There’s a certain amount of lingo that comes with the provision of health care. In most developed countries, these words are “doctor,” “nurse,” “scalpel,” “appendix,” that sort of thing. But American health care has its own unique vocabulary: “co-pay,” “HMO,” “COBRA,” “doughnut hole” . . . And we’re always adding to it. The latest word is “exchanges.” A mere twelve months ago “exchanges” were something to do with stocks or trying to get a larger size when you’re given a too-tight thong for Christmas. Now, suddenly, it’s the new health-care buzzword. You go to the federal website for the “exchanges,” if you can get through, and they redirect you to the state websites for the “exchanges,” if they’re working. In Oregon, there are some 1,700 different rules that determine eligibility for the new “exchange.” In Maryland, you’re advised that “we may share information provided in your application with the appropriate authorities for law enforcement and audit activities.” But we’re used to all that by now, aren’t we? The point is it’s going to be complicated, time-consuming, and in breach of almost any elementary understanding of privacy. That’s what makes it quintessentially American.
Most developed nations have a public health-care system and a private health-care system — of variable quality, to be sure, but all of them far simpler to navigate than America’s endlessly mutating fusion of the worst of both worlds. Obamacare stitches together the rear ends of two pantomime horses and attempts to ride it to the sunlit uplands. Good luck with that. But we should remember that this disaster has been a long time incubating. The Democrats’ objection to the pre-Obama “private” health system is that Americans wound up spending more than any other country for what they argued were inferior health outcomes. But the more telling number is revealed by Avik Roy elsewhere in this issue: In 2010 (in other words, before Obamacare), U.S. government expenditures on health care were higher than those in all but three other countries in the world. Quick, name a European social democracy full of state-suckled wimpy welfare queens: France? $3,061 per capita in public-health expenditures. Sweden? $3,046 per capita. Belgium? $3,000. In 2010 the United States spent $3,967 in public-health expenditures per person — more than anywhere on the planet except Norway, the Netherlands, and Luxembourg. I am confident that, under Obamacare, we’ll be outspending even the Norwegians. But in reality our so-called private system was a public system in all but name.
Why did we think otherwise? That gets back to the fundamental disconnect between America’s national mythology and who Americans are as a people, or at least as a voting majority, in the 21st century. To reprise the Frenchman I quoted in this space a while back, “Americans love Big Government as much as Europeans. The only difference is that Americans refuse to admit it.” And, because they refuse to admit it, they’ve wound up with a uniquely disastrous form of statism — a kind of statism on the sly, in which the zombie husks of private industry are conscripted as the front men for de facto nationalization. As part of the sky-is-falling rhetoric over the soi-disant shutdown, the media warned that, with federal employees furloughed, many American homebuyers would be delayed in moving into their new homes.
Tragic. But how did it come about that government bureaucrats are mixed up in your home closing? It’s bad enough that the feds have a piece of so many mortgages, but it’s far worse that, even if you walk into the realtor’s office and plunk down a certified check for the entire cost of the house, you’re still obligated to comply with all the federal HUD paperwork. In many key areas of life — your home, your health, your bank — Americans now enjoy considerably less freedom of maneuver than Europeans. They don’t think of it like that because it’s statism at one remove. But third-party statism is inevitably more cumbersome, bureaucratic, and expensive — summed up in those commercials for “Medicare supplement plans,” patiently explaining why an already hideously unaffordable taxpayer-funded entitlement nevertheless apparently requires huge additional private expenditures in order to function.
If you blur the lines between public and private as artfully as American statism does, eventually everything becomes the government, and your private sphere is no more genuinely private than those private museums, boat launches, restaurants, and campgrounds ordered closed at no notice by the shock troops of the National Park Service. In South Dakota, the NPS attempted to shut down an unmanned, open-air parking area on the shoulder of the highway to prevent Americans from looking at Mount Rushmore. Apparently, the view belongs to the government and you can enjoy it only with their approval. In the days of absolute monarchy, a medieval proverb nevertheless assured us that a cat may look at a king. But in South Dakota freeborn Americans may not gaze upon their presidents without the permission of the bureaucracy.
It was a rare, direct, explicit revelation of how, underneath the “exchanges” and other sock puppets, American statism’s conception of itself is as expansive and unbounded as the most doctrinaire Eurosocialist’s. They should demolish those guys on Rushmore and chisel in a giant federal official-scenic-view application form, with sky-high small print explaining that your confidential information will be shared only for the purpose of “audit activities,” and with pyramid-sized boxes to check rising into the clouds and up to the heavens.
– Mr. Steyn blogs at SteynOnline (www.steynonline.com).