National Health Care?
Today, we are in the midst of a heated argument over whether or not to nationalize our health care system. Those promoting a national health care system cite reasons like: making health insurance more affordable so everyone can have it, making the insurance industry more competitive, bringing accountability to the health care industry, and saving the country more than a trillion dollars in its second decade. Those against a national health care system cite reasons like: increased costs, rationed care, inflexible care, less competition, less innovation, and poorer care for everyone. So who’s right?
It’s easy to get caught up in arguments over individual proposed advantages and disadvantages. So the answer to the argument over nationalized health care can only come from a better understanding of an important guiding principle, the principle of subsidiarity.
Subsidiary simply means that nothing should be done by a larger organization that can be done as well by a smaller organization. In our political life, that means that we have to ask, ”Which is the lowest level of government that we can assign the responsibility to and still accomplish our goal?”
We use the principle of subsidiary in our daily lives without even thinking about it. For example, we ask others for advice rather than rely on just ourselves for answers to a problem. In this case, a larger organization can better serve us because it can provide us with more and perhaps better ideas. Secondly, a company will ask a group of their employees to form a committee to solve a particular problem. Presumably, the committee will be closer to the problem and have a better insight into a workable solution. In this case, a smaller organization will serve the company better because it’s closer to the problem and it can quickly decide on the best solution.
In our political lives, subsidiarity tells us that national defense has to be the responsibility of the federal government. We know that trying to defend the country at any other level would not only be ineffective, it would also be inefficient. Secondly, subsidiarity tells us that the job of protecting us against crime in the city has to be the responsibility of the city. A lower level of control (say at the neighborhood level) would be difficult to coordinate. The bureaucracy of a higher level of control would try to standardized its response to all crime and, in effect, would undermine its effectiveness.
So how about health care? Who should be responsible for administering it: the federal government, state government, city government, ourselves, someone else? The principle of subsidiarity tells us that the organization with the responsibility should be the smallest group that is able to provide the care. In order to find that level, we need to first identify those organizations that are able to provide the support and then pick the organization at the lowest level.
A quick review of our government indicates that while the federal government could administer it, state governments could also administer it. Governments at lower levels, i.e. city and county, would have a significant problem administering it because they don’t have the same access to new technologies and facilities.
The principle of subsidiary tells us then that the proper level of administration is the state government. But does that make it right? Here are a few common sense reasons why the principle gave us the right answer. First, a government organization that controls both the price of health care and dictates its application, will promote a lack of competition, a lack of innovation, more standardized care, and finally undermine the incentive for doctors to work.
Second, when health care is administered at the state level, there are automatically 50 competitors for doctors and health care workers. Those states with the best health care system will be rewarded with better health care premiums, better hospitals, and better medical staffs. The citizens of the state would be rewarded with better health care.
Third, once health care is administered by the federal government it becomes a benefit that is owed to all of its citizens. When we believe that health care is owed to us, we have less of a reason to prepare for our own care and we become less self-reliant. Also, when we believe that health care is owed to us, we are more likely to over use it, i.e. more drugs than we need, longer and more frequent hospital stays, more emergency room services, unneeded medical equipment, etc.
Fourth, the farther away the sick get from the average person, the less involved the average person becomes with their care. That’s an important concept because the more impersonal our society becomes, the less reason there is for us to care for one another and the system will undermine the moral responsibility we have for each other.
Finally, health care at the federal level carries with it, the worst of the above problems. It undermines our moral responsibility to care for one another, it becomes something that is over used, it undermines our self-reliance, and it stifles both competition and innovation.