A lot of the debate about health care seems to center around cost and payment. I’m not going to discount the importance of these issues, but I can’t help but feeling we’ve skipped a step. With any policy, before we start considering cost, I think we should consider what is the right thing to do. I happen to think universal, portable health care is the right thing to do both morally (to avoid the de facto rationing/denial of care based on income and employment status) and economically (to avoid the much higher cost of ER visits and other late-stage care vs. prevention and early detection/treatment). Does someone out there not agree? That’s fine. That’s great. Let’s have that discussion. Make your case for why we shouldn’t try to improve the way health care is funded and provided in this country. (Make sure you’ve read Betrayal of Trust first, though, unless you like putting your ignorance on display.) As near as I can tell, the people who are against health care reform seem to have skipped this step in favor of talking about cost first – when they’re not busing hordes of brownshirts to disrupt town meetings, that is.

Let’s say, for the sake of argument, that we’ve determined to reform health care. Now the issue of cost comes into play. In an ideal world, reforming health care would actually reduce costs – e.g. by replacing late-stage intervention with early-stage, by reducing paperwork or duplication of administrative effort – so that nobody would have to pay more. Unfortunately, we don’t live in such an ideal world. Too many are uninsured now, and getting them insured will cost more than we can hope to save. If total medical cost is going to increase, somebody has to pay more than they do currently. Who?

This brings me to my other major point: the opposition to the “redistribution of wealth” implied by increasing taxes on the wealthy (more precisely the high-income). Everybody’s against redistribution of wealth . . . when it suits them. All too often, they’re blind to other kinds of redistribution from which they have benefited. Here’s a hint: any time government money to anyone other than the exact same people from which that money came (which would be pointless), redistribution has occurred. Anyone who has received a student loan, farm subsidy, or government contract has been on the receiving end of redistributed wealth. Where was their outrage then? Nowhere in evidence, of course. Redistribution toward me is the Natural Order of Things; redistribution away from me is the Worst Kind of Socialism. It’s kind of like everyone attributing their success to personal merit and their failures to others’ malice or discrimination, and my response is the same: bollocks. Whether or not a particular kind of redistribution is justifiable has nothing to do with who’s considering it. In the particular case of health care, those who are most secure in their insurance status – notably those on Medicare – have been putting off this crisis by voting for measures (or people who will vote for measures) that will minimize effect on their own costs by maximizing the number of Other People who are uninsured. It’s like a Ponzi scheme, and like all Ponzi schemes it’s not sustainable. The people who have been benefiting from health-care injustice for years are finally being asked to pay in, and now they’re suddenly hyper-aware of the the tradeoffs that they themselves have made inevitable.

The Medicare example makes this even more clear. Baby Boomers on Medicare are one of the major factors driving up overall health-care costs. As a group, they’re relatively wealthy, yet they expect the government to pay for all manner of expensive surgery and medication to correct for their own entirely voluntary lifestyle choices – poor diet, poor exercise habits, etc. – in the past. They love their socialized medicine, so long as nobody talks about means testing, and at the same time they are one of the groups most opposed to providing the same for others. All for me, none for thee. I’m OK, screw you. This attitude is the hallmark of health-care-reform opponents. They don’t care about what’s right. They don’t care about society-wide tradeoffs or long-term effects. All they care about is the immediate effect on their own pocketbook. Sure, they’ll enlist those gullible fools who are willing to believe that their own medical risks are low and their future incomes are high, getting some to forego actual productive work in favor of participation in the town-meeting astroturf campaign, but the people actually driving the anti-reform campaign are doing so entirely out of selfishness.

Go ahead. Prove me wrong, if you think you can. Tell me what your real factually and logically consistent reasons are. I’d love to hear someone even try. Just once.