Does American healthcare need Henry Fielding?

Ironically, I’ve been stuck at home sick much of the week, while the healthcare debate has been unfolding at the Supreme Court in Washington.

I’ve followed those developments closely, but I’ve also been reading about another fascinating chapter in the long evolution of democratic governments in the West.

It turns out the idea of having a professional, government-operated police force is a relatively late concept.

The first formal police force organized in London was created – weirdly enough – by Henry Fielding, author of the classic novel “Tom Jones.”

Prior to Fielding’s organization of the Bow Street Runners, you basically had two choices when it came to protecting yourself from crime, both involving what libertarians might describe as elements of the free market.

You went about with your own armed gang, which was a common practice for the aristocracy and wealthier merchants, or you hired a vigilante known as a “thief-taker” to try to capture any criminal who had already done you wrong.

When Fielding tried to organize a force of actual beat cops, paid for by Parliament, the idea was initially dismissed and derided as a dangerous expansion of big government, an infringement on liberty.

People literally worried about the emergence of a “police state.”

But those ideas were soon swamped by the simple reality that London — one of the most prosperous cities on earth — was growing into a Somalia-style war zone, governed by bandit-leaders and their incredibly violent gangs.

The vast majority of average citizens couldn’t afford the “free market” forms of security that protected wealthier citizens.  Murder, rape and kidnapping were as common in the city of King George as they are now in lawless corners of Africa.

Thinking about that moment in the mid-1700s, I couldn’t help but ponder the analogy to our modern healthcare debate.

A lot of Americans think it represents a dangerous expansion of the government’s power if we move toward an arrangement where we citizens are required by law to purchase insurance coverage.

The “police” state concerns of the past have been replaced with the “nanny” state concerns of today.

But I wonder if those ideological concerns can withstand the new simple reality:

Tens of millions of Americans now lack healthcare and, as a result, we’re seeing more and more “third world” style crises in our communities, including shamefully high infant mortality rates, and people dying from treatable ailments.

Obviously, the free market offers healthcare solutions to anyone with the money to pay for them.

But just as police protection was viewed as a luxury in the 1700s, for many of our neighbors proper healthcare is now a kind of out-of-reach pipe dream.

The last time the World Health Organization ranked national healthcare systems, ours had fallen to number 37, trailing Costa Rica and Morocco.

For their part, Londoners in the Georgian age didn’t accept a police force and set aside their libertarian instincts out of altruism, in order to protect their more vulnerable neighbors.

They did so because the alternative to “big government” was a kind of gridlock of fear, a city of chaos in which free enterprise and prosperity were being stifled by crime.

I wonder if the same eventual evolution won’t occur in America.  We will resist the notion of government-organized healthcare until the alternatives are simply too gruesome, and too disruptive.

I suspect that only when enough Americans have died prematurely, or when our prosperity is seriously threatened by a healthcare system that is too costly and unwieldy, will we finally reach a consensus that some government fix is required.

Does this mean that we will have taken another step along the slippery slope toward despotism?  Maybe.

But a lot of us are now quite comfortable with the idea of having policemen on the beat at night, just as we have grown satisfied with having a government-run education system.

Yes, it is important to maintain proper checks on the size and strength of government.  But it turns out that having a healthy, safe, and educated population is no less important for the maintenance of liberty.

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40 Comments on “Does American healthcare need Henry Fielding?”

  1. Peter Hahn says:

    The other part of the health care system that is bringing us down is the cost. Its not just that too many people are sick and don’t get coverage. The rest of us that do get good health care get it at a cost that is unsustainable.

  2. mark wilson says:

    Completing the circle, the other consuming news story of recent weeks, the shooting of Trayvon Martin by an armed citizen in what—evidence suggests*—was an act of misguided vigilante justice, shows the kind of “public safety” we might have had (and might yet have) in the absence of a regulated police force.

    *Evidence also seems to suggest that it shows the limits of the regulated police force, as well.

  3. Jim Bullard says:

    A very thoughtful perspective Brian. I’ve been laid up sick this week too so I literally “feel your pain”. You have my full sympathy and wishes for a speedy recovery.

  4. PNElba says:

    I wonder if the same eventual evolution won’t occur in America. We will resist the notion of government-organized healthcare until the alternatives are simply too gruesome, and too disruptive.

    Yes. So the answer is to go along with everything the conservatives are proposing: the Ryan budget, dismantling Medicare/Medicaid, cutting SS, ignoring climate change, continuing tax cuts for the rich and subsidies for oil, increasing the defense budget, etc. It appears the majority of Americans support these changes. Ok, let’s have them and see how they work out.

