Sullivan dismisses public healthcare.
One reason I’m a conservative is the British National Health Service. Until you have lived under socialism, it sounds like a great idea. It isn’t misery – although watching my parents go through the system lately has been nerve-wracking – but there is a basic assumption. The government collective decides everything. You, the individual patient, and you, the individual doctor, are the least of their concerns. I prefer freedom and the market to rationalism and the collective. That’s why I live here.
When Ezra points out that the British love their system, Sullivan creates an elaborate mental construct to avoid the obvious.
Satisfaction is a subjective function of subjective expectations. If you have the kind of expectations that many Brits have for their healthcare system, it is not hard to feel satisfied. The Brits are very happy with their dentists as well. And there is a cultural aspect here – Brits simply believe suffering is an important part of life, especially through ill health. Going to the doctor is often viewed as a moral failure, a sign of weakness. This is a cultural function of decades of conditioning that success is morally problematic and that translating that success into better health is morally inexcusable.
Yes, clearly the masochistic British spirit explains why they prefer a system that costs less, covers every citizen and outperforms America in important metrics such as infant mortality.
Now for some aimless noodling.
But if most Americans with insurance had to live under the NHS for a day, there would be a revolution. It was one of my first epiphanies about most Americans: they believe in demanding and expecting the best from healthcare, not enduring and surviving the worst, because it is their collective obligation. Ah, I thought. This is how free people think and act. Which, for much of the left, is, of course, the problem.
Accuse me of shooting barrel fish all you want, this argument deserves to be deconstructed. Sullivan, for example, does not demand the best from his healthcare. The Atlantic Monthly does that. It is not unfair to point out that Sullivan would not be nearly so sanguine about American healthcare if he had to compete on the individual market like the other half of America does. It is also not unfair to point out that with a pre-existing condition, Sullivan would not get individual insurance at any price if he did not live in a liberal nanny state like Massachussetts. There is no particular stigma in that; I have a preexisting condition. Given the term’s ever-expanding definition (and the ulcer-causing specter of medical bankruptcy) half of America has one by now.
That is not to say that Sullivan does not have a point. Palin-like, we could define America as people who live in Massachussetts and/or pay into generous employer-provided group plans. In that case American healthcare is indeed stellar. True ‘muricans demand the best and Adam Smith’s benevolent hand graciously delivers it to them. Awesome! Naturally non-American Americans can also ‘demand’ great healthcare if that makes them happy. Those kind of people also enjoy ‘demanding’ a tasty zero-calorie beer and intelligent programing on FOX News. Whatever noise comes out of the wind hole, Adam Smith will bitch-slap not-quite-as-real Americans with denials, spiteful rationing and murder by spreadsheet.
On the other hand, if you consider all legal US residents equally American then Sullivan’s argument is just fucking stupid.