State Health Care? Choice Is Healthy Too
— My nanny’s son almost died last year. It started with a pain in the boy’s stomach, a light fever. His mother took him to the local government hospital, where treatment was free, but the doctors were overworked and indifferent. They gave the boy some antibiotics and discharged him.
The fever got worse; the pain became acute. I insisted she take him to the private hospital up the road, where doctors performed an ultrasound scan. They found a liver abscess, brought on by a severe amoebic infection. The doctor told me the boy was just a few days from developing sepsis. They kept him in the hospital for two weeks. Treatment was expensive, perhaps more thorough than it needed to be, but the doctors were diligent and attentive. They saved the boy’s life.
I’ve found myself thinking of this episode several times recently, while watching America’s great battle over health care unfold. I’ve had some bad experiences with American insurance companies myself. I find it shocking that almost 50 million people live without insurance in the richest country in the world. I’m a big supporter of universal health care, and of President Barack Obama’s plans to reform the system.
Unlike anyone else I know who supports universal health care as strongly as I do, though, I find myself hesitating when it comes to one crucial aspect of Mr. Obama’s plan — the so-called “public option” that would set up a government entity to compete with private insurers. Over the past few months, I’ve found myself in sometimes heated arguments with friends who otherwise share pretty much my world view. They can’t understand why I would leave patients at the mercy of markets. They don’t understand why I would oppose a role for the state in providing affordable health care.
I think the difference between my friends and me is this: Most of them came of age in the United States in the 1970s and ’80s, a time of market ascendance, during which the role of the state was steadily being rolled back. I grew up during the same period in India — a period marked by government control, when every aspect of the economy and, indeed, of everyday life was subject to bureaucratic whims and political interference.
In ways both big and small, I remain scarred by this period. For me, as for many of my generation in India, government is and always will be, to paraphrase Ronald Reagan, the problem, not the solution.
As far as I’m concerned, it was government, with its centralized economy, its army of bureaucrats and stifling red tape, that condemned India to poverty while its neighbors, the Asian Tigers, embarked on the greatest march to prosperity the world has ever seen.
It was government, defined by Nehru’s infatuation with socialism and central planning — an infatuation nurtured on several trips to the Soviet Union — that tied down industry and innovation, and restricted the country’s economy to what derisively became known as the “Hindu rate of growth” (an anemic 3.5 percent or so).
Throughout my childhood, I remember suffering the indignities, inefficiencies and hassles inflicted by corrupt bureaucrats who held my fate in their dusty files and leaking ink pens.
Government, to me, was the humiliation of having to beg a bank clerk for foreign currency every time my family wanted to travel outside the country. Under the draconian Foreign Exchange Regulation Act, Indians were restricted to only $50 of foreign exchange per international trip.
Government was the sense of marginalization imposed by the state’s import controls and heavy tariffs — measures designed ostensibly to nurture domestic industry, but which I experienced as a feeling of isolation, of being denied the mundane pleasures (music cassettes, peanut butter, olives, cheese, chocolate) that my relatives in the United States took for granted.
Government was the surly service and rickety maintenance of the nation’s only airline, the state-owned Indian Airlines.
It was having to book calls with the monopoly telecommunications provider to my grandparents in the United States hours, or even days, ahead.
It was the shabbiness and occasional food poisoning of the state-run beach resort outside Pondicherry, a well-located property that could have been something special, but that had fallen instead into decrepitude and lassitude, a watering hole for sleazy politicians.
Government made everything difficult. Getting a driver’s license or a telephone line, opening a bank account, enrolling a child in school: All these required multiple trips to some functionary’s office, groveling abjectly while he made his “needs” known.
A friend recently told me about the ordeal he went through to get his father’s death certificate sometime in the 1980s. He had to cajole — and pay — three separate bureaucracies. It was the first (but by no means last) time in his life he had paid a bribe. “Even in death, we couldn’t escape the government,” he said, chuckling.
India is still a bureaucratic nation, but things feel different today — more free, more open, less under the thumb of the state. The country’s market reforms, initiated in the early 1990s, have introduced an element of choice and competition that I never knew as a child.
You can get a phone line in a day now. You can fly a multitude of airlines, all with excellent in-flight service. When you get sick, you can go to a private hospital.
I know, of course, that none of this necessarily means that a government plan in America would be similarly flawed. I know, too, that the private sector has repeatedly proven its rapacity and insufficiency, and it may be that a public plan is the best way to achieve universal care.
But embedded in the debate over health care is really a more general set of ideological disagreements — over the role of government in the economy, and over the balance between the state and markets. These are important issues; it’s facile to dismiss opponents of the public plan as mere tools of industry. Shaped as I am by my experience of a venal and ineffective state, I’m willing at least to listen — if not necessarily concede the point — to them.