  5. Paul says:

    Before I support Paul Ryan’s budget I would like to see the alternative budget from the senate democrats. But it looks like again this year they will shirk their legislative duty and produce nothing but political rumblings about the other side.

    The house republicans are trying to do things that are very unpopular with many Americans. The democratically controlled senate is doing nothing.

    What a mess.

  6. Joseph M. Liotta says:

    This article is right on. I can’t see the argument that requiring people to purchase health insurance is unconstitutional. The Supreme Court as now constituted will see it differently. They would be wrong and it won’t be the first time. There is one outstanding precedent. The government requires all of us to “buy” social security insurance.

    The problem with the Affordable Health Insurance Care requirement is that the insurance companies can still charge whatever they want and if everybody is required to purchase insurance from them, then the rates will go up. Where is the savings to the individual or to the “system”?

    In my opinion the health care “insurance” should be tied into the social security program/medicare program. Everybody gets covered for the basics as does medicare ar the present time. If individual employers want to supplement this with plans for their employees that can be possible. If anyone wants to purchase supplemental insurance that is also possible. For the unemployed and under employed there could be an expansion of medicaid.

    Don’t let anyone get away with saying that medicare is bankrupt. The federal treasury owes the fund more than 5 trillion dollars. Its first priority must be to pay that back. How? Reinstate the payroll tax and income tax to previous levels. Both side of the political isle are responsible for these demises.

    This country needs to compartmentalize its budgets. 1. Health, 2. Defense. 3. Infrastructure 4. Education and so on. Each of these budgets should be transparent and non can borrow for the other. Each should stand on its own merits. This is a much better way of organizing the funding of our country’s needs and priorities.

    That in my opinion is what is needed. It will take political courage to accomplish this but if it is done the needs of the people of our country will be met. As of now what is happening is hard to swallow.

  7. Walker says:

    Nice article, Brian, but the history behind it is a little shaky, as a look at the Wikipedia article on Police will show.

    Not surprisingly, the concept of governmental law enforcement goes back to ancient China and Greece. Britain seems to have lagged well behind the rest of Europe, but even the Anglo-Saxons had early law enforcement provisions. The Bow Street Runners appear to have been the first police force in London, but certainly not in the world.

  8. brian mann says:

    Walker – Right. In like fashion, the idea of government-run healthcare isn’t new to the world. There are a lot of precedents.

    And so, I think it’s fair to ask, in countries like France, Germany, Switzerland, etc., has the presence of government healthcare led to despotism?

    –Brian, NCPR

  9. Phil says:

    Hello New Yorkers! It seems to me a major part of the hearing before the Supremes this week was about whether the Feds have the right to mandate expensive programs (e.g. expanded Medicaid) on the states and then expect the states to shoulder much of the cost.

    We know all about this in New York. Our legislators have been doing this for years, pusing costs of programs onto counties and then bragging about how much money they have saved the taxpayers. Most counties complain about this every year and then raise property taxes again and again.

    Are Washington legislators any different from our state legislators? I hope the Supremes reject Obama Care so that sensible health care reform can be created that both expands coverage and reduces costs.

  10. Walker says:

    The last time an effort to do something about health care was shot down, it was eighteen years before anyone was ready to bring it up again. During that time, our health care costs climbed from under 14% of GDP to over 16%. Countries with universal health care systems are spending about 10% of GDP on health care.

  11. JDM says:

    Walker: “Countries with universal health care systems are spending about 10% of GDP on health care.”

    And they’re soaring ever higher!

    “According to World Bank figures, public expenditure on healthcare in the EU could jump from 8% of GDP in 2000 to 14% in 2030 and continue to grow beyond that date. ”

    The only thing we can be sure of is this: if we let the government try to fix the problem, the problem will not get fixed, and it will cost us 3x to 4x just because the government got involved.

    The SC is going to pass judgment on the last, greatest attempt for government to solve this issue. They will give it a big, fat, fail!

  12. Peter Hahn says:

    JDM “the only thing we can be sure of …” thats silly

    “Countries with universal health care are spending about 10% of their GDP on health care” WE are already at 17% plus, and we are soaring too – more than they are,. They have the government run health care, We have a largely privately run system.

    Think about it.

  13. PNElba says:

    “The democratically controlled senate is doing nothing.

    What a mess.”

    Last I heard the Democrats did not hold 60 seats in the Senate.

  14. knuckleheadedliberal says:

    JDM, did you even read what Walker wrote?

  15. PNElba says:

    I’m guessing JDM didn’t read his entire tiny url article. It’s actually pretty good. Here are a couple of things I came across:

    “Healthcare spending will continue to rise, not only because of the many inflationary drivers outlined in Part I, but because of growing recognition that better health is linked with greater national wealth.”


