Anteckningar från USA (6) Om grundläggande frihetsvärderingar
Jag gjorde i höstas en lång resa i USA, till största delen i västkuststaterna. Det här är en anteckning från den 31 oktober efter ett samtal med en intressant Albuquerquian. Samtalet handlade om sjukvårdsreformen i allmänhet, och om hur det kommer sig att amerikanen har en så rigid syn på ”government” i synnerhet.
Det längsta samtalet hade jag med Butch Phillips, fotograf i 60-årsåldern med egen studio och utställning i en lokal nära torget. Det visade sig att han var högst engagerad i, och mycket välinformerad om, den pågående debatten om det amerikanska vårdsystemet. (Dessutom var hans fru läkare.) Han var mycket kritisk mot systemet som det nu ser ut, och mot politikernas oförmåga att ta de nödvändiga radikala greppen. Han menade att USA måste på sikt få ett ”single payer system” och han hoppades att förslaget om ”public option” skulle vara en inkörsport till just det.
För min del tror jag att han på den punkten kommer att bli besviken. Public option-modellen, om den nu överhuvudtaget kommer att förverkligas, kommer med all sannolikhet inte att på allvar hota de privata försäkringsbolagens ställning. Frågan är om ens konkurrensen kommer att öka. Det skulle inte förvåna mig om försäkringsbolagens och läkemedelsindustrins lobbyingkrafter, de viktigaste motståndarna till en reform enligt Butch Phillips, kommer att se till att det offentliga försäkringsalternativet blir så omgärdat med regler att det blir en krympling på marknaden.
Jag frågade honom om hur det kommer sig att USA, som annars ordnar sin produktion så rationellt och effektivt, just när det gäller vård- och omsorg har valt, och till stora delar slåss för, ett sekunda system. Det finns bättre lösningar för vårdens finansiering ändå är man politiskt inte villig att acceptera dem. Hans svar var att det hänger samman med grundläggande frihetsvärderingar som sitter djupt hos väldigt många amerikaner. Ju mindre staten lägger sig, ju mindre staten utför, desto bättre. Om det finns minsta lilla möjlighet att låta privata företag ha hand om finansiering och produktion så måste det bli så. Även om marknaden fungerar mindre bra som i fallet vårdens finansiering.
Jag tror att han har helt rätt i sin analys.
Läs hela dagboken här.
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