When it comes to fixing our healthcare system, there are several fundamental disconnects between progressivism and conservatism. One of these, perhaps the main one, relates to the advisability of collectivizing healthcare expenditures via taxpayer subsidization and debt accumulation. Conservatives tend to view the collectivization of healthcare financing as the root of the problem; whereas progressives tend to view it as the answer to the problem. (Obviously, for this to be true, among other things conservatives and progressives must be defining “the problem” differently.)

As a conservative I hold to the view that any real fix of our healthcare mess is going to require individuals to take on much more of the financial responsibility for their own health, and that doing so is both morally desirable and fiscally mandatory. I also believe it is going to be extraordinarily difficult to get a substantial proportion of the American public to accept personal responsibility for something that, they have been convinced, is and ought to be a right. I think most of us here understand how difficult that will be. But as we formulate our arguments in this regard, we are obligated to take a sober look at another major issue we face as we fight to individualize healthcare expenditures. It is an issue which, I fear, judging from the content of the debate, has not yet occurred to many of us.

While we conservatives (and especially libertarians) might like to think otherwise, when you look at the big picture it becomes apparent that collectivizing the bills has not been the unmitigated disaster we like to claim. There have been substantial benefits, and chief among these is the incredible progress we’ve made in medical learning and medical technology over the past half century or more. In fact, the taxpayer subsidization of healthcare has been the catalyst for an incredible golden age of medicine.

It turns out that, the moment everything that is deemed “healthcare” is “covered” by taxpayer-supplied or taxpayer-subsidized health insurance, and therefore payment is guaranteed for virtually any medical product by the full faith and credit of the United States government, a huge amount of investment money suddenly appears to fund research and development in every aspect of medicine you can imagine. And the next thing you know, you’ve got medical progress.

Medical entrepreneurs figured out in about a minute and a half that to be successful, all they had to do was to come up with a product that offered a measurable benefit to some group of people with some illness — no matter how marginal that benefit might be, or how expensive their product — and they were certain to have a ready market for their product, not to mention a customer who would pay the going rate without complaint (well, for at least the first several decades). The more products you could develop, the greater your profits. And so, especially beginning in the 1960s, R&D budgets went through the roof.

An utter explosion in medical progress, virtually all of it arising in the United States, began at that time. With a bit of sputtering, it continues until this day. Except for the Manhattan Project and the moon shot, the kind of concentrated scientific effort that was applied to advance the science of medicine during these few years is unsurpassed in human history. And like the Manhattan Project and the moon shot, it was ultimately funded by the taxpayer.

I am of course not arguing that everything that was developed and sold to the healthcare marketplace during this time has been non-crap. There has been plenty of crap to please anybody.

However, the medical technology that has been developed since the 1950s has done immeasurable good. Uncountable heart attacks and strokes have been prevented or aborted; cancers have been cured or beaten back; people who formerly would have been crippled can conduct normal daily activities without assistance; and some scourges of mankind (such as smallpox and polio) have been nearly vanquished altogether.

With all this good stuff, however, has come a big problem. We are spending ourselves into oblivion. For, as a side effect of this explosion in medical progress has come an explosion in medical spending, spending to such a degree that, unless we bring it under control, we are headed for societal chaos.

The point I am trying to make is that the rate and magnitude of medical progress we have enjoyed in our lifetimes has been financed by a collectivized, no-limits, ultimately disastrous payment system, and not by “natural” market forces.

It is certainly possible, in theory at least, to devise a more fiscally responsible payment system, based to a much greater extent on personal responsibility, while still allowing incentives to exist for medical progress to proceed. In fact, medical progress is poised for a major leap forward given today’s technological advances. But under a new, less collectivized system, the type of progress we see, its pace, and the way it becomes distributed across the population, will look a lot different than it does today — a lot different than we have all come to expect. We had better understand these changes, and manage expectations accordingly. If we are not prepared to do so, we will be vulnerable to withering attacks, for yet another reason, by the fairness mavens of the left.