Why America Hates Universal Health Care: The Real Reason

[I originally published this essay in December of last year, before I started blogging for PJM. I was planning to write a new last-minute plea for sanity as we approach the zero hour for the health care vote in Congress -- but I inevitably ended up just re-phrasing the ideas contained in my original essay. So rather than repeat myself, I present below a reprise of what many have said is the one and only essay you'll ever need to read about universal health care.]


I watch the debate over health care with amazement. A million words are spoken on the topic with every passing minute, and as far as I can tell no one has ever addressed the real issue that's upsetting everyone.

So, rather than wait in vain for someone else to finally speak the honest truth about the single-payer system, I'll just have to do it myself.

Let's Get Blunt

America should listen to Dr. Earl Sunderhaus. ASAP. Because he holds the key to the health-care debate.

Who? you might ask. Never heard of him.

    Dr. Earl Sunderhaus
I hadn't heard of him either until I saw a brief article last month in the Raleigh News & Observer with the unsubtle headline "Blunt doctor gets in trouble."

The article detailed the travails of an elderly North Carolina eye doctor named Earl Sunderhaus who opened a 21st-century Pandora's Box when he poked a patient in the thigh and informed her that she was too fat. Insulted, the patient complained to the state medical board, and now the doctor might lose his license.

But Sunderhaus was not about to back down:

Sunderhaus notified The News & Observer that he was about to be "screwed" by the medical board. He admitted he told the patient that thick eyeglasses would not cause her to go blind "but her thick thighs and diabetes would."

"I poked her thigh to emphasize that diabetes is the leading cause of blindness," he said Thursday. "People have got to accept criticism without getting their bowels in an uproar."

He then upped the ante by threatening to counter-sue the medical board.

A follow-up article in the Asheville Citizen-Times gave more details about the eccentric doctor, who has notions that range from the kooky (disband the DEA, compulsory vasectomies) to the enlightened. Turns out Dr. Sunderhaus wasn't merely poking this one patient in particular, but rather poking an entire nation of patients just like her:

"They are chastising me for telling her she should lose some weight because it is raising the cost of health care and it is also bad for her children and she is going to end up with diabetes," Sunderhaus said. "I had to take three days out of my practice and go down to Raleigh, losing income, just because somebody didn't like that I told her that she was fat."

The patient complained that Sunderhaus poked her thigh and told her she was fat, and scolded her as irresponsible for being unemployed and relying on taxpayers to pay for another pregnancy.

"I told her the thick glasses were not going to blind her, she would go blind because of her thick thighs because diabetes is the No. 1 cause of blindness in this country," Sunderhaus said.

...

Sunderhaus said he feels it is his responsibility as a physician to tell his patients to live healthier lives and that obesity and diabetes are costing the country millions of dollars.

...

"Telling this lady that she is fat is the truth, and it's for her own good health," Sunderhaus said. "She should be taking better care of herself, and it will be cheaper for us as a society."

And to drive home his point, he poked the North Carolina Medical Board too,

"I'm the type of guy who can tell them to stick it up their butt because I am 77 years old, and if they don't let me practice, I'll just quit."

Eccentricities aside, Dr. Sunderhaus has spoken the unspeakable, and by so doing has changed the frame of the health-care debate.

Because millions of Americans are secretly thinking the exact same thing as Dr. Sunderhaus and I: Why should we be forced to pay for the costs of other people's irresponsibility?

Proponents of the single-payer national health plan can't understand why anyone would want to oppose the faultless idea of universal health care. It's completely egalitarian, it's altruistic, and it's free, they say. What's not to like?

"Free" is an illusion -- but that's not the point

Well, opponents of universal health care have focused on one particular objection to the idea, conclusively demonstrating that it's not free at all. It's "free" only in that the government inserts itself as a middleman into the payment system, so that you pay for your health care indirectly in the form of higher taxes to the government which then turns around and gives the money to doctors and hospitals -- rather than individuals paying the doctors and hospitals directly. It just looks "free" on the surface. But someone has to pay for the medical care, and under the single-payer concept, that someone is Uncle Sam. But since Uncle Sam gets all his money from American taxpayers ... you end up footing the bill anyway, and also footing the bill of a vast new government bureaucracy.