    “a US think tank, looked at a number of diseases, and found that the loss
    to the US economy owing to the lower productivity of the affected individuals was far greater than the government’s expenditure on treatments for those conditions.”


    “By 2030 the outlay will be more than recouped by society through the enhanced productivity and longer working lives of people who have benefited from medical advances.”

  16. Mervel says:

    The current health care system is probably unsustainable. That is why I would oppose an expansion of that system even further. 40% of americans, alreayd get government funded healthcare, either through medicare, medicaid or they work for the government. Essentially we have already seen what the future of government health care in the US is.

    Government health care or government provided health care does not have to look like the monster we have come up with however.

    The first step is a total restructuring of that industry, until that happens this is all a joke.

  17. PNElba says:

    From JDM’s link:

    Chart 8. Total cost of treatment of chronic disease in USA – $277 billion.

    Lost economic output due to chronic disease in USA – $1.047 billion

    Odd. Treating disease actually saves money.

  18. Mervel says:

    I know that is why we need MORE of the current health care business!

  19. JDM says:

    Thanks for reading and reciting parts of the article PNElba.

    It makes my point that the last thing we need is for government to get involved and mess things up.

    Let’s hope the Supreme Court frees us up from the Obamacare debacle and we get a stab at real health care reform.

  20. JDM says:

    And, here’s Lou Dobbs explaining information Senator Jeff Sessions introduced on the Senate floor:

    $17 Trillion in hidden costs that Obamacare snuck into the system, that no one, up till now, has even noticed.

    Those waskely wabbits are up to no good, again!

    Obamacare – original price tag: $900B over ten years
    CBO recent scoring: $1.7 Trillion over ten years
    Jeff Sessions report: $17 Trillion over ten years. (He used the same “optimistic” projections that Obama used to get this number).

  21. JDM says:

    And before you pooh pooh Lou Dobbs and Senator Sessions, note this:

    The Obama administration is not coming forth with anyone to dispute these numbers.

    If they do, post them here, please.

  22. tootightmike says:

    I think the Affordable Care Act suffers from a lack of publicity. I have paid attention to this issue, listened to the news faithfully, read the written stories, and endured the wrangling of the political parties….but it wasn’t until this week that I understood the tax penalty part. It wasn’t until this past Wednesday that I came to understand the way that the subsidies would work. Both of these parts of the legislation look like very good and workable ideas…so why didn’t I (we) hear them explained until now??
    The problem is that we have allowed this entire discussion to be hijacked by a few very wealth players…they have colored this as an arbitrary cost forced onto us by an overbearing government, when actually it could be easily and equally be characterized as a giant giveaway to the poorer classes.
    Admittedly, I did not read the Affordable Care Act. I doubt that anyone here did. We have allowed our opinions to be shaped by our shepherds, and I dearly hope that we do not lose this legislation before we even understand it.

  23. knuckleheadedliberal says:

    JDM, “Let’s hope the Supreme Court frees us up from the Obamacare debacle and we get a stab at real health care reform.”

    Is that an admission that we need single payer universal health care?

  24. Walker says:

    JDM, as for your Jeff Sessions revelation, I tried searching for “Jeff Sessions” “$17 Trillion” and all I came up with was hard right websites. So I went to the two most reliable conservative newspapers, the Wall St. Journal and the Washington Times. Neither one of them saw fit to do a story on the Sessions blockbuster. I think that pretty much tells the story. If you can find a reliable news journal taking the story seriously, I’d be interested to see it.

  25. Jim Bullard says:

    JDM quotes Walker: “Countries with universal health care systems are spending about 10% of GDP on health care.”

    And comments “And they’re soaring ever higher!”

    The US spent 16% of GDP on health care in 2007. It is now over 17% and soaring higher. Those countries with universal heath care are not only spending less than us but they are getting far better outcomes. The US recently dropped to 37th in overall quality and our life expectancy is 50th. That alone should tell us that there is something to be learned from those with universal health care. We have great technology but poor access. Universal access is what makes the difference.

  26. PNElba says:

    “It makes my point that the last thing we need is for government to get involved and mess things up.”

    JDM, maybe you should read the article. Most of the proposals, in that article, to remedy the increases in health care cost involve – guess what – true socialized healthcare, unlike what Obamacare does.

  27. PNElba says:

    Wow!!! Another 17 trillion dollars in costs??? Actually it’s over 80 trillion according to some wingnut websites because they include SS funding shortfalls also. Let’s also consider the source – Jeff Sessions, one of the dimmer light bulbs in Congress.

    The additional obligations, when combined with existing Medicare and Medicaid funding shortfalls, leave taxpayers on the hook for an extra $82 trillion in health care obligations over the next 75 years.

