[해외논단] 美 건강보험 개혁의 감춰진 진실

무소불위에 가까운 권력 장악
의사들 수입 40%로 감소 예상

오바마 행정부가 보건보험 개혁 법안의 의회 통과를 끈질기게 추진한 이유는 무엇일까. 대단히 큰 가치가 있기 때문이다. 이런 유형의 보건보험 국유화가 중도 좌파 문화를 미국에 영구적으로 정착시키는 지름길이라고 필자는 지난 여러 해 동안 주장해 왔다.

마크 스타인 美 칼럼니스트

보건보험이 국유화될 경우 시민과 정부의 관계를 근본적으로 재규정하여 정부는 무소불위에 가까운 권력을 장악하게 된다.

서구세계의 대부분 지역에는 아직도 명목만 남은 보수주의 정당들이 명맥을 유지하면서 간혹 총선에서 승리하지만 집권효과는 별로 없다. 즉 중도 우파 정당들은 집권을 해도 힘을 쓰지 못한다. 무늬만 보수 정권 행세를 했던 프랑스의 자크 시라크 정부가 대표적인 사례다.

어떤 이념의 정당이 선거에서 이기든, 집권당에 구애받지 않고 제 갈 길을 가는 방대한 좌파 관료체제의 등에 얹혀 가는 꼴이 되기 때문이다. 즉 정치는 다당체제이나 정부는 1당체제이다.

미국 공화당이 이런 상황을 파악하지 못하는 가운데 민주당은 대선이나 중간선거의 승리보다 더 중요한 사안이 있다는 것을 안다. 정부가 일정 규모 이상으로 커지면 계속 늘어나는 정부기관의 일자리를 국가주의자들이 메우게 된다. 그런 국가주의자들 가운데는 골수 공산주의자들 외에 사회개조, 다문화주의, 온정주의를 지지하는 국가주의자들이 포함된다.

2차대전 이후 유럽 복지국가의 짧은 역사에서 중요한 요소는 종신 대통령이 아니라 종신 관료체제였다. 독일에서는 보수파가 집권했고 영국에서도 곧 보수파가 집권할 전망이지만 좌파는 별로 초조해하지 않는다. 왜냐하면 대처 같은 예외를 빼면 대부분의 우파정권들이 다음에 좌파정권이 등장할 수 있는 길을 닦는 역할 이상을 하지 못하기 때문이다.

그런 일을 지금 미국 공화당이 하고 있다. 공화당의 거물 정치 자문가들은 민주당이 인기 없는 보건보험 개혁 법안을 통과시키기를 원한다. 법안이 통과되면 불만을 품은 유권자들이 11월 중간선거에서 공화당을 압도적으로 지지하여 승리하도록 만들 것이란 이유에서다. 일단 중간선거에서 공화당이 이기면 통과된 개혁 법안을 무효화할 수 있다는 것이다.

민주당의 관점에서 보자. 건강보험 개혁 법안을 의회에서 통과시킨 다음 2010년 선거에서 패배할 경우 공화당과 몇 년 동안 어색한 동거정부를 유지하게 될 것이다. 2012년 대선에서 민주당이 이겨 재집권했을 때 국유화된 보건보험제도는 온전히 남아 있을 것이다.

이 보건보험 제도는 정부가 진행하는 절차의 특성상 더 많은 예산과 인력을 흡수하여 2년 전 법의 통과 때보다 훨씬 더 비대해져 있을 것이다. 이는 중간선거 패배를 보상하고도 남는 성과다.

복지제도의 비교대상으로 언급되는 영국이나 프랑스도 이런 규모의 보건보험 개혁에는 아직 착수하지 않았다. 오바마의 보건보험 제도는 미국 경제의 6분의 1을 정부에 합병시키는 것을 의미한다. 즉 영국이나 프랑스 경제 전체와 맞먹고 인도 경제의 2배가 넘는 산업부문을 정부 조직 속에 편입시키게 된다.

인구가 3억이며 선진화된 미국 사회에서 이처럼 큰 규모의 경제를 중앙 집중화하려는 시도는 없었다. 유럽연합조차도 종합적인 보건보험 개혁을 꿈도 꾸지 못한다. 다만 구소련이 시도했으나 어떤 결과를 빚었는지 누구나 안다.

오바마의 개혁은 보건보험이나 비용통제의 문제가 아니다. 이 제도는 독단적으로 의료비를 통제하거나 지불을 거부하게 된다. 이 제도가 시행될 경우 의사들의 수입은 지금의 40%로 줄어들 것으로 예상된다. 의사들이 부동산 중개업자나 회계사로 전업하려면 지금이 재취업 훈련에 적합한 시기다.

정부 보건보험 제도는 의료개선에 목적을 둔 것이 아니라 정부의 확장에 목적을 두고 있다. 이런 시각에서 볼 경우 지금 미국 민주당이 하는 일을 충분히 이해할 수 있다. 

마크 스타인 美 칼럼니스트

워싱턴타임스·정리=오성환 외신전문위원

It's not about health care
By Mark Steyn

So there was President Obama, giving his bazillionth speech on health care, droning yet again that "now is the hour when we must seize the moment," the same moment he's been seizing every day of the week for the past year, only this time his genius photo-op guys thought it would look good to have him surrounded by men in white coats.

Why is he doing this? Why let "health care reform" stagger on like the rotting husk in a low-grade creature feature who refuses to stay dead no matter how many stakes you pound through his chest?

Because it's worth it. Big time. I've been saying in this space for two years that the governmentalization of health care is the fastest way to a permanent left-of-center political culture. It redefines the relationship between the citizen and the state in fundamental ways that make limited government all but impossible. In most of the rest of the Western world, there are still nominally "conservative" parties, and they even win elections occasionally, but not to any great effect. (Let's not forget that Jacques Chirac was, in French terms, a "conservative.") The result is a kind of two-party-one-party state: Right-of-center parties once in a while will be in office, but never in power, merely presiding over vast leftist bureaucracies that cruise on regardless.

Republicans seem to have difficulty grasping this basic dynamic. Less than three months ago, they were stunned at the way the Democrats managed to get 60 senators to vote for the health bill. Then Scott Brown took them back down to 59, and Republicans were again stunned to find the Democrats talking about ramming this thing into law through the parliamentary device of "reconciliation." And, when polls showed an ever larger number of Americans ever more opposed to Obamacare (by margins approaching 3-to-1) Republicans were further stunned to discover that in order to advance reconciliation, Democratic "reconsiglieres" apparently had been offering (illegally) various cosy big-government sinecures to swing-state Congress members to induce them to climb into the cockpit for the kamikaze raid to push the bill through. The Democrats understand that politics is not just about Tuesday evenings every other November, but about everything else, too.

A year or two back, when the Canadian Islamic Congress attempted to criminalize my writing north of the border by taking me to the Canadian "Human Rights" Commission, a number of outraged American readers wrote to me saying, "You need to start kicking up a fuss about this, Steyn, and then maybe Canadians will get mad and elect a conservative government that will end this nonsense."

Makes perfect sense. Except that Canada already has a conservative government under a Conservative prime minister, and the very head of the "human rights" commission investigating me was herself the Conservative appointee of a Conservative minister of justice. Makes no difference. Once the state swells to a certain size, the people available to fill the ever-expanding number of government jobs will be statists - sometimes hard-core Marxist statists, sometimes social-engineering, multi-culti statists, sometimes fluffily "compassionate" statists, but always statists. The short history of the postwar welfare state is that you don't need a president-for-life if you've got a bureaucracy-for-life: The people can elect "conservatives," as the Germans have done and the British are about to do, and the left is mostly relaxed about it because, in all but exceptional cases (Margaret Thatcher), they fulfill the same function in the system as the first-year boys at wintry English boarding schools who for tuppence-ha'penny or some such would agree to go and warm the seat in the unheated lavatories until the prefects strolled in and took their rightful place.

Republicans are good at keeping the seat warm. A big-time Republican consultant was on TV crowing that Republicans wanted the Democrats to pass Obamacare because it's so unpopular it will guarantee a Republican sweep in November. OK, then what? You'll roll it back - like you've rolled back all those other unsustainable entitlements premised on cobwebbed actuarial tables from 80 years ago? Like you've undone the federal Departments of Education and Energy and all the other nickel 'n' dime novelties of even a universally reviled one-term loser like Jimmy Carter? Andrew McCarthy concluded a shrewd analysis of the political realities thus:

"Health care is a loser for the Left only if the Right has the steel to undo it. The Left is banking on an absence of steel. Why is that a bad bet?"

Indeed. Look at it from the Democrats' point of view. You pass Obamacare. You lose the 2010 election, which gives the Republican Party co-ownership of an awkward couple of years. And you come back in 2012 to find your health care apparatus is still in place, a fetid behemoth of toxic pustules oozing all over the basement, and, simply through the natural processes of government, already bigger and more expensive and more bureaucratic than it was when you passed it two years earlier. That's a huge prize, well worth a midterm timeout.

I've been bandying comparisons with Britain and France, but that hardly begins to convey the scale of it. Obamacare represents the government annexation of "one-sixth of the U.S. economy" - i.e., the equivalent of the entire British or French economy, or the entire Indian economy twice over. Nobody has ever attempted this level of centralized planning for an advanced society of 300 million people. Even the control freaks of the European Union have never tried to impose a unitary "comprehensive" health care system from Galway to Greece. The Soviet Union did, of course, and we know how that worked out.

This "reform" is not about health care, and certainly not about "controlling costs." As with Medicare, it "controls" costs by declining to acknowledge them or pay them. Dr. William Schreiber of North Syracuse, New York, told CNN that he sees 120 patients per week - about 30 percent on Medicare, 65 percent on private insurance plans whose payments take into account the Medicare reimbursement rates, and about 5 percent who do it the old-fashioned way and write a check. He calculates that under Obamacare, for every $5 he makes now, he'll get $2 in the future. That suggests now would be a good time to retrain as a Realtor or accountant or the night clerk at the convenience store. Yet Rep. Louise M. Slaughter, New York Democrat, justifies her support for Obamacare this way:

"I even had one constituent - you will not believe this, and I know you won't, but it's true - her sister died. This poor woman had no dentures. She wore her dead sister's teeth."

Is the problem of secondhand teeth a particular problem in this corner of New York? I haven't noticed an epidemic of ill-fitting dentures on recent visits to the Empire State. George Washington was said to have had wooden teeth, but presumably, these days, the Sierra Club would object to the clear-cutting. Yet, even granting Mrs. Slaughter the benefit of the doubt, is annexing the equivalent of a Group-of-Seven economy the solution to what would seem to be the statistically unrepresentative problem of her constituent's ill-fitting choppers? Is it worth reducing the next generation of Americans to indentured servitude to pay for this poor New Yorker's dentured servitude?

Yes. Because government health care is not about health care, it's about government. Once you look at it that way, what the Democrats are doing makes perfect sense. For them.

sinecure:한직 lavatory:화장실, 변기 premised:전제로 한 actuarial:보험통계의 steel:무력