If you listen to the congressional debates on health care you will hear the members of the GOP criticizing the plans put forth by the Democrats while offering very few ideas of their own. The Republicans have no idea at all how the country's health care industry should be run, and they know it. That's why they are my guys. All they know, really, is that they haven't a clue. But that's one more thing than the Democrats know, and, actually, may be all they need to know.
Let me explain:
The problem of determining the best, the most efficient, the least expensive and the most humane way to deliver health care to the public is hard -- really, really hard -- and there is nobody in Congress who can do it. That's because the members of Congress are all human and the problem is simply too hard for mere human reason to make much of a dint in it. I suppose, as a theological notion, that God ought to be able to figure it out, but the problem is so difficult that those of weak faith may find it difficult to believe in a being who can solve so knotty a problem -- I mean, divine omniscience is fine as a theory, but surely there are limits...
But until that voice from the sky pipes up and straightens us out we are more or less on our own to figure out what to do. God help us. You should have figured out by now, since I a merely a man, and since I make no claim to have a pipeline to divine wisdom, that I have not the slightest notion what to do about health care -- or more accurately, I do have my opinions (don't we all) but I have no convincing arguments that my opinions are right. I have no plan for health care. But I do have a meta-plan -- a plan about coming up with a plan -- and based on the insight provided by my meta plan I am quite confident that the current administration has it exactly, 180 degrees bass-ackward, wrong.
So here is my meta-plan for health care:
Step one is to give up on the idea that we can figure it out. There isn't going to be any clear, universal, over-arching theory that solves all of our problems. It's not going to happen. We need to get over it. A corollary to this is the realization that all the five-year plans currently being touted for health care are wrong in some important particulars, and many of them are wrong in all particulars. This isn't because the people who formulated the plan are lazy, or stupid, or ignorant, or evil. They have merely taken on a task too difficult for them to accomplish, and their only real fault is a certain lack of intellectual modesty.
Step two is to get more people working on the problem. I'm not talking about a hand full of Czars and blue-ribbon panels here, or even a few thousand politicians or tens of thousands of bureaucrats, what I had in mind was more like, well, everybody. I think we should all run off, willy-nilly in all directions, and look for the best way to manage health care in our own personal lives based on our own individual silly-assed notions of how to go about it.
I admit that result won't be pretty. Since we all have opinions about how the problem should be handled, and since all of our opinions are different, we will find ourselves looking out over a chaotic sea of people doing things that strike us as wrong. And most of them will be wrong (remember that the problem is hard) but some will be less wrong than others and people will notice. After a while clusters will start to form. It is perfectly fair to crib off your next-door neighbor's health care plan. If his plan seems to be working out better than the mess you've made of things then maybe you make your plan look more like his. Maybe you and he and some of your other neighbors team up and pool your resources. Eventually, small pockets of spontaneous order will emerge, but mostly, things will still look pretty much a mess.
While this part of the meta-plan will be characterized as "every man for himself" that's not altogether fair. It's more like every man for himself... and for his family and friends... and for his neighbors, his business associates, and for the people in his care... and when need be for strangers in need who appeal to him directly. But the locus of control would remain with the individual and I would expect him or her to be kind and fair to others.
Finally, step three is the step my more progressive readers have been waiting for -- the step where we harvest the empirical evidence gained by our higgly-piggly experimentation and finally condense it down to a coherent plan. Well, I have some bad news. There is no step three. Step two is all there is. The unfortunate truth is that the messy hodgepodge envisioned in step two is probably the best of all possible worlds -- not perfection, because that is seldom possible -- but the best we are going to ever see.
All the plans for "Universal" health care lose me on the word "Universal." The mess we find ourselves in now stems, in large part, from a near-universal plan for health care that our grandfathers thought up fifty years ago. They devised a targeted plan for big-company wage slaves who worked the same job for forty years, and then retired and were promptly buried with their new gold watch. Using a combination of mandates and tax-incentives they managed to herd a majority of the public into employer-provided health care plans, most of which worked reasonably well until the world changed. Then, with people living longer past retirement, and with people changing jobs more often, what used to be a "one size fits all" plan started to bulge at the seams. But the incentives and mandates associated with the old plan prevented the growth of alternative setups that might have been better suited for the new realities. And here we are.
It perturbs me that people look at our current problem that stems from having too many of our eggs in the same basket and they decide to blame the basket. Most of the plans being pushed call for the creation of a spiffy, modern new basket, and this time making sure we put all of our eggs in it. As if the only problem with the current setup is that, last time, we missed a few eggs.