Thursday 18 April 2002

Health care stalinism

Imagine you decide one day to buy some new clothes. You go to the shop, and discover that all the clothes are free. However, before you rejoice too loudly, you are told that you have to wait some months for your clothes. And you cannot just pick and choose your clothes, either: A qualified tailor will decide what clothes you need, if any. It turns out that the state now owns all clothes stores in the country, except a couple in the capital city. And they are all run on the same principle: Each has a fixed budget for buying clothes, paying the workers etc. So the more customers, the less or cheaper clothes for each. But since it is free, you should just be thankful that you are allowed inside at all.

This, dear reader, is the situation in Norwegian hospitals. And still it surprises some people that the places are dirty, run-down and a threat to life and limb for the patients (and probably the workers as well).

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It should go without saying that when you have a fixed budget, the customer is not king. A satisfied customer may have some emotional value to the kind-hearted worker, which is all very nice. But as Adam Smith pointed out when he founded modern economics: The baker does not make bread because of the kindness of his heart, but out of enlightened self interest. An extensive body of research on the differences between capitalist and communist societies bears witness to the truth of this.

It is a cruel irony that in my native Norway, we follow the principles of a western market economy when dealing with jeans or bagels; but when it comes to our very life, stalinism reigns supreme. Budget committees preside over your life or death.

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Now you may argue: "It would be unfair if the rich could get better health care than the poor." Yes! It is unfair! Life is unfair and has been so for all of recorded history. It is unfair that the rich have bigger and better cars, finer clothes, exotic vacations and big homes. That's the point of being rich, to have more and better stuff. That's why people spend their time trying to get rich. And that's why people work instead of playing their day away. On this is all of civilization built: That we can specialize and exchange goods and services, so that in the end all will have more of what they want.

"Yes, but health care is special. After all, once you are dead you cannot enjoy any other of life's pleasures, neither those of the rich nor those of the poor." So true! The same holds for food. If you don't have food, you will soon be just as dead as from a burst appendix. And quite painfully too, I'm afraid. So we should definitely stalinize all food production. Make sure that nobody gets food without first applying to the proper authorities, who will then process the applications in an orderly manner, taking into account all factors. Clearly the overweight should be sent to the end of the line; they do not need food as much as the thin. There is a lot of great job opportunities in replacing your neighborhood grocer's with a suitable state-owned Food Distribution Center.

Why don't we do that? Because there is already enough food for everyone. There is no need to ration bread, because there is more bread than you can chew and swallow. Well, WHY is there enough bread? Because we have a functioning market economy in that sector, that's why. In North Korea there is not enough food, and neither would there be in Norway if we went deep enough into stalinism. Correspondingly, there would also be enough health care for everyone if we could flush the crap of communism out of our health care system. Then we would get the same pyramid of needs as we have with food: Everyone can afford bread and milk (in Norway, that is. Not the USA, more about that later). Not everyone can afford filet mignon on a regular basis, or wine and brie. The same should apply to health care.

The problem with privatizing the hospitals is not that the rich get too much health care. The problem is if the poor does not get enough. The way around this it so make sure that the poor are not THAT poor. This is where the American model has failed, in so far as it has failed at all. Americans (with the possible exception of the poor) tend to think that the poor deserve no better, because they don't work their way out of poverty like my grandfather did. Norwegians tend to feel that the poor deserve to have their basic needs fulfilled by sheer virtue of being human; but they don't deserve any luxury. Since most people want luxury, the percentage of people in paid work is at least as high in Norway as it is in America. Never under-estimate the power of greed: People may pray to God for their daily bread; but once they have that, they start praying to the Golden Calf instead.

We take for granted that private bakeries will better give us our daily bread than state monopolies. We take for granted that private breweries will make all the beer we can possibly manage to drink. If reason prevailed, we would extend this to our entire health care system, and run the stalinists out of town with hot tar and feathers for the needless pain and death they have caused over the years.