Charles W. Tidd, Jr., Newtown, Conn.: Your column today
continues to avoid a central issue: a great number of Americans do not
trust the government with their health care. This mistrust is not the
result of television ads by insurance companies but follows from
increasingly frequent routine encounters with the government: waiting
for a passport, figuring out the tax law, having an intelligent
conversation with someone at the DMV, listening to the news – Hurricane
Katrina, the federal prosecutors, the pardons by both Clinton and Bush,
immigration. The list goes on and on.
Why in the world do you want to trust the nation’s health care to the government? He who pays the piper calls the tune.
I write you because there is no question that our health system
needs to be fixed, but until the issue of public mistrust of government
is addressed, any sort of universal health care will be shunned by many
Paul Krugman:: Do people really distrust the government? I
think we have this program called Medicare, which most people seem to
like. On the other hand, maybe people don’t know that it’s the
government: former Sen. John Breaux was famously accosted by a
constituent demanding that he not let the government get its hands on
Here is the link.
People like Medicare because it pays some of the bill, while keeping interference in the medical process to an apparent minimum; admittedly non-interference is in part illusory because the indirect effects of Medicare (e.g., it drives up prices) have become enormous. Almost all government payments of this kind are popular, whether or not the programs are a good use of scarce resources. People are looking to get something from their costly government, and not necessarily because they trust it.
As Medicare expenditures rise, this illusion of non-interference will become much harder to maintain and indeed Medicare itself may become less popular. I am always curious to hear — from single-payer proponents — which interest groups they think will have a decisive say over the system, and how those interest groups differ in America vs. Western Europe. That is one reason why we cannot simply replicate the VA approach writ large, or for that matter the French system. For a sobering wake-up call, compare the flood defense policies of the Netherlands to, say, Louisiana.