One would be forgiven for thinking that the onset of sickness or disease, or a sudden injury, might well be a death sentence in this country. With bombastic and irresponsible films like Michael Moore's SiCKO in theaters and the filmmaker himself being interviewed on every major news network, it would be reasonable to be confused. As the 2008 election takes shape, with the Democratic candidates far ahead of the Republicans in terms of polish and fund-raising, and with all of them espousing some version of universal health care and carrying on about the terrors of private health insurance, one would even think that the welcome winds of change were blowing through the quiet streets of middle America. The reality, unfortunately, is far more complicated, for if the winds of health care change are coming, they are fueling more of a long-tempest than they are a reassuring summer breeze. Despite the hype, despite the recent press, the switch away from our current health care system and toward some form of universal coverage would be a disaster. This paper will explain why, focusing on three basic justifications: superior care, superior savings, and accordance with American values.

The United States may not have the world's best health care system, but this in no way implies that it does not currently possess the best health care system it can. While advocates of universal care point (usually selectively) to the good parts of other country's systems, they tend to ignore the substantial differences between those countries and the United States. We have a massive immigration problem, a huge continental land mass, a strong tradition of constitutionally mandated federalism, and a culture of citizens that works more, eats worse, and exercises less than in other countries. No other single country with universal care can lay claim to those same conditions, and so it seems beyond all leaps of logic to assume that their systems of care would work equally well in the United States. Instead, it seems more likely to assume that the system we have is the system that is best suited to us.

This does not mean we like the system we have, but it does mean that it works. As noted thinker and political philosopher F. A. Hayek once noted, “Constraints on the practices of the small group, it must be emphasised and repeated, are hated... the individual following them, even though he depend on them for life, does not and usually cannot understand how they function or how they benefit him” (13-14) And yet, Hayek continues, precisely because we dislike them we should realize that we would have changed them already if doing so would do any good: “Disliking these constraints so much, we hardly can be said to have selected them; rather, these constraints selected us: they enabled us to survive” (14). Hayek's comment is prescient when applied to the debate over health care, for one of the fundamental realities often ignored by advocates of universal care is the harsh truth of scarcity: medical supplies, from pharmaceuticals to blood to actual life-saving equipment like MRIs, as well as doctors and medical facilities, are not infinite. Instead, the blood we use on one patient is blood no longer available for another. The private insurance model works to limit the provision of care to those instances in which care is actually most acutely needed, so that the pint of blood really is there for the patient who needs it. This produces harsh outcomes, sometimes even fatal outcomes, and we should be sad and outraged. But out emotional responses do not constitute an informed objection, even if they do evidence our humanity. What we need to realize is that the tragedies would be more frequent and more horrific, without the invisible hand of economic reality to guide medical decision-making.

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