The American Spectator : The Real Health Care Debate: Who Decides?

Text Size

The Right Prescription

The Real Health Care Debate: Who Decides?

By Doug Bandow on 3.17.10 @ 6:08AM

Clearly the government shouldn't. But neither should employers.

The debate over health care is rushing to a climax. Hundreds of thousands if not millions of words have been spilled over the details of competing plans to federalize American health care. But the basic issue is simple: Who decides?

The issue is not one of public versus private. The U.S. system is an inefficient hybrid, with government paying nearly half of the bills and shaping private spending through the tax preference for employer-provided insurance. The result is a third party payment system in which nearly nine of ten medical dollars is paid in the first instance by someone else.

No surprise, national outlays are high and rising. Too many people -- whatever the exact number -- lack adequate coverage for health care crises.

"Reform" is a question of direction. Expand government, and especially federal, control. Or increase patient choice and private options.

The former is the favorite in Washington. And it means more fully turning control of health care over to politicians, bureaucrats, and assorted "experts." Indeed, that's the very purpose of Democratic "reform."

During the Clinton health care debate, Wall Street analyst Kenneth Abramowitz advanced the cause of managed care: "Right now, health care is purchased by 250 million morons called U.S. citizens," he said. It was necessary to "move them out, reduce their influence, and let smart professionals buy it on our behalf."

Do we believe that "smart professionals," whoever they may be, can best decide how much health care we receive from whom for what conditions? Should "smart professionals" decide how we are treated? Giving the federal government the power to make these decisions is what Obamaesque "reform" is all about.

It is a frightening possibility.

"Reformers" start with the assumption that "we" spend too much on health care. Nowhere else in the economy do we act as if there is a proper proportion of the economy that should be expended on an activity. Do we spend "too much" on automobiles? What is the "right" percentage of GDP to devote to beer? Should society reduce or increase outlays on art?

These are stupid questions. Bad incentives as a result of third party payment mean we buy medical care inefficiently, we spend more than we should for what we receive in return. But it makes no sense to total up expenditures on health care and let the government decide whether they are appropriate.

After all, we don't complain about national spending on cars, beer, art, or anything else. Spending on these are properly personal decisions by people using their own resources. If someone wants to devote more money to paintings and less to housing, that's what liberty is all about.

So it should be for health care.

The U.S. is a wealthy society with an aging population. New technologies, drugs, and devices can greatly enhance the length and quality of Americans' lives. But every decision involves a trade-off, since demands are infinite and resources are finite. Despite what the president and congressional Democrats would have us believe, it is impossible to simultaneously enhance choice, improve quality, increase access, and cut costs. There ain't no such thing as a free lunch, no matter how much politicians might claim otherwise.

Given the importance of medical care -- most people are more concerned about the condition of their heart than their car -- it is particularly important for individuals to make the inevitable and difficult trade-offs. Obviously, choosing health care is more difficult than buying an auto; people usually need advice from "smart professionals." But no matter how well-intentioned and knowledgeable, "smart professionals" are not equipped to decide how much we pay for what coverage for what services provided by which professionals.

Yet that's what government health care programs do in the U.S. If public money is being spent, whether by a state or the federal government, then government has to make decisions about how much will be spent for what purpose. It is inevitable, but not the sort of decision government should make for everyone else.

Page: 1 2 3 >

topics:
Obamacare, Hillarycare

About the Author

Doug Bandow is a Senior Fellow at the Cato Institute and the Senior Fellow in International Religious Persecution at the Institute on Religion and Public Policy. A former Special Assistant to President Ronald Reagan, he is author of Beyond Good Intentions: A Biblical View of Politics (Crossway).

Letter to the Editor View all comments (42) | Leave a comment

Denver Todd| 3.17.10 @ 8:44AM

Eliminating employer health plans and allowing everyone to buy their own pre-tax health plan on the open market would really empower people.

aiongold| 3.19.10 @ 10:05PM

interested

basur| 10.27.10 @ 6:08AM

Doug,
To answer the question of this article...
I DECIDE!

Please do not doubt it.

Curly Smith| 3.17.10 @ 9:13AM

Whoever pays the premium gets to decide. In government run health care, the government decides. The taxpayers get to vote on whether or not you get a heart bypass. In company run health care, the shareholders decide. It's death by proxy vote.

When a fourth-party (a company) provides funds for a third-party (the insurance company) to pay a second-party (the doctor) then the first-party (the patient) gets little to no input on the treatment. If you want input then pay the doctor yourself for the basic needs and buy catastrophic health insurance for the rest. Oops, catastrophic health insurance has largely been legislated out of existence by prior "reforms".

You don't get "patient control" if the patient doesn't pay bills or the premiums.

IRISH22| 3.17.10 @ 1:48PM

You have identified one of the BIG LIES of "third party reimbursement": that government and/or employers pay for health care. Since government has no money unless it takes it from taxpayers, we all pay for government-provided health care. In a more subtle way, we all pay for our employers' premiums through lower wages. I like your argument though -- since we are doing the paying we should do the choosing!

Bob| 3.17.10 @ 9:33AM

Bandow, most of the time I think you are off of your rocker, but this time you are directly on target. But what happens when because Grandma doesn't have the money to pay for procedures at the end of her life, she dies? What happens when a young 20-something gets in an accident and doesn't have health insurance? What if a 5-year old develops leukemia and the insurance policy doesn't cover it? Do we let these people die? If the answer is "no", then giving people choice will not lower the cost -- in fact, it will raise it as individuals under the pressure of a medical emergency will not make wise decisions. And most of the money in medicine is spent on procedures that are not planned.

If you think it is acceptable to let those people die, then you do think healthcare is a privilege. If you don't think it is acceptable, then face it, you think that healthcare is a right.