    But I have a few questions. Who did the analysis? Why did they include figures from existing Medicare and Medicaid funding shortfalls when the ACA actually addresses lowing the costs of those programs? And, why was analysis over a period of 75 years?

  28. Peter Hahn says:

    That 1.7 trillion number is an urban legend on the conservative blogosphere. The actual CBO report said their new projections were very similar to their old ones (just projected further)

  29. JDM says:

    Walker: “and all I came up with was hard right websites”

    I posted one from Foxnews. I gather you consider that “hard right”.

    Walker: “If you can find a reliable news journal taking the story seriously”

    Jeff Sessions said these words on the Senate floor. If you don’t hear it in the liberal news, then I gather, it didn’t happen, according to you. Jeff Sessions didn’t say the words that his image and mouth were saying while being recorded on a digital recording device.

    Must be “hard right” digital recording devices don’t record “reality”. I’ll have to look into a “liberal” digital recording device and see what it catches.

  30. PNElba says:

    Peter, this 17 trillion “analysis” is different from the 1.7 trillion falsehood that was being spread a week or so ago.

    Well if Jeff Sessions said those words, it’s definite proof of their validity.

  31. Walker says:

    JDM, I have some news for you: not everything said on the floor of the Senate (or the House) is the Gospel Truth. Honest.

    When reliable news organization fail to cover a shocking revelation, you can be pretty sure that it is totally bogus. Whether it comes from the left or the right.

    The Wall Street Journal is a credible newspaper, and they sure aren’t leaning left. Ask yourself, if this was a real story, wouldn’t they cover it? If they don’t choose to cover it, what does that tell you?

    And to answer your question, yes, I consider Fox “News” to be a largely unreliable, hard-right propaganda machine.

  32. Peter Hahn says:

    Also not everything you read on the Internet blog sites is true.

  33. Pete Klein says:

    First, get well.
    Second, something I’ve never understood in the health care debate.
    Any person or group that purchases health insurance knows that the “larger the pool, the lower the cost.” This is what the insurance companies say. They say as the risks are spread to more and more people, the lower the overall cost to the individual.
    Presuming they are telling the truth, doesn’t it make sense that if everyone from the President on down, all 300 plus million of us, is covered by the same plan, the cost is lower for everyone?

  34. JDM says:

    Walker: “And to answer your question, yes, I consider Fox “News” to be a largely unreliable, hard-right propaganda machine.”

    I thought about that after I asked, and I realized I would answer the same if asked about left-leaning CNN, CBS, PBS, NPR, ABC, and a few others.

    I agree, there is worth-while stuff in the Wall Street Journal, which means they must be somewhat balanced if you and I find common ground there.

    I don’t hold up the WSJ and say, “if it isn’t here, it isn’t news” however.

  35. Peter Hahn says:

    Actually there is an actual (but tiny) Fox news, which is supposed to be quite fair. But most of Fox is opinion/entertainment, which is highly partisan and not accurate.

  36. Mervel says:

    Health care is not affordable with our current system, it just is not. Sure who wouldn’t want government paid health care, big corporate drug companies LOVE obama corporate health care, they get VERY rich from this plane so do insurance companies, everyone gets paid except the average taxpayer who does not work in health care.

    It is a scam and worse than our current system which at least has some minor free incentives for cost control.

    Until obama has the guts to stand up to the health care industry he is NO different from Bush giving favors to his energy friends and actually worse since this plan feeds the beast directly with our money.

  37. hermit thrush says:

    It is a scam and worse than our current system which at least has some minor free incentives for cost control.

    not according to the gao:

    Several provisions of PPACA were designed to control the growth of health care costs. The full implementation and effectiveness of these cost-control provisions… would slow the growth in federal health care spending over the long term.

    whereas, if “certain cost-containment mechanisms are not sustained over the long term,”

    Spending on health care grows much more rapidly under this more pessimistic set of assumptions.

  38. Mervel says:

    When was the last time cost control mechanisms worked in any government context?

    The only way you will control this beast is to radically restructure how we pay corporations in this industry.

    Like I said EVERYONE in the industry will make less if you want to have cost control, does anyone really believe that this will happen? I would go with the more pessimistic set of assumptions.

  39. hermit thrush says:

    When was the last time cost control mechanisms worked in any government context?

    sheesh mervel. how about every other country with national health care. i mean, look! these countries have cheaper health care precisely because health care spending is constrained by the government. the affordable care act makes us more like those countries, not less. it’s not perfect, but it can (and will!) be improved down the road. and the aca most certainly does start to reform how people in the industry get paid, for example by shifting away from free-for-service and towards fee-for-quality.

  40. hermit thrush says:

    sorry, should be fee-for-service

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