Casino Medical Care

Since World War II, most of the industrialized world has had some form of State regulated or managed medical care system. In Europe, this is an aspect of the Welfare State. In Japan, medical care is an employer responsibility in the lifetime employment system. Even in developing Asian countries, such as India and China, governments have undertaken massive programs to bring modern healthcare to rural villages. Among major countries, the United States stands alone in its obstinate refusal to make any provision in law for the health of its citizens.

Americans, being Anglophones, are fixated on either the British or Canadian government-run systems. Those are either the model or bugaboo of medical care for most Americans. Conservatives are given to making claims based on falsehoods or fantasies, as in the Bush Administration's case for invading Iraq, so, unsurprisingly, they have made bogus claims about those foreign national health services. Refuting conservative propaganda, studies have shown that the availability of medical care and waiting time for major surgery (as in cancer treatment) are not significantly different in Canada from the corresponding factors in the United States. Moreover, the success rates of medical treatments are not better in the United States than elsewhere. Indeed, in some areas such as childhood deaths, the United States lags countries with "socialized medicine."

The one aspect of medical care in which the United States persistently leads the world is its cost. Americans spend more on  medical care than citizens of any other nation. On a per capita per dollar basis, those expenditures make American medicine the least effective in the industrialized world. In other words, Americans pay far more than others for a given result. Put differently, the American medical industry is grossly inefficient in delivering its services. That, I believe, is a direct consequence of what most Americans most deeply value: money, not life. In America, when the robbers demand, 'your money or your life,' it is not clear what the victim will offer.

Americans also have a penchant for gambling. This was once thought to be a Chinese vice which could not afflict more sober, Puritanical people, but it turns out that even the most religious Americans love vacationing in casinos. Lights, glitter and slot machines vibrate in the heart of the Bible Belt as well as Las Vegas. Californians recently voted to allow Indian casinos to expand up to 500%. This will allow Southern Californians to gamble away their wages along the California freeways leading to Las Vegas, perhaps leaving less of a bonanza for California's neighbors.

The Americas were a bonanza for Europeans, who, thanks to Guns, Germs and Steel, were able to exploit new riches. Human beings had been largely confined for millennia to Eurasia, save for those few who managed somehow to escape unnoticed to Polynesia, Micronesia, Indonesia, Australia and the Americas. Neither the Europeans nor Chinese nor Indians were aware of Hawaii, New Zealand and Australia until the famous voyages of discovery by Magellan, Cook and others in modern times. Finding a relatively unpopulated, undeveloped world, especially in the Americas, had not happened for at least 14,000 years before Columbus' voyage. The conquest of regions unable to resist European advances proceeded quickly and persistently after Columbus, and continues to this day. The possibility of leaving the old country, of becoming the master of one's own fate and possibly the fates of others, of becoming Lord John or Lady Jean, has an irresistible allure for the ambitious. America was founded on taking a risk to become rich and famous. California is the epitome of that adventurous wanderlust, where storied Sierra gold paves Hollywood Boulevard. However one arrives in America, one becomes a risk taker, a gambler, just by being there. Probability is carried by the air, the land and the water into the culture. High on the perfume of success, people are eager to throw the dice.

So it is with medicine and medical care. One way to look at it is the inevitability of disease and death. But that is just the way old folks - the Old World - see it; not what the young care about. In a country without a History, without a clearly established social order, anything goes. The Law of the Jungle prevails in such a place, particularly because its youthful inhabitants are filled with a sense of their invincibility and immortality. For them, there is always More and Better.

When America is at last filled up, when it becomes like the Old Country, Americans will see the necessity of a National Health Service. This filling up might happen in this 21st century. I have always advocated institution of a National Health Service. It might even come about in what remains of my lifetime. But, given what it represents, apart from its necessity, now I don't know whether it is a good thing or a bad thing.

Posted 02/23/2008 12:01:23 PM                Last update: 02/23/2008

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