It is the received wisdom of the vocal that the government (usually meaning the federal version) should provide health insurance (really health care) for all citizens (and, according to some, all non-citizens) who do not otherwise have it. Those who advocate for such government intervention into the health care of its citizens usually do not see any reason such intrusions would do anything but solve a problem. There is seldom any discussion of the underlying issues raised by actions of government.
To begin a discussion of government funded health care one needs to determine just which part of health care the government does not already control. The federal government already provides health care for military personnel and for their dependents; for the veterans, for both service and non-service needs; and for all recipients of Medicare and Medicaid. The Food and Drug Administration controls all prescription medicines. The state governments control the licensing of all medical professionals. The state and local governments control public health issues through various boards of health. The local government schools require vaccinations before students may attend. Hospitals are government regulated. Medical schools are under government control. Much of the medical research is funded with tax money. Even private health insurance us regulated by the states.
What is left? Is it just a matter of who pays how much for what for whom? Are there any other issues? The matter of who pays is a major matter. The cost projections of government programs have never been accurate. The recent prescription drug legislation was presented to the public as costing a lot less than later estimates. No one knows what the real costs are, but they are always higher than projected. It is not just the military that is plagued with cost over runs. There is no incentive for government at any level to reduce costs. All talk of eliminating “waste, fraud and abuse” is only a ploy to keep up the appearance of responsible management to perpetuate the bureaucracy. What government agency, department, commission, bureau, office, administration, or committee has ever recommended a reduction of its budget, much less its own elimination? No elected official wants any cut in government spending in his constituency. Why it’s, it’s, un-American! Sadly, it is. It’s also a weapon to be used by the challenger in the next election against the incumbent. Often with success.
From where will this money come? There is no magic method of free money. Someone has to pay. There is no free lunch, even if it is the government doing the cooking.
It is the taxpayers who will pay. It is never any other way. The taxpayers are the only ones with the money. They will pay both directly to finance the government’s program and to finance the interest on the debt the government incurs to keep the taxpayers from knowing the real cost. The taxpayers (and non-taxpayers) will also pay through inflation caused by the government’s debasement of our currency through its money creation monopoly. This is the real secret to financing things that cost too much: just print more dollars!
How much will be paid? Who gets to set the price? How will this price be determined? Who is asking these questions? Who is answering?
It is an old principle that the buyer sets the price. This is only true in a free market. Because of its legal authority to use force, the government can set any price it wants. This renders the market controlled. The only way that the government can control costs is to decree the price it is willing to pay and force the providers to accept it. The providers will use their political influence to have that price set very high. This is the way it always works.
What services and products will be covered for how long? Advocates of the “universal, single payer” system don’t spend much time on this question. They are wise not to do so. Rationing is the dirty word. Just because we don’t like to acknowledge the elephant in the living room does not mean that it is not there. Someone will have to say what is covered and not covered. All private insurance companies do this.
While rationing will be a reality, it will not be obvious. Various methods of duplicity will be employed: enormous amounts of paperwork, the usual bureaucratic run around and red tape, shortages, waiting times will be (except for the elite) horrendous (yes, I can see you are bleeding, but your number has not yet been called).
The question of coverage goes beyond what is provided. We will also need to know what is mandatory. Will pregnant women be required to have and abortion if it is determined that their child has a very expensive to treat illness? Will the very old and sick be told to go home and die, quickly? Will there be any appeal? How will those with political influence be prevented from using it? Can you believe that your elected officials will get the same coverage and service you do? Who decides? Who decides who decides?
It is also an old principle that the payer of the piper calls the tune. Since the taxpayers are the ones paying, they will call the heath care tune. No. We elect people to government office; they will call the tune. No. The elected ones hire agency employees; they will call the health care tune, just as they do in every other area in which they are in control. Yes, it is the bureaucrats, the faceless ones, who will issue the regulations and guidelines, usually in a dialect that resembles English but is really only known to them. We mere mortals have very little hope of understanding this stuff. Even the Internal Revenue Service cannot give the right tax advice. But what if we do not like the regulations and guidelines? Too bad. What if the bureaucrats get it wrong and something untoward happens? There will be some kind of a grievance process, but who of the faceless ones has ever lost a job because something untoward happened if the approved procedures were followed and the proper paperwork filed?
The tune calling by the government goes beyond rules governing health care products and services. Government control of health care will give the government bureaucrats authority to regulate what you eat and drink to a larger extent than they now do. If the next government sponsored food pyramid farce says that something is to be avoided, the faceless ones could simply prohibit its existence. It is more likely it will be taxed out of existence. It also may seem to some government expert, purely in the interest of your health and well being, that you are required to eats certain things. Let’s hope that it is not broccoli, George.