A commentator after the debate last night suggested that McCain's proposed solution to the health care problem would result in a complete dismantling of the American health care system as we know it. My immediate thought, "Is that a bad thing?"
Seriously. Our "health care" "system" is a complete abomination full of half-assed misunderstandings of what it wants to be and how to get there. It can't decide if it wants to be a mandatory tax-payer funded charity or a voluntary free-market insurance program. The result is that it's the worst of both worlds, full of the inflated prices, random inefficiencies, and increased taxes often associated with bureaucracies and the cold, heartless, bottom-line driven uncaring of corporate greed.
On top of all that, because someone "cleverly" figured out that there were a
bunch of advantages to making health care a job-related "benefit" (there are:
collective bargaining advantages and untaxed income at the least), we have a
system which makes it extra-difficult for people who don't earn their income
from a single full-time employer to get any kind of insurance/care plan, and it
pretty much denies people the ability to shop around for the best plan for
their needs (because the choice in many cases is to use the plan your employer
provides or throw away that money and buy another plan on top of it).
Oh, that reminds me of the other idealogical schizophrenia in our current system: insurance vs. care. If it's insurance, then it's paying some amount of money now against the unlikely event of a medical issue you would otherwise be unable to afford to cover. It makes sense for insurance not to cover pre-existing conditions; you're insuring against the unexpected, not the already known, or it's not really insurance. It also makes sense for them not to cover routine care or unnecessary procedures; you should be budgeting for these as well. [And they should be affordable, either because cost is low enough or income is high enough, or there's a major problem there.] Care, on the other hand, is there to take advantage of collective bargaining (and possibly unequal ability-to-pay based payments into a common pool) to ensure everybody who's part of the system has access to some agreed-upon minimum level of care available to them. It's actually more suited to routine care and minor needs than to major issues, and may not be able to deal well with emergency or expensive exotic needs (which one should probably separately insure themselves against). The problem with our system as it exists is that, again, it's a half-assed conglomeration of these two concepts put together, rather than in a way where each fills in for the deficiencies of the other, in a way that each inherits some of the deficiencies of the other (such as the care aspect of a plan not covering pre-existing conditions).
My current stance is that both sides of the ideological argument are right.
Picking either one and going with it would be a drastic improvement over the
crap we're attempting to live with right now. Both have major failures
inherent which are unavoidable. The debates typically consist of each side
pointing out those failures of the other and pretending the failures in their
own system don't exist. There seriously doesn't seem to be any perfect system
to handle this stuff at this scale, but there are systems which are less full of failure than ours.
It's very hard to enact change in a large system, and I rather despair that there's any way to untangle this huge mess and turn it into something reasonable, even if we could sufficiently settle the ideological disagreements underlying it all. It might well be that the only way to get to any system that works is to, in the words of Neal Stephenson, "...just let the damn thing fall over and build a tower that doesn't suck." Although how to keep everybody alive and healthy while we're building the new one is a tough question; not that we're doing such a great job now, but I'd hate for it to get worse just so it can get better. But would it be better to keep seeking local maxima (so never really getting more than a little better) just to avoid the short-term worsening? I couldn't say.