The argument then devolves into the minutiae of which system is more efficient and cost-effective: The current cumbersome HMO system, which still feels overpriced despite the theory that "market dynamics" should keep costs reasonable; or a new system dependent on government red tape, which long experience suggests will be even more cumbersome, less efficient, and ultimately more expensive overall than the flawed free-market system.

And that's pretty much where the discussion over health care has stalled: If we have to have a middleman unnecessarily taking a cut of our doctor payments, should that middleman be a private company like an HMO -- or should it be the government?

To my mind, that question is actually irrelevant. Because there's a much deeper philosophical objection to "socialized medicine" that is so un-PC that it is rarely if ever voiced in public. And for that reason, the opponents of socialized medicine never even mention the real flaw in the concept that nags the unconscious of most Americans:

Not all ailments are equal.

Blame: the final taboo

A built-in false assumption with the health-care debate is that sickness is always no-fault sickness. It's never socially acceptable to assign blame for people's medical problems -- especially blame on the patient.

But I'm not afraid to confess that I'm a judgmental person. And I'm pretty confident that most Americans who oppose socialized medicine share this same judgment: that some people are partly or entirely to blame for their unwellness.

I'm perfectly willing to provide subsidized health care to people who are suffering due to no fault of their own. But in those cases -- which, unfortunately, constitute perhaps a majority of all cases -- where the unwellness is a consequence of the patient's own misdeeds, bad habits, or stupid choices, I feel a deep-seated resentment that the rest of us should pick up the tab to fix medical problems that never should have happened in the first place.

I'm speaking specifically of medical problems caused by:

• Obesity

• Cigarette smoking

• Alcohol abuse

• Reckless behavior

• Criminal activity

• Unprotected promiscuous sex

• Use of illicit drugs

• Cultural traditions

• Bad diets

Now, I really don't care if you overeat, smoke like a chimney, hump like a bunny or forget to lock the safety mechanism on your pistol as you jam it in your waistband. Fine by me. And as a laissez-faire social-libertarian live-and-let-live kind of person, I would never under normal circumstances condemn anyone for any of the behaviors listed above. That is: Until the bill for your stupidity shows up in my mailbox. Then suddenly, I'm forced to care about what you do, because I'm being forced to pay for the consequences.

Reluctant busybodies

What I don't like about the very concept of universal health care is that it compels me to become my brother's keeper and insert myself into the moral decisions of his life. I'd rather grant each person maximum freedom. I'd prefer to let people make whatever choices they want, however stupid or dangerous I may deem those choices to be. Just so long as you take responsibility for your actions, and you reap the consequences and pay for them yourself -- hey, be as foolish or hedonistic or selfish or thoughtless as you like. Not my business.

But if the bill for your foolishness shows up in the form of higher taxes on me, then I unwillingly start to care what you do. And, trust me on this, you don't want me turning my heartless judgmental eye on your foolish lifestyle. Because I'd have no qualms criticizing half the stuff you do.

Do you want that? No. Do I want that? No. And that's the point. Instituting a single-payer universal health-care system, or even a watered-down version as the government is now proposing, compels me to become a meddlesome busybody in your personal choices. And it will compel you to become a meddlesome busybody in everyone else's personal choices. It forever douses the beautiful flame of individualism -- freedom to act without interference, just so long as you are ready to accept the consequences, whatever they may be.

The sickening truth

My list of unhealthy activities above requires a bit of explanation. Let's briefly look at each "health sin" in turn:

Obesity

Yes, I know that in some cases obesity can have a genetic component -- that some people simply have a tendency to get fat. But the majority of obese people are overweight merely because they eat too much and exercise too little. Simple as that. And as a result, they are mostly or entirely to blame to for their own obesity. Now, there are all sorts of excuses offered up in defense of the overweight: They never learned proper nutritional guidelines; their eating is a symptom of underlying psychological problems; they were raised by parents who fed them unhealthy foods; and so on. To which I reply: I don't care! Grow up already. Get over your immature problems and cut back on the potato chips. Is that so hard? It actually costs less to eat more healthily. And since being overweight is the #1 medical problem in this country, with countless ailments caused or exacerbated by obesity, making people become personally responsible for their physical conditions is the quickest route to solving the issue. If we made all medical treatment completely free, then people would continue to ruin their bodies with food and just let the free doctors deal with the resulting mess. Hey doc -- fix me!

