Today I’m dealing with the fourth of five issues that I have identified as barriers to accepting ‘socialized medicine.’ One fear, perhaps the main one, is that if medicine is government-controlled, then doctors will lose their incentive to become excellent, and those who pioneer medical technology will lose their incentive to invent new medicines, etc. The capitalist idea (which I think is usually right) is that money motivates people. So the concern is if the free market is taken away, then the money will dry out, and thus, so will the motivation is taken away.
Suppose the government said things like this: “Each hospital will get the same level of funding, regardless of how well or how poorly you manage your facility,” or “Each doctor will be paid the same and keep your job, regardless of how well you do,” or “Each inventor of medical technology will receive the same compensation, whether you do a crappy job or whether you invent a cure for AIDS.” If this is socialized medicine, I agree with the conservative that this would be an unmitigated disaster.
Perhaps the easiest analogy is with public education. I almost regret mentioning public education, because of its well-documented problems and short-comings. Public education is perhaps the paradigmatic case of those who fear government control of institutions, so it is surprising that I am mentioning it. But I am not holding out public education as a shining example of how to do things right; rather, I am merely pointing out some features that a large institution that falls under government control might have. We simply can’t say, “Oh, public education failed in such-and-such a case, and so medicine probably will too.” This is because making sick people healthy who want to be healthy is much different than getting children to excel at math who hate mathematics. So I don’t think we can compare the two except to notice how the government runs large institutions that interface with the population at large.
So, let’s address some of the fears I mentioned in the second paragraph. Has the government abdicated its responsibility to provide enough money for education? No, I don’t think they have. There is plenty of money out there (is it $6000 per child per year now?). Do teachers get to keep teaching even if they perform poorly? No, teachers are fired all the time. Is there a lot of competition for good teaching jobs? Oh yeah, it’s hard to even get a substitute job in some districts. Have education think-tanks stopped trying because the government funds education and not the private marketplace? No, there is a lot of money flying around in research and development of new pedagogical tools. If you invent a new method to teach kids math, or a new science textbook, then you get rich! Just because the money comes from the government does not mean it will be distributed equally regardless of performance.
I will say one more time before I am accused of being insane, NO, I do not believe that public education is a perfect system, even though I like the idea. But I don’t think you can make the analogy between education and medicine, because government control is a much, much more difficult thing to implement at the level of education. Kids just do not want to be in school, and so a lot of the money ends up being wasted. The reason that kids from private schools do (only very slightly) better on their ACTs is probably because kids from wealthy families often have lots of other advantages (like hiring an ACT tutor – just ask me!). There is simply no reason to believe that the field of medicine will no longer be competitive if the government funds it.
