold treatment chez moi

The whole debate is simply unfathomable to the average Dutchman. Or perhaps I should say to any Dutchman. Why would anyone oppose improving a system that at the moment doesn’t provide for everybody?

The more I think about it, the more I realize that the health care debate encapsulates the uniqueness of America as a whole, which I think can be summarized in a few basic precepts:

1. Americans believe in self-reliance, and in getting ahead through hard work.

The Dutch believe in hard work as well, based on their Calvinistic origins, in which hard work and frugality are rewarded in heaven. But, of course, that’s where the difference lies. Americans believe that the hard work that they do should pay off in getting ahead in this life.

Not only that: once you get ahead, you have a God-given right to enjoy the fruits of that labour in whatever way you want. The Dutch frown on showing off your own wealth, and – somewhere deep inside – frown even on wanting any more than just barely enough.

Once Americans have “made it” – or their families have done it for them – they see absolutely no reason why they should have to share that wealth with others. This is not to say that they don’t share their wealth with others: they do. Americans are remarkably generous. Most Americans donate to charities or volunteer their time in some way.

The difference is that sharing the wealth in this way is voluntary. They feel the right to choose whether and how and how much to share. Which leads to basic principle #2:

2. Americans have a deep distrust of government.

This traces all the way back to colonial America, when the British king imposed taxes on the colonists without their having any say in the matter. Despite the fact that most Americans’ ancestors immigrated much later than that, this distrust endures. Any move to raise taxes in any way for any reason is actively opposed by most Americans. They pay far less in taxes than western Europeans do, but still complain that it’s too much. The general assumption is that the government will screw it up in some way or another: there will be waste, fraud, misappropriation of funds, whether intentional or not. It’s simply better not to give the government any more money than absolutely necessary because it will, by definition, be wasted.

It’s not just about taxes. Americans fight any change that gives the government any additional power. Again, this has to do with colonial America. The colonists felt themselves to be full-fledged British citizens, but were treated as inferior by the king. Today they are true believers in the idea that “power corrupts, and absolute power corrupts absolutely.” Bureaucrats, given power, will, almost by definition, abuse that power, and, once they’ve increased their power, they will never willingly give it up again. Americans believe they must always be on the watch for such abuses.

This also explains their visceral response to any hint of socialism or communism. Just using the term “socialized medicine” to describe the health plan is enough to give Americans a bad taste in their mouths. Where socialism to Europeans is a respectable political orientation – I’ve had students politely launch into detailed explanations of exactly what socialism is, as if that would change that instinctive disgust – in America it reeks of government dictatorship a la Stalin. Which, of course, relates to principle #3:

3. Americans believe in freedom.

Obviously, most of us believe in freedom. But to Americans, this is no mere abstract concept. Freedom is a very real and concrete ability to make our own decisions about our lives. That includes choosing to work, choosing not to work, choosing to pay for health insurance, and choosing not to pay for health insurance.

However, if a person takes advantage of that freedom and chooses not to go out and get a job, then that’s his own fault. We have the freedom to choose how to spend our own money, and we would find it a violation of our freedom to have to support someone who’s chosen not to work.

Likewise for health insurance: if Joe Shmoe decides not to pay for health insurance and instead invests in Hatoyama’s return mission to Venus, he’s expressing his own view of freedom. But I have the freedom not to have my tax dollars subsidizing his health insurance because he’s been too stupid to arrange it for himself.

Which takes us back to principle #1: self-reliance. People are expected to make something of their own lives. They are expected not to ask for help from others. If help is offered, fine. But don’t ask for it and don’t expect it. Joe Shmoe, who’s too short-sighted to pay for health insurance, should just suffer in silence, not expect or ask for the rest of us to bail him out.

4. Americans are firmly convinced that capitalism is the best system.

This last principle is closely related to principle #1 as well. In a capitalist system, Americans believe, the person who works hardest and is the cleverest in offering products or services will be successful. Thus, the health care system will work best if it is left to the free market. Competition between service providers, whether they be doctors or insurance companies, will keep downward pressure on prices. Where Dutch people would argue that a government-run system can impose price controls, Americans see only an inefficient, competition-stifling bureaucracy which will surely raise costs in the long run (See principle #2).

So opposition to the health care plan exemplifies the American mindset. Self-reliance and hard work mean you should earn money to pay for your insurance by working hard. If you don’t, it’s your own stupid fault. The government should not offer health insurance because it’s sure to screw it up with bureaucratic meddling and incompetence, and it will only raise our taxes to pay for that incompetence.

In addition, that growing health care bureaucracy will gradually grow in size and power, and will limit our freedoms one way or another: by dictating what illnesses are covered, what doctors we can see, or whatever other limitations the bureaucrats can come up with. A system based on competition, closely resembling the existing system in the US, will work far better.

It’s impressive how such basic, essentially positive principles can, to us, on this side of the pond, look so cynical and pessimistic. It seems to me that both those for the health care plan and those against it essentially agree on these principles. The only difference is of degree, i.e. how much self-reliance do we demand of people, how much do we distrust government, and so on. And if it’s just a difference of degree, isn’t there a middle ground?

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