Cigarette smoking

Smoking kills you. Slowly. Expensively. Everybody knows that by now. Want to pay for your own medical bills as you lie in the hospital dying of emphysema or lung cancer? Fine. If you're willing to pony up the cash, then smoke all you want. But if you want me to shell out millions of dollars to pay for the treatments and care you'll require, then I'm going to come over there and yank that cig out of your mouth right now.

Alcohol abuse

Destroyed livers, car accidents, pancreatic failure, brain problems -- the medical effects of alcohol abuse are well-known. The question is: Can we assign "blame" on the long-term alcoholic for his or her behavior? Contemporary psychology tends to give alcoholics and other addicts a free pass on responsibility, but I am less charitable. Every time you pick up that bottle, it is a conscious decision. And once again, under normal circumstances I just wouldn't care, but if I'm compelled to pay for the expensive reconstructive surgery of a drunk who smashes his car into a tree, then yes, I care, and I blame the drunk.

Reckless behavior

Stupid people do risky things. Teens who imitate pro wrestling or the Jackass movies in backyard stunts. "Extreme sports" fanatics who jump off cliffs wearing flimsy parachutes. Leaning over the rail and taunting the tigers at the zoo. Eating mysterious mushrooms you found while out hiking. Playing "chicken" in drag races. Car surfing. Auto-erotic asphyxiation. Playing Russian Roulette. Using a hairdryer while in the bathtub. Dumb, dumb, dumb. Me? I don't do stupid things. I spend my whole life trying to minimize risk. But those who consciously take risks often end up with injuries. Hospital emergency rooms are constantly filled with such people. Now, why should people like me who rarely if ever experience preventable "accidents" have to fund the foolishness of those who throw caution to the wind?

Criminal activity

Crime is dangerous. Not just for the victim, but for the criminal too. Gang members are constantly fighting with each other. Criminals often get injured during the commission of a crime, either while fleeing the scene or during apprehension by the police. Every minute of every day somewhere in this country, drug dealers are shooting at each other and stabbing each other in turf wars or deals gone bad. Doctors and hospitals in poor urban areas spend much of their resources treating gunshot wounds on victims who refuse to reveal how they got injured. And once again, the taxpayer is expected to pick up the tab. When was the last time you heard of a drug dealer diligently paying off the $100,000 hospital bill for the reconstructive surgery he received after being injured in a gun battle?

Unprotected promiscuous sex

AIDS. Chlamydia. Syphilis. Gonorrhea. Human papillomavirus. Herpes. Preventable. Preventable. Preventable. Preventable. Preventable. Preventable. Cover your peckers, people! The problem with discussing STDs is that the discussion always gets muddied with moral issues. But let's try to set that aside for the moment. On a purely cost-analysis level, STDs are a significant unnecessary society-wide medical expense. Luckily, most STDs are now treatable or at least don't require costly long-term care. With one noteworthy exception: AIDS. I realize full well that it's totally un-PC to say this, but why should those of us who go to great lengths to ensure that we never get AIDS have to subsidize the astronomically expensive long-term care of those who through their own cavalier voluntary actions contracted AIDS? Once again, the responsible are expected to pay for the costs incurred by the irresponsible. If I stuck my hand in a blender, should I present my hospital bill to a guy with AIDS and expect him to pay it? And this gets to down to the core of why I oppose the notion of socialized medicine: If left to my own devices, I really don't care about people's private sexual practices, risky or not; but if compelled to pay for the treatment of people's STDs, then suddenly I must become a nanny-state moralist, monitoring and criticizing any activities which might lead to an HIV infection. I don't want to be in that role.

Use of illicit drugs

The social and medical costs of drug abuse are ruinous. Meth, heroin, crack and other drugs cause a plethora of serious medical problems, both short-term (overdoses, risky behavior) and long-term (rotting teeth, heart failure, malnutrition, immune system collapse, etc.). Drug-users fill our emergency rooms and treatment centers, incurring incalculable expenses. Because even under the current system some of these costs are already borne by the taxpayer, I already feel resentful of having to subsidize drug abusers. But under universal health care, my (and most other taxpayers') resentment would go through the roof. Because I choose to not abuse my body and brain, I incur no costs for others to bear. But addicts give absolutely no thought to the social effects of their actions, and their thoughtlessness has become one of the main reasons to oppose socialized medicine.

