First of all, there are some realities (not discussed much by politicians) about health care.
(1) There is no possible way the nation can afford to give the very best state-of-the-art medical care to every citizen. Advanced medical care is very expensive, and we have a lot of people in the country. So one way or another any government plan is going to have to make painful decisions, ration some treatments, and deny some people expensive care (the “death panel” scare). In the private market, this is done by economics. If one can’t afford the treatment, or at least the insurance that would cover the treatment, one forgoes it. What are the political ramifications of a government bureaucrat making those decisions for a person?
(2) Cost control by capping hospital and physician payments will simply result in fewer physicians, and perhaps fewer hospitals, even while they have more people to service. Just as rent control causes scarcity of rental properties (for reasons obvious to everyone except the politicians who impose them), and price controls cause scarcity of the product, so capping physician incomes will simply reduce the incentive for people to undergo the arduous and expensive training needed to become a physician.
(3) In no other area has government control of an activity ever proved more efficient than market controls. There are obvious reasons for this – government agencies lack completely the competitive market forces that keep private endeavors lean and cost-competitive, and make them attend to the needs of their clients. Hence government agencies always become bloated and expensive, and relatively inefficient in delivering the services they are supposed to deliver, and relatively unresponsive to their clients. Why would a government health care agency be any different?
(4) This is not a new experiment. Europe has many examples of government-run health care programs, and so one can simply look at how they have done. In general, they have not done as well. In a few areas they seem better than our system, but in many areas they are far worse. Do we really want to have a system where the waiting list to see a (government) doctor is measured in months? A 2006 British study showed that on average British women diagnosed with breast cancer waited 122 days to begin treatment – and that was for a diagnosed disease.
A 2009 British study reported:
Long wait times have become second nature, despite dangerous consequences. In the period between 2001 and 2006, the United Kingdom saw the median wait time increase from 44 to 51 days for hospital admission after the decision to admit had been made. In 2004, according to a BBC report, waiting times in Scotland and England were 8 months for cataract surgery, 11 months for hip surgery, 12 months for knee replacement, 5 months for repairing a slipped disk, and 5 months for hernia operations. In 2007, in 42% of the localities surveyed, hospitals had to turn women in childbirth away because their maternity wards were full.In the face of these facts, it is clear that a government-run single-payer system is going to have problems, and while it may increase the number of people nominally covered, it is going to reduce the quality of care for everyone. (as one wag said, socialism allows everyone to share the misery equally). And it may bankrupt the government, if Medicare hasn’t already done that.
I’m certainly not clear what the solution ought to be. The assumption that everyone in the nation “deserves” the best health care is clearly flawed. We don’t argue that everyone in the nation “deserves” the grandest possible house or car, or that every child in the nation “deserves” to go to Harvard or Yale or MIT. Those arguments are clearly absurd. So why isn’t the argument that everyone “deserves” the best health care equally absurd? Perhaps people “deserve” the level of health care (or health insurance) they are willing and able to pay for. If they can’t pay for what they really want, it is probably because of other life choices they have made – to spend their money elsewhere, to not get advanced education, to not take a high-paying and high pressure job, etc. etc.(Yes, yes, I know that liberals will immediately argue that some people simply couldn’t do those things because of their abilities and circumstances – true, but irrelevant in the real world, which is at bottom a competitive world.)
Perhaps there is some “minimum” level of health care that ought to be available from the government to everyone, but beyond that people can choose (or not) to pay for or buy insurance for better and more complete treatment. That is more or less how Medicare works now, but the Medicare “minimum” level is pretty high, probably higher than the nation can afford in the long term.
In any case, it ought to be evident that the “single-payer” government system of which some liberals are so ideologically enamored is not likely to be the solution, and may indeed make the situation much worse.
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