PERSPECTIVErnMother Goose vs. HellrnThe Real Debate on Health Carernby Thomas FlemingrnTo read the newspapers, one would think there was a liealthrncare debate going on in the United States. But the wordrn”debate” impHes two parties, and the spectrum of the currentrndiscussions is limited to the deeper shades of pink, since neitherrnthe white flag of reaction nor the black flag of anarchy is beingrnraised. What few of us like to admit is that America already hasrna national health care svstem, a collusive cartel whose membersrnare the insurance industry, the American Medical Association,rnand the vast bureaucracy of state and federal agencies designedrnto provide medical services to government employees,rnthe indolent, and well-to-do retirees sucking up the nation’s vitality’rnin monthly installments of Social Security and Medicare.rnBecause some people are either too rich or too smart tornsquander their money on health insurance and others are usingrnemergency facilities they do not pay for, we are said to bernundergoing a crisis. Speaking personally, 1 would give a greatrndeal to be able to opt out of the system. Looking back over thernpast 25 years, I would have done quite well, investing my moneyrnin the markets instead of squandering it on health insurance,rnand by the time I retired, I would have accumulated somethingrnlike a half-million dollars, at which point it would be up to mernto decide whether 1 really needed a triple by-pass more than myrngrandchildren needed an education.rnBut, someone will say, what about all those medical expenses?rnThe truth is, the mere fact of insurance is by itselfrnresponsible for driving up the cost of health care. If there wererna genuinely free market for medical services—and bv free 1rnmean a market not distorted by insurance or regulation—rnmost medical doctors would earn roughly what college professorsrndo, that is, slightly more than they are worth. But underrnthe current fascist system, which Mr. Clinton would like to turnrninto something more like National Socialism, we find ourselvesrnin bondage to a medical cartel that virtually compels usrnto divert a large part of the nation’s resources away from creatingrnand doing and toward mere carcass maintenance.rnThe most telling comments on our national obsession withrnhealth were made, some time ago, by Plato, who realized thatrnmany diseases were the result of indolence and vice. Thernmore licentious a society, the more disease-ridden—and litigious.rnIn an immoral societv, he said, hospitals and courts ofrnlaw flourish. Is it not disgraceful, asked Plato, to honor doctorsrnand lawyers and to waste time on treating problems that a prudentrnman might have aoided? He had particulady harshrnwords for one Herodicus, a valetudinarian who invented arnmedical treatment for prolonging life: “In constantly attendingrnto his fatal disease, he was not able to cure himself, but he spentrnhis life nursing himself in idleness, suffering anxiety if he departedrnfrom his regimen, and using his skill to ward off death,rnhe reached the age of senility.” Plato concluded his argumentrnby saying that self-indulgent people, who contributernnothing to their societies, arc not worth the trouble to keeprnalive. The Athenian was not thinking of a modern nation-staternbut of a small city in which eeryone was related to each other,rnif onlv fictionally. Applying his msight today, we mightrnquestion the wisdom and morality of elded patients who, inrnclinging to mere existence, divert resources away from theirrngrandchildren.rnWe are already a society of self-indulgent valetudinarians,rnand the first effect of a national health system will be tornenhance our already well-established therapeutic mentalitv—rnalthough we shall ultimateh, as Garrett Hardin suggests, haernto begin weeding out the most worthless from the ranks. Ofrncourse, in a private, pay-as-‘Ou-go system, there would be nornneed for euthanasia, but in the American future only the veryrnrich will cnjov the luxury of free choice.rnThe nondebate over health care is only a small part of thern10/CHRONICLESrnrnrn