Medical reform has been attempted before, and the outcome can be foretold with some accuracy: efforts at reform will fail because any meaningful reform would be financially damaging to powerful vested interests, and so national bankruptcy will have to be an essential part of the work-out. Feelings of the electorate on the matter are irrelevant.And from Rolling Stone:
Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action, while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers.The cynicism bodes ill but is quite justifiable. The gulf between voters and the people supposed to represent us is is wide and growing. We might well be reaching a tipping-point when we all feel it's our right - or duty - to game the system for the benefit of ourselves and our families.
It might be time to look at another way of formulating policy. The current way is obscure, complex and legalistic. It's far too arcane, time-consuming and open to manipulation to serve ordinary people.
Social Policy Bonds could be the answer. A bond regime would target outcomes that are meaningful to all members of society. All activities, research, programmes and initiatives would be devoted to achieving these outcomes at least cost to the taxpayer. Apart from the huge benefit of greater efficiency, Social Policy Bonds would be transparent. If the aim were to subsidise or buy off medical insurance companies, for example, that would have to be openly stated when the redemption terms for the bonds are drafted. Even US lawyers and lobbyists might find it irksome to insert such terms into a list of otherwise socially beneficial policy goals.
What's the alternative? Societies in which extracting whatever one can get away with for oneself and one's family are not pretty. Theordore Dalrymple writes about his experiences in Rhodesia:
The black doctors who earned the same salary as we whites could not achieve the same standard of living for a very simple reason: they had an immense number of social obligations. They were expected to provide for an ever-expanding circle of family members and people from their village, tribe, and province. An income that allowed a white to live like a lord scarcely raised a black above the level of his family. Mere equality of salary, therefore, was quite insufficient to procure for them the standard of living that they saw the whites had and that it was only human nature for them to believe themselves entitled to, on account of the superior talent that had allowed them to raise themselves above their fellows.
These obligations also explain the fact, often disdainfully remarked upon by former colonials, that when Africans moved into the beautiful villas of their former colonial masters, the houses swiftly degenerated into a species of superior, more spacious slum. The degeneration of colonial villas had nothing to do with the intellectual inability of Africans to maintain them. Rather, the fortunate inheritor of such a villa was soon overwhelmed by relatives and others who had a social claim upon him. They brought even their goats with them, and one goat can undo in an afternoon what it has taken decades to establish. Out of Africa, 'The American Conservative', 16 January 2006