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The Nightmare of Universal Health Care
by Scott Shore
03 March 2004RX

It is a mistake to think that we must either put up with our current system or take a leap into the darkness of socialized medicine.

I am not a doctor, a trial lawyer or an executive at an insurance company. I have no particular ax to grind one way or the other.  I am among the millions who pay exorbitant insurance premiums every month and feel that quality of care is going down as price goes up. There is no doubt in my mind that the growth rate of health care expenditures must be curbed both as a cost to society and a cost to patients. Something must change. Many people have put their faith in the idea of government control of the health care system. Many point to Canada or other industrialized nations that have gone that route. The answer of universal health care, however, is a solution that we shall regret for years to come. Do you really want the government that gave us the public school system to provide our health care? 

Let us start by stating some obvious truths. The demand for “health” is virtually inelastic. For non-economists that means that people have an infinite demand for health and to heal illness. Even with their own money, most people will give up their homes and other assets to prolong their lives and rid themselves of pain, suffering and serious illness. Admittedly some people would rather shorten their lives than go through endless medical procedures which might only give them a few more months or years of life. The vast majority, however, will quite understandably cling to life until the very end, even if this means going through a lifetime of savings. If medical care were paid for by anonymous “taxpayers” as an entitlement there would be little reason to demand anything but the most advanced and expensive treatment, if it had even the slimmest chance of working. Human suffering is a terrible reality and one which we would all prefer either to avoid altogether (i.e. to die peacefully in our sleep at a ripe old age in good shape) or to pay to minimize it. Given infinite demand and limited supply, there are only a few options. We can temporarily go on a mad health care spending spree and ultimately bankrupt the country. 80% of the GDP would go to prolong the last few weeks of citizens’ lives. After this spree, we would all be poor and there would be no economy left to support health care. This first option seems a bit short-sighted.

There are other options. We can either ration health care or deliver universal second-rate health care. These are, in fact, the only viable options.  With limited dollars and a universal “entitlement,” somebody -- politicians in the case of government -- will have to decide who gets how much health care and the quality of the care.  Should Parkinson’s patients get more access to the system than Alzheimer’s patients? What about cardiac patients? How much for heart failure, valve problems or heart attacks? How much money is set aside for various types of cancer patients? Should money be allocated by the severity of sickness or the chance of cure? Should society determine the economic value of different patients -- for example a breadwinner for six would get more money than a single person? If we establish a standard for age should we favor the young (who have many more years of life) or the old (who need care chronically)? What procedures get preference? Do we use the most economical (serve the most people) or the most effective (fewer patients but better outcomes) procedures? Should social outcasts, “unproductive” artists, non-taxpayers or those with a criminal record be at the bottom of the priority list for health care? In essence, we have given enormous power of choice over our lives and body to the State. Some government sponsored “Medical Board” will choose Life and Death for its citizens? Is this really what the leftist, civil liberties crowd wants?? To this writer the whole system sounds ghoulish and ripe with opportunity for favored access to the politically connected. Is political influence or politically determined disease-priorities a better means of rationing health care than private insurance or tax write-offs of a reasonable sum in a Health Security Account?

I have another concern about government-controlled health care.  All these folks talk about the so-called civil liberties violations of the Patriot Act. Can you imagine Big Brother having all your medical records? How long do you think it would take before the healthcare system became a big “background check” for the government. The US Senate can’t even ensure the privacy of its own email system and we are supposed to have our most private health concerns known to the government. What if a person goes through a period of depression or requires mental health treatment at some point in life? How long before government jobs either require (or suggest) that your records be made available. What about a person who has worked to overcome alcoholism or an addiction? Will the government be able to dictate certain medications or other regimens to high-risk patients with the threat that failure to follow government directions is irresponsible and forfeits your coverage? Will the whole healthcare system become a metaphor of a UNIVERSAL SEATBELT?  What if people choose not to follow the directions of their appointed doctors? Will the government pay for homeopathy, aromatherapy, reiki…? If not, why not? Who determines what medicine is “official” and what medicine is not permitted? If the AMA decides that homeopathy is quackery (and against their financial interests) does that suggest that the beneficiary of universal health care is involved in reckless behavior? Should the taxpayers pay for reckless behavior? If an overweight person has been warned three times to go to a diet clinic or lose a certain number of pounds and does not, are we responsible to pay for his or her diabetes treatment? Are smokers covered under the system? It would seem to me that a tax-funded program justifies the intrusion of the taxpayers through the government into the habits of all Americans.  The real ugly truth is that the very wealthiest Americans will opt out of this monstrous system and the country will have two distinct classes of healthcare.
Certainly reforms can be made in the current health care system.  The creation of Health Savings (Security) Accounts, the capping of excessive “pain and suffering” components of lawsuits against health care providers and an end to discriminatory international drug pricing. Pharmaceutical companies should not expect to recapture all the fixed and R&D costs in the US and then sell at variable cost to socialized countries.  That will mean lower drug prices for Americans and higher drug prices of patented American drugs abroad. If poorer countries have to pay more, that’s the way it goes. Pharmaceutical companies can’t expect a free market in the US that subsidizes socialist markets abroad. Ultimately new technologies like telemedicine and improved devices will flourish in a responsibly streamlined Federal approval process.  Important drugs should be made available with different levels of FDA ratings. In other words, if a patient wants to try a medication that may have higher risks, that should be the patient’s choice -- not the Federal Government.  It is a mistake to think that we must either put up with our current system or take a leap into the darkness of socialized medicine. There is a tremendous amount of research and literature that shows the value of a market-driven healthcare system. It’s less expensive, better care and more humane.

Scott Shore is a political commentator and management consultant in Providence, Rhode Island.

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