The only way your scenario (and my scenario) works is to FORCE people to carry insurance (as with autos). If you don't, the reality is that since most people would not be able to afford the coverage they now have, they would vote for Medicare for all.

What people want is to be covered for everything with no limits and to pay nothing for it. That is basically the system we have right now. But with 40% yearly price increases as we're seeing right now, this has to stop. If people really had a taste of free market health insurance, we'd move to Medicare for all very quickly.

That's why I continue to propose a hybrid system where the government pays for the mandate of emergency care and catastrophic coverage, and then people can buy tiered policies with different levels of coverages with the understanding that if the policy they buy doesn't cover something, they might die. We should also limit any program to citizens only.

Choice is good, but full choice will not, in the end, survive because people will not like the outcomes.

Nick| 3.17.10 @ 9:53AM

Pay no attention to 3/5 Bob's comments, folks.

For those who don't know, he is known as 3/5 Bob, because until last June, he thought that blacks had 3/5 of a vote, under the original U.S. Constitution.

He also doesn't know the scientific fact of when human biological life begins because he is unsure of when "ensoulment" happens.

He also claimed he translated the Bible from the original Aramaic when he was a teenager.

He is a pseudo-intellectual and an anti-Christian bigot.

Don't waste your time arguing with him.

Bob| 3.17.10 @ 9:59AM

1/5 Nick....

Doesn't know the Constitution....
http://en.wikipedia.org/wiki/T.....compromise
Doesn't understand science....
Doesn't know anything about Biblical Aramaic....
http://en.wikipedia.org/wiki/Biblical_Aramaic
Doesn't know enough to make any relevant comments.....

Talk about wasting time?????

Hmmm....

Nick| 3.17.10 @ 10:04AM

3/5 Bob,

Thinks the Constitution gave blacks 3/5 of a vote....
Thinks "ensoulment" is a scientific term....
Thinks there are Bibles in Aramaic around to be translated....
Doesn't know much of anything, except how to manipulate economic data....
Doesn't persuade anyone on this website....

Why would anybody read his tripe?

Bob| 3.17.10 @ 10:07AM

1/5 Nick,

Thinks the Constitution doesn't say anything about counting slaves at 3/5th of a regular person....
Doesn't understand the biological growth of an embryo...
Doesn't understand religious beliefs...
http://en.wikipedia.org/wiki/Ensoulment
Didn't even know that parts of the Bible were written in Aramaic...
http://en.wikipedia.org/wiki/Biblical_Aramaic
Doesn't know anything about economics...
Doesn't add anything to this website...

Did he even graduate from elementary school???

Nick| 3.17.10 @ 10:18AM

"Thinks the Constitution [...]" - LIE
"Doesn't understand [...]" - LIE
"Didn't even know [...]" - LIE
"Doesn't know anything about economics..." LIE, I know a little. Enough to know it can't predict anything and can be manipulated by even the moronic.

Where do you come up with this garbage? I know you're envious of all the compliments I get on this site. You should repent of your covetousness.

I grew up in the suburbs, in the 70's. Not in Compton, or East L.A., or whatever. My elementary school didn't have graduations.

They didn't feel the need to prop us up with phony self-esteem with a ceremony for something we were expected to accomplish as a part of growing up.

Somebody definitely over-inflated your ego.

Bob| 3.17.10 @ 10:26AM

So, 1/5 Nick, you are using the "liar, liar, pants on fire" defense? I guess your suburban elementary school didn't teach you much and thus there was no reason to inflate your ego.

By the way, I grew up not far from Compton, and couldn't wait to leave that neighborhood. It wasn't a boosted ego -- that exists only in the suburbs. No one gave a damn about ego -- only 4% of our class even went to college. The thing that motivated me was wanting a better life than my parents. That requires work, something, it seems, you never learned to do. Try actually studying the issues, Nick, instead of being fed junk like you were in the suburbs.

Nick| 3.17.10 @ 10:57AM

3/5 Bob,

Nice job at obfuscation.

As you know, I have the quotes and witnesses to back up my claims.

You have none. If you did, you would produce them. That is why you are a liar.

Where did you place in your elementary school graduation class? Ha-ha!

How's that toothache?

Ken (Old Texican)| 3.17.10 @ 11:16AM

Hey Nick.
One thing about it. Bob would not make a very good scientist. He keeps running the same experiment...and expects different results.

His experiment of course is to keep coming here and spinning elaborate lies and false choices...and keeps expecting to convince someone ...heh...anyone.... of anything.

Nick| 3.17.10 @ 6:40PM

Ken,

How right you are!

3/5 Bob wouldn't know science if it smack him upside his head.

Ted| 3.17.10 @ 11:12AM

So it appears Nick and Bob are the bestest of buddies.... The Odd Couple. So who's Felix and who's Oscar, pray tell?

Nick| 3.17.10 @ 11:17AM

Ted,

I'm definitely an Oscar! Ha-ha!

Sorry, if these posts are redundant.

But, as a public service announcement to the poor unsuspecting souls who might wander in here, and think 3/5 Bob is worthy of serious argument, I feel obligated to warn them.

Petronius| 3.17.10 @ 12:07PM

Raw nerve time again. Good stuff Doug. It's not just the medical choices we "morons" make that mommy govt. wants to take away, it's all the others. And with-holding medical care is their new deus ex machina for changing our behavior and achieving absolute despotism. Case in point. If you require surgery and belong to the NRA; surrender your guns or wait to die.

Ken (Old Texican)| 3.17.10 @ 12:18PM

Doug,
To answer the question of this article...
I DECIDE!

Please do not doubt it.

Dustoff| 3.17.10 @ 3:37PM

Why would anyone use WIKI for info.

somnolence| 3.17.10 @ 3:39PM

Bob, not everyone has to have a car. