One is stirred to thank Rush Limbaugh. He has told us that if health-care reform is passed, he is going to pack his prejudices and leave the country, presumably in five years when the provisions of the hated “Obamacare” begin to bite.
Limbaugh’s putative destination: Costa Rica. Bravo. The man has taste. Democratic for decades, Costa Rica is the jewel of Latin America. It is in its way a paradise. Straddling the Central American isthmus between the Caribbean Sea and the Pacific Ocean, Costa Rica offers the most extraordinary diversity of fauna and flora, mountain and valley. Even the beaches are diverse, from the white sands of the Caribbean to the black volcanic sands of the Pacific.
But is this the place for Limbaugh, as he escapes the creeping socialism he fears is around the corner, if the Democrats can get their act together and pass a health-care bill? Sadly for Limbaugh, he may have to find peace elsewhere. Costa Rica will be too full of jarring realities for the Loud One.
Consider, with one-tenth of the U.S. per-capita income, Costa Rica manages to provide adequate health care to most of its 4.5 million people, and they have, at 79 years, a longer life expectancy than do Americans.
Worse for Limbaugh, the government funds the health-care system — although he will be able to buy private insurance that he can use in one of two private hospitals. To see all those healthy, long-lived people enjoying freedom, despite a massive government option, could be injurious to Limbaugh’s health.
Limbaugh’s affection for drug companies may also be challenged, making his exile life a living hell. Drugs can cost up to 80 percent less than they do states-side.
But there other disquieting things that Limbaugh’s research overlooked. General Limbaugh was a staunch believer in the therapy of invasion, including those in Iraq and Afghanistan. He was a favorite of Dick Cheney; and while the latter was vice president and warmonger in chief.
So what is a man like Limbaugh to do in a country that has no army? Not one person with a rifle.
So what great service has Limbaugh’s possible defection done? It has forced us to look around the world for a new home for our greatest broadcaster and to see how far state medicine has gone in rotting the fiber of otherwise great nations.
Limbaugh made everyone look, from the “Tonight Show with Jay Leno” to La Prensa. Looking for a new home for Limbaugh is the pastime of the moment — and it is not easy.
Western Europe, Canada, Australia and New Zealand, Iceland are out, out, out, out. We cannot send a national treasure to these infamous places, struggling under the yoke of socialist medicine. Much of the rest of Latin America leans toward government provided medicine, even if delivery is spotty.
Our man needs a home of limited government, widespread gun ownership and medicine for those who can afford it. Limbaugh must turn his eyes from mamby-pamby nanny states like Costa Rica to robust lands, where people do not expect the government to provide answers and do not look to it.
Somalia quickly rises to the top of the heap. No government, no regulation, universal gun ownership and no socialized medicine.
Then, there is Iraq. Pasha Limbaugh might fit right in. He has done more than his bit for the Iraqis, bringing them the wonders of democracy and cruise missiles. He could report back to Dick Cheney regularly on what has been wrought there. A one-man truth squad, checking on the mainstream media and its penchant for negative news.
Nah. Limbaugh is a rich man with no known linguistic skills. He would be happier in London. There, he could handle the notorious National Health Service — which the Brits love to hate — by listing its failings in a blog. No need to mention that any politician who suggests repealing it would be thrown into outer darkness.
No worries. Limbaugh knows the power of a horrifying anecdote. Britain frowns on gun ownership, but then exiles must assimilate.
Breath easy, Costa Rica.
President Barack Obama starts from a pretty compelling argument: In the rich industrialized nations, the rich and the poor should be able to afford to get sick. They surely will. Disease does not means test.
But after that, the health care argument gets away from the president. In fact, he hasn’t made his own argument.
This week Obama has argued passionately for reform, as he did in his prime-time news conference Wednesday night. But we have yet to hear his personal view of what an American health care system should look like. One suspects that it is the solution that dare not speak its name: a single-payer system, a government system. Yes, a–dread word–socialist system.
The empirical evidence from Australia to Ireland, Canada to Norway is that this is the way to go. Every country with a national health service pays less for health care per capita than does the United States. And not one has contemplated canceling their system.
Yet it is a concept that may be too radical for Americans. It also may be too late in the evolution of the health care industry to nationalize the system.
Canada had the most difficulty nationalizing health care of any major country, and is still groaning. Canada did not plunge in; it waded into a state system, and put it all together in an age of sophisticated medicine. But it is not without problems: for example, Canada failed to comprehend that if everyone who needs to see a doctor sees one, more doctors will be needed. There is a chronic shortage of doctors in Canada.
Britain, by contrast, nationalized its health system after World War II, when medicine was simpler and the process was easier. It was also a time of post-war idealism. Today, like most state systems, it functions well enough but not perfectly. Well enough for Britons living abroad, including in the United States, to fly home for major surgery.
The world of single-payer does allow for private insurance, and it is flourishing in countries like Ireland. This provides a second tier for those who feel the basic system is too rudimentary. Under this arrangement if you want a procedure for a non-life-threatening ailment, which would require a long wait in the state system, you visit the specialist–called a consultant in the British Isles–and the insurance company picks up the tab. The idea is that the well-off get what they want, and the rest get what they want.
Obama’s problem is that he can diagnose the problem but has failed to prescribe a solution that he appears to believe in. He is waiting for Congress to produce something that he can sign onto, called reform, and that will not expand the budget. Where European and some Pacific countries have allowed private systems to piggyback on state systems, Congress is struggling with the reverse and the president is going along. Congress is planning to have the state piggyback on the employer-paid system.
The idea that employers should carry the health care burden probably goes back to the 19th century when railroads, coal mines and ships found it best to employ a doctor to keep workers on the job. Today, it is an incongrous burden on American firms in an age of globalization.
The three principal schemes for a new day in health care seek to preserve private insurance as primary, mandate portability, demand that commercial insurers do not reject pre-existing conditions, and provide some kind of safety net from the government. And, yes, the whole new edifice will be revenue-neutral.
At his press conference, Obama was ebullient, funny at times–the very picture of a man about to get what he wants. By contrast, in the halls of Congress, the lawmakers who are supposed to deliver this package are despondent. They do not know what the president will accept and are not persuaded that huge federal spending will not result. There is real political fear on Capitol Hill. Wednesday night did not allay it.