America’s “health care reform” debate is mostly fake.
Confucius, who lived so long ago that famine, not obesity, menaced public health, supposedly observed that “the first step to wisdom is to call things by their proper name.” If so, then angry congressional town hall meetings and serial legislative impasses are not really about health care, let alone reform.
If “reform” implies improvement, then that’s not what we’re shouting about. Rather, the demand is for “entitled” medical insurance.
Most Americans don’t expect Uncle Sam to provide their housing, let alone dictate its kind, size and location. We don’t scream at members of Congress to buy our groceries or choose our automobiles, let alone decree in which two or three supermarket chains or car dealers we can shop and what products we can select. As a result, there’s a myriad of food choices and a new or used car, truck or SUV for the vast majority.
Since courts ordered the end of the Bell Telephone monopoly, nearly the entire populace, rich, middling and poor, now seems to have an internet-connected cellphone. Except for the truly destitute, another multibillion-dollar industry functions without government-designed products or service plans.
But health care — medical insurance — is different, we’re told. It’s too big, too inflexible and far too costly to be treated as another commercial commodity.
It is, and increasingly has become so (consuming roughly 18 percent of the gross domestic product), the more the federal government gets involved. Even before passage in 2010 of the 2,300-page Obamacare “reform,” Medicare, Medicaid and Social Security, the other gargantuan social programs, were on financially unsustainable growth tracks destined to break the federal bank while choking all other spending, including defense.
Douglas Holtz-Eakin, former head of the Congressional Budget Office, projected that Obamacare would cost $1.07 trillion in subsidies in its first 10 years, $2.85 trillion in the following decade. In the “new normal” economy — itself largely the result of additional Obama-era taxes and regulations — meager 1 to 2 percent annual growth and historically low labor force participation rates meant loading nearly universal, federally subsidized health care onto the entitlement camel’s back was always a destructive fantasy.
In affordable democracies, government at all levels — local, state and federal — can only be the agency of last resort. For reasons of liberty, equality and security we do not privatize functions such as justice and defense — police, courts and the military. But most other economic and social activity belongs in the private, not the public, sphere.
Want cultural opportunity? Don’t establish a Ministry of Culture. Likewise with medical treatment. Those praising models like Great Britain’s National Health Service for universal access don’t mention its delays and limitations.
Before competition from UPS, FedEx and the others, the U.S. Postal Service took days or weeks to get a package across country. Now it, too, offers overnight delivery. Instead of more government dictates, more unsustainable taxpayer subsidies, empower medical insurance competition. Separate insurance from employment and add that “fringe benefit” money directly to salaries, let individuals shop for coverage at levels they choose and can take from job to job, and permit firms to sell policies across state lines.
Rate individuals. In a country in which close to 150 million people have at least one chronic condition, many of those caused or worsened by unhealthy behaviors, smokers will pay more than non-smokers. Just like for life insurance. So will the overweight, chronic drinkers and couch potatoes. Reform should incentivize healthier behaviors, not subsidize unhealthy ones.
Chronic, expensive pre-existing medical conditions cannot be “insured,” any more than fire insurance can be written for buildings already in flames. Individuals with such maladies should be eligible for a program that operates more like after-the-fact reparations, not anticipatory insurance. Here — not for the public in general — government subsidies may well be necessary.
Involve government with standards — purity of drugs, safety of procedures, oversight of insurance company financial stability and so on.
The long campaign for “universal health care” reflects in no small measure the statist compulsion, dating to the progressive era, for government by experts, dictating to the common people for their own good. That necessarily means an ever-contracting sphere of individual liberty and free choice leading to more rigid supply of goods and services, lower profits and less innovation.
Claims that health care will be the exception in which government really does know best should, like items sold in health food stores, carry this advisory: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”