Cultural traditions

All sorts of American subcultures have standard behaviors which increase the risk of medical complications. And I'm not talking about primitive tribespeople walking on hot coals. Instead, I'm talking about upper-class socialites who lie on tanning beds and give themselves skin cancer; street kids who engage in late-night "sideshows" of cars spinning and flipping in crowds of drunken teenagers; immigrants who fish in polluted harbors and feed their kids mercury-laden flounder; congregationalists who try to cure a disease by means of an exorcism; and all sorts of unwise activities specific to different cultural enclaves. Normally, including right now, I tend to think of such things as merely part of the rich tapestry of American society; but if compelled by the realities of socialized medicine to consider the long-term medical ramifications of such traditions, suddenly I become judgmental, condemning these practices and their practitioners solely because I have become partly responsible for paying the bill after the party's over.

Bad diets

Who among us hasn't looked on in horror at the grotesque dietary intake of the average American? Donuts, white bread, lard, Coca-Cola, pork rinds, preservatives, sugar, grease and artificial coloring. Little toddlers drinking sweet sodas instead of milk. Teenagers eating junk food instead of brain-building food. Nary a fresh vegetable in sight. Health nuts like me spend our lives trying to treat our bodies like temples, and provide good examples for everyone else; but it's hard to compete with intense cultural pressure to eat the worst imaginable foods. As above, under normal circumstances I would sigh in mystification and let other people go their merry way, killing themselves with bad food. Yet once I start to ponder the overwhelming society-wide medical costs of keeping millions of unhealthy people alive for decades and decades, my anger grows. I want to ban advertisements for unhealthy foods on TV. I want to outlaw donuts. I want to tax McDonald's to cover the full environmental cost of their products. I want to do all sorts of quasi-fascistic things that normally I would never advocate.

Because that's what socialized medicine does: it turns each of us into a little fascist. A nagging nanny who tells other people what to do and how to live.

    Criminal activity often leads to injuries.
Do we want that kind of society? I don't. If you look at other countries with socialized medicine, Great Britain being the most glaring example, these invasive and oppressive government dictates have already started to circumscribe people's freedom, with every kind of potentially dangerous activity or unhealthy comestible being declared forbidden -- for the good of society as a whole.

We call it "socialized medicine," but in the end it pushes us toward fascism.

Freedom vs. empathy: the final dilemma

Which brings us back to Dr. Sunderhaus. On one hand, we're headed toward a totalitarian nanny state whereby your freedoms are constrained for the good of others. But at the exact same time we've entered the Era of Hurt Feelings where it's taboo to tell anyone they're doing something wrong. The solution proferred by the universal health-care advocates is to expand the circle of responsibility to include all of us. So, rather than insult an individual by telling him or her to get healthy, we all have to pretend we're all equally in need of self-improvement, and we all endure the restrictions and hardships and costs which by all rights should be reserved exclusively for those who earned them.

The attitude of people like Dr. Sunderhaus perhaps offers a way out of this dilemma. Drop the pretense of decorum. If someone has grown obese eating chocolate, the do-gooders would respond by banning chocolate entirely for all of us -- to avoid offending the sensibilities of the individual who abused it. Dr. Sunderhaus would just tell the abuser, "Lady, put down that Hershey bar -- you're too fat!" Horrors, horrors!

But if we had a nation of Dr. Sunderhauses, we wouldn't need socialized medicine. Because each person, at last, would assume complete individual responsibility. And I'd rather that the doctors do the bullying in private to the people who deserve bullying than me being forced to intervene in other people's private business myself.

Since it's nearly impossible to sort out who is personally responsible for which ailments, the only logical solution is to let each person pay for their own care, because that way there's nothing left to argue about. But if we share costs, we share blame, and that's the origin of resentment and anger that the average American feels about socialized medicine.

Instead of bankrupting the country to pay for foolish people's foolish decisions, I want to take a giant Sunderhaus finger and poke each American in the thigh and shout: "Shape up!"