PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon, as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

The question in the headline was part of a thought-provoking piece this morning in the Wall Street Journal.

It appeared under this headline:

Universal Health Care Makes Politics Sick

Why would a president or prime minister want to be responsible for every single patient in the country?

From London, the author, Joseph Sternberg, asked probing questions about universal health care, often called a “single payer system” in this country – or going back a few years, ObamaCare. And, often in Europe, called “National Health Service.”

Sternberg started his piece this way:

“Elizabeth Warren is making socialized health care her signature campaign issue. Were British politicians not embroiled in their own election season, they might be weighing in with a question about this: Is she insane?”

Britain’s political class, Sternberg writes, knows all too well the perils of a state-run health system, indicated by:

• Cancer survival rates that lag far behind other European countries with more market-oriented health systems
• Winter crises
• Shortages of doctors and nurses
• Rationing
• Interminable waiting times

More from Sternberg: “It’s worth contemplating the ways state-run health care strangles a country’s politics like a python suffocating a pig. As soon as the government takes on full responsibility for health-care provision, health-care provision becomes political. And given the importance voters quite naturally place on their own health, health-care politics becomes the worst sort: Emotionally fraught and inescapable.

“Consider three of the myriad ways this distorts British political life.

• First, no amount of money is ever enough.
• Second, when the government runs health care, every political question boils down to health care.
• Third, and worst of all for a politician, to be the leader of a government that manages health care is to be personally responsible for every sick patient in the country. Every single one.

All of this called to mind for me a seminal issue in my past as a health care lobbyist in Oregon.

Early in my lobbying career, I was heavily involved in what came to be called “the Oregon Health Plan, a version of Medicaid in Oregon. It was an effort by the then-governor, John Kitzhaber, who had experience as an emergency room doctor, to put medical treatments under Medicaid into a specific order of priority based on their treatment efficacy.

Then, the government would fund as much of the list as possible, but not all of it if money was short.

Sounded good.

Didn’t turn out that way.

It led to complaints about whether it was appropriate to ration what should be a right – health care.

Early on, beyond all of the policy rhetoric, a classic case emerged. A young boy served by the Oregon Health Plan needed a heart transplant to survive. The treatment was not high enough on the priority to be covered, so it was turned down.

That produced a huge outcry over how the State of Oregon could let a young boy die.

The Legislature got involved and – no surprise here – the heart transplant was funded beyond the regular Oregon Health Plan budget.

Had I been a legislator at the time I might have voted for the “extra” money, too, given the incredibly serious status of the issue – literally a life or death. Putting treatments in priority order made sense in theory, but not so much in practice.

Now, to be sure, this was a story about one aspect of health care in Oregon– services for low-income citizens under Medicaid, not services for the entire population. Still, it indicates the reality that, under a single payer system, government would be responsible for all patients, including the sick ones.

Sternberg contends: “Nationalizing health care nationalizes bad outcomes, in every sense. Botched care—deadly cancers gone undetected, births gone wrong, autistic patients fatally mistreated—becomes national news because health care is national policy. Voters then expect to hold their politicians accountable for their doctors’ mistakes. Imagine one big rolling VA scandal coupled with the politicization of every instance of medical malpractice, and you get a flavor of what it’s like to read a British newspaper every morning.”

Is that something America wants?

Elizabeth Warren, Bernie Sanders and others would say yes. Others, including those on the political right, would say no.

A better approach that nationalized health care, I contend, would be for a system to be developed that takes the best of Europe and the best of the U.S., merge those credentials, and offer quality health care options, including through smart private health care operatives, such as the hospitals and health insurers I represented for 25 years.

Sternberg gets the last word: “Seven decades into their own misadventure in socialized medicine, British pols have little choice but to labor in this salt mine. Why any American politician would volunteer to do so is a mystery for the ages.”