Reflections of a stormy petrel

One: there already are death panels in American health care provision. They are the accountants who decide how long the companies can afford to give healthcare to customers who have chronic or expensive conditions.

Two: the Republican notion that the current system can be tweaked or bullied to remedy such problems is nonsense. It is positively crazy. If seriously pursued, it will lead to a situation where corporations have to deficit spend to keep patients with chronic and expensive conditions alive, which will eat into their budgets and threaten the rise of a Fannie May and Freddie Mac situation.

Three: in order to deal with chronic, expensive or long-term cases, there is need of a body which is not only capable of but allowed to deficit spend. There is only one such body: the State. The State routinely deficit spends on such things as the police and the military, the courts and the jails, which never will bring in an income but which are indispensable for society. Indeed, Adam Smith's classic definition of the "expenses of the sovereign", by which he meant the public sector, is: all those expenses which are necessary for society but which the private sector cannot profitably pursue.

Four: it is an atrocious lie that people who demand a right to health care are "inventing new rights". The denial of health care to anyone is the denial of the three basic rights: life, because it places the person in the immediate and evident danger of death; liberty, and the pursuit of happiness, because it reduces what is left of life to a despairing struggle to be allowed to draw a few more breaths. If you think this is what the Founders meant, you are not only a fanatic, but a sadist.

A real and serious issue with exporting any European or Japanese model of universal health coverage to the USA is the size and diversity of the nation. The attempt to micro-manage the British Health Service - by now reduced, thanks to the growth of local parliaments, to England alone - from Westminster is notoriously one of the major problems with this body, although in my view neither the biggest nor the worst. To expand it over a country eight times as populous as England and sixty times as large would be to multiply problems to an intolerable extent, and to deliver to the Federal Government an amount of power which it is neither well placed nor legally supposed to handle. Any attempt at universal health cover must be based on the States, and, for choice, have its decision-making as far down the level of organization as is compatible with its goals. The issues with this are obvious: first, the inevitable rise of a "postcode lottery" of the kind that is being fought against in Britain as we speak, and much more deeply rooted in the vast differences between states; and second, the danger that some states might take their sets of ideological blinkers to health care provision. I am thinking both of those states that produce leaderships and governors that demand "equal time" for creationism in class, and of infernos of PC and denial such as the three West Coast states. For this reason, establishing an American Health Service would not only be a complicated business, but one that would demand a great deal of legally enforceable protections against mismanagement, and, if necessary, a certain amount of resource transfers from richer to poorer areas.

(Incidentally, I would like to point out that John McCain dodged one Hell of a bullet when he chose his running mate. Among those who favoured a young Christian conservative, the favourite was not Sarah Palin - although she was much better known than the media would have us believe - but Louisiana Governor Bobby Jindal, a man barely in his thirties and widely regarded as a rising star. The problem is however that, while both Jindal and Palin have expressed vague personal Creationist views, Palin has explicitly stated that she would not force her views on the Alaskan education authorities, whereas Jindal has been caught red-handed trying to slip Creationism into the Louisiana school curriculum. And there is far less excuse for him than for her, since he is a self-declared Catholic, and the Catholic Church explicitly rejects Creationism. Jindal is as unacceptable as a candidate to the Presidency as Huckabee - whom I condemned months ago for the same reason - and just as unelectable; and worse, in that as a Catholic he should know better.)