Who Should Pay for What We All Need?

Conservatives are today engaged in a great battle to honor one of their foremost principles, that of minimal government. They assume that government is grossly overgrown.

Let us look at that for a moment. I suspect that most liberals would agree, actually, that there is an optimum size for government. I am unsure what that size is, but I agree that the smallest effective size is a good idea. After all, by definition, anything else is excessive and wasteful. If so, then it’s only the particular size that is debatable, plus one additional little factor.

My personal belief is that it is indeed possible to make government more trim and efficient. I suggest starting by reducing the salary and staff of congresspersons by 25% across the board. Oh, that’s not on the table? Well, I don’t think that we should be thinking about eliminating whole programs and agencies that millions of people depend on.

The larger question, to my way of thinking, revolves around whether the government should assume a duty when doing so is the most cost-efficient and effective way to address a particular need. For example, we have no difficulty accepting that the proper way to address our national need for military defense is within the federal government. (Let’s leave aside for the moment that the military budget is at present more than 80% larger than it was just a decade ago, and has long been grossly overgrown. Let’s note that state militia are not constituted to be the mainstay of defense. And we’ll note that the paranoid weekend-soldier militias that play gun games in the woods because they fear the immanent arrival of the New World Order’s black helicopters and similar stuff, are not a part of the task of national defense.) Yet there are no conservative placards protesting the grossly overgrown budget at the Pentagon, let alone the half dozen wars we’re usually involved in at any given time.

But what about those national needs that are most efficiently and cost-effectively met by national programs? Does the federal government not have an obligation to prevent its citizens from falling into deep poverty when, by themselves, they cannot? Isn’t it better to do something through a government program if it makes people better off and costs less than it would otherwise?

Some would say absolutely not. It is the duty of each citizen to take care of himself. Well, that’s nice in theory, perhaps, but there are many, many cases in which people are simply unable to do that. Some believe that this is because they are lazy, but this is simply not so—which is not the same as saying that there are not lazy, undeserving people. What about people who become ill, and are not only unable to work, but unable to take care of themselves? And there are the mentally ill, many of whom we now see homeless on our streets, now that we’ve honored their right not to be locked up. What about elderly people who have no money and no family to help them? People with no family who have suffered disabling injury?

It is the liberal position that the government must do what it can to ease the suffering of those who are unable to do so for themselves. Not to do so would be to assign them all to the equivalent of the slums of Kolkata, to abject misery and early death. Surely, conservatives must agree that this is not something that should happen in the richest country the world has ever seen.

Then there is this other matter, the current recession. Millions of people are out of work. Many have spent their savings, sold their house and belongings, and have come to the end of their unemployment benefits. Some find themselves facing the stark reality of the street.

Appallingly, there are people who see these unfortunates, clean and well dressed, standing in long lines to look for jobs or claim the unemployment benefits they paid for, and call them lazy and undeserving. What can they be thinking? For most of us, complete destitution is no further away than a serious illness and a lost job.

Where do we draw the line for what we should pay for? There seem to be many conservatives who draw the line very close to them. It is my very strong belief that we as a nation have a moral imperative to prevent the kind of misery I have mentioned above. It is not a liberal/conservative thing. It is a moral imperative.

The real liberal/conservative debate should not be whether we take care of the destitute and ill, but should rest on determining less clear obligations. That’s the additional factor I referred to above. How best to provide for health care is the most obvious of these at the moment. The conservative position is that the government should do nothing, that this is a duty best assumed by the individual and his family.

The problem with this is that we have an enormously inefficient medical system that is more costly than many or most of us can afford, that leaves millions uninsured, and that is considerably more costly than European national systems. Conservatives tend to raise their hands and shriek “eek, socialism” at the first mention of national health care, no doubt envisioning the horrors of Stalin’s USSR. But the best medical systems in the world, the most effective and the most cost-efficient, are those like France and other EU nations have, and they are socialist only in the sense that everybody pays for them because that’s the cheapest and most effective way to get the best health care systems in the world. That’s something they have and we don’t.

Consider also our incidence of medical bankruptcy. Medical bankruptcy occurs when an illness costs more than a person or a family can afford to pay. Sixty percent of American bankruptcies are directly related to medical costs, but there are no medical bankruptcies in countries that have national health care plans. With many lifesaving procedures costing hundreds of thousands of dollars, medical bankruptcy is something that could happen to any of us except the very rich. My suspicion is that the conservatives who make blanket statements about the individual’s responsibility for health care would have second thoughts if they learned that the surgery they must have in order to live will cost a quarter-million dollars that they have no hope of paying.

The fact is, our choice in health care is between a system in which everyone is covered for all costs at a good price, or the present system, which leaves millions uninsured (who we pay for anyway), which costs nearly double what most Europeans pay, and which is notable for what it does not cover.

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