Barefoot Doctors V. Scroogecare

By Richard Brookhiser

Ever since it was first outlined, President Clinton's health plan has been wonk heaven: a field day for number crunchers, policy analysts and all the sobersided types who use hand-held computers even though they know the figures anyway. Matthew Arnold wrote of ignorant armies clashing by night; the health- care discussion has been conducted by highly knowledgeable armies clashing on the MacNeil/Lehrer NewsHour.

As with all big issues, there is another side to it: the level of passionate beliefs and impulses. We call them irrational only because they resist rationalizing away; they are as important as anything that can be put on a bar graph or a spread sheet. In the interests of truth in labeling, opponents of the health plan, like me, and supporters should explore these motives. I'll show mine, if they'll show me theirs. Better yet, I'll show both sets.

The unspoken motives of proponents of the President's health-care plan are power-lust, arrogance and resentment of doctors. (Each of these has a more emollient name, but we'll get farther if we keep the bark on.) The lust for power, or at very least the conviction that increased state power is the solution to all ills, simply has to be present in any proposal to boost regulation over one-seventh of the nation's economy. Two years after the collapse of communism, and at a time when even the mild-mannered Eurosocialists are considering a four-day workweek in order to boost their % stagnant employment statistics, faith in the efficacy of state management remains surprisingly strong here. The reason is that the potential problem solvers look forward to a busy future and to the political rewards that will flow from attending to their self-imposed labors. If ambitious reform programs were administered by Martians, or by hardware, you'd see a lot fewer humans agitating for them.

The second secret trait of the Clintonites, arrogance, might be more precisely defined as the arrogance of lawyers, especially those trained in the Ivy League and working inside the Beltway. Lawyers are paid to put deals together. Restructuring the American health industry may be bigger than ingesting Paramount, but once you give a lawyer the assignment, all the rest is commentary. If a couple dozen lawyers can't handle this, then what good are their fancy educations, and what good have they done by forsaking the even fancier jobs they might have held in the private sector? If the gargantuan project should show any little chinks when it is finished, these can be patched through litigation, thus calling on the talents of more lawyers. When drunks treat hangovers in the same manner, it is known as taking the hair of the dog that bit you.

Finally, the resentment of doctors -- especially prosperous American doctors -- is an afterimage of the '60s, that crucial decade in the character formation of the people who now rule us. Back when Bill Clinton wore a beard and Hillary Rodham wore glasses, right-thinking college students were much taken with the romance of barefoot doctors, those Cuban and Chinese medicos who lived among the people, treating simple ailments with simple means instead of prescribing uppers for bored housewives or performing nose jobs on their insecure daughters. The attitude may have been filed away in a footlocker with the beads and the bongs, but its long arm strikes out at physicians today.

What can opponents of the President's health plan reveal to match this collection of prejudices? I confess proudly: my emulation of the man whose season comes around every December, Ebenezer Scrooge. Every time I hear it said, in accents of panic, that 37 million of my fellow citizens lack health insurance, I find myself thinking, as that keen economist said when he was approached by professional do-gooders, "Are there no workhouses?"

Let me be more specific. About one-sixth of the number of uninsured are twentysomethings who have not bothered to incur the expense because they think they are immortal. For them there is little reason to be concerned. Most will manage to avoid major health catastrophes until they learn the facts of life. Those who don't, run the risk with their eyes open.

That leaves the large remainder of those between jobs, those working in part-time jobs and those who simply aren't working. The cost of helping them by means of either the Clinton plan or a single-payer system such as the Canadians use would be rationing of care and a general lowering of the level of quality, as talented and self-motivated potential doctors refuse to become paper pushers in white coats.

To avoid these grim alternatives, the wonks on my side have proposed schemes that would make health insurance a portable benefit. Individuals, instead of employers, would buy health insurance and would receive the tax benefits for doing so. My wonks claim that their system would act as a brake on costs, since insurers would have to deal with consumers directly. The poor would be treated as they are now, through Medicaid, or with means-tested tax credits.

This is an attractive vision. But honesty compels me to say that if the choice is between the status quo and Clinton or Canada, I take the status quo. The American health system is the best in the world. It has saved the life of people I know, more and more of them as I grow older. I'm not going to dilute it to please some power-tripping bureaucrat who got his law degree when Abbey Road was released.