The Government Healthcare Tar Baby (Opinion)


By: Charles Ormsby – September, 2009

Having consulted with their constituents over the August recess, our elected representatives will be heading back to Washington fully intending to ignore what they were told. Their meetings with voters ranged from respectful (Niki Tsongas) to downright contemptuous (Barney Frank) to non-existent (John Tierney).

Presumably, Tierney knows what’s good for us and he can’t be bothered to mingle with the commoners. While enjoying his Lamborghini-style health insurance plan – paid for by his constituents – he doesn’t want to hear about our preferences when it comes to managing our healthcare choices.

Ooooppppssss … I forgot! Under the government-run healthcare system Tierney intends to vote for, we won’t be making any choices; government bureaucrats, czars and expert panels will make those decisions for us.

So, you have this big lump growing at the base of your skull? How old did you say you were? Hhhmmmm … maybe we can fit you in for a biopsy or MRI next year, but only if demand slackens.

You say you are afraid it is cancerous and may be inoperable by then? Don’t worry. If we did the tests now, we couldn’t operate anyway because your Societal Cost of Health Intervention Test (SCHIT™) score shows that, even if we did bestow treatment on you, you only have four years of socially useful life remaining. Yes, you might hang on longer than that, but what good will you be to society? And the costs of those final years … Oh my God, society can’t afford that!

What did you say? “But it’s my life”? How quaint!

No, you can’t offer to pay for all or part of the cost yourself because, you see, if you buy those services there will be just that much less available to others with a higher SCHIT™ score than you have.

You know that society has just so many resources, so we commissioned a panel of experts to determine how to best distribute them and to minimize societal costs. The experts came up with a model called Determination of Available Medical Necessities™. The DAMN™ model dictates that if your SCHIT™ score isn’t at least five, we can’t allocate such scarce resources; and, it has to be ten or higher to justify surgery or chemotherapy.

Too bad you didn’t contract this problem earlier when your DAMN™ SCHIT™ score was much higher! Looks like you are SCHIT™ out of luck!

Did you say something about death panels? No, no, no, no! We don’t have those. Heaven forbid! Don’t listen to that whacky woman from Alaska. We are just managing limited healthcare resources in the face of excess demand in order to maximize the common good.

What else would you expect from socialized medicine?

“Healthcare is a right” may be the rallying cry prior to passage, but once everyone has a right to it, at no out-of-pocket cost, demand will skyrocket and rationing will be imposed, as it has been in every country that has put government in charge … no exceptions.

There will just not be enough supply to satisfy demand. Someone will have to perform triage. With the government in charge the bureaucrats will need a DAMN™ SCHIT™ score to make the triage decisions appear objective (obviously with a different name, like MOMMY or PUPPY).

Access to healthcare will no longer be a right; it will depend on your score or whatever the government says it depends on. You will have no rights and no recourse, unless of course, you have pull with someone in Washington.

Decisions regarding one’s health and providing resources for one’s healthcare is a personal responsibility. No one has a right to free medical services. Healthcare can’t be a legal right because, if it were, it would impose a legal obligation on others to perform such services which would be tantamount to … slavery.

The imposition of slavery can be masked by paying people to perform the services commanded, but this just shifts the burden of slavery to the broader population in the form of increased taxes. The voter’s resistance to taxes (those selfish lowlifes!) and the demand for healthcare services eventually reach a political balance and we end up losing both the right to manage our own healthcare and the right to keep the fruit of our labors. Only the bureaucrats win.

Compassion for those unable to afford healthcare is a common emotion and is shared by this writer. The seemingly easy way to assuage these feelings is to shift our moral responsibilities to the government.

Unfortunately, government control invariably makes the problem worse. Costs shoot upward and attempts to control costs lead to either denial of care (by force … you can’t have it) or reductions in compensation to providers (by fiat).

If you like the “reductions in compensation” approach, think again. This leads to only two options: either a reduction in quality as competent professionals leave their medical practices (the most likely consequence), or forced labor (competent people forced to serve at wages below their market value).

If you don’t like rationing of service, or reductions in quality/competence, or forced labor … what is the alternative?

Let’s grant that there are a substantial number of individuals that cannot afford, or have great difficulty affording, needed medical care. What can we do without imposing tyranny?

Let’s think about our goals and how we can reasonably achieve them.

Here are goals we can all share: better quality, lower costs, more options, more choice, greater incentives for healthier lifestyles, less paperwork, and less bureaucracy.

Note that the last three items, if achieved, would further lower costs. Also note that more people would be able to satisfy their healthcare needs themselves if costs in general – and especially their costs if they chose healthier lifestyles – are lowered.

Does anything about government control suggest it can or will accomplish or even incentivize ANY of these objectives?

Go down the list. Won’t government move everything in the wrong direction?

If moving a lever one way moves us in the wrong direction, maybe we should try to move it in the opposite direction: Less government.

Unleash the free market. Free the insurance companies to design policies demanded by their customers … not designed and dictated by legislators … and sell them nationwide. Let unfettered competition force them to tailor policies to reflect your actual risks and the insurance protections you want … at prices that objectively reflect those risks and the resulting financial obligations.

Let customers save money by just protecting themselves from catastrophic events and paying for all non-catastrophic events out-of-pocket. These customers, who now care about costs when they shop for medical services, will force providers to compete on both quality and cost. Providers, if freed from regulations that stifle innovation and raise costs, will devise more efficient ways to provide healthcare services and stay in business.

Stop subsidizing unhealthy lifestyles. Unhealthy behaviors are known to cause high medical costs. People can make these choices if they wish, but they shouldn’t be allowed to impose the consequences on others. Their insurance premiums will reflect their choices.

When all this is done, Americans will need fewer healthcare services and those they do need will cost less. The overall magnitude of our national healthcare problem will be dramatically reduced.

Of course, there still will be hardship cases: the indigent, children with birth defects, those who decide to risk not having even catastrophic coverage, and even those who cause healthcare issues due to bad choices – smokers, alcoholics, drug-users, the obese, couch-potatoes, and motorcycle daredevils.

What about them?

The ultimate safety net is charitable giving. America is already the charity/giving capital of the world. With overall national healthcare costs dramatically reduced, substantial resources will be freed up for additional giving including expansion of charity hospitals and clinics.

While such charity will not be guaranteed and the charitable services offered may be less convenient or less extravagant, that is the incentive to not need it. That being said, those who face such issues through no fault of their own will, almost certainly, be well taken care of.

If you don’t think so, you can always take out your wallet and be a do-gooder that actually DOES some good instead of one that dodges their moral responsibilities by laying them off on others and, in the process, embracing a tar baby that we will never be able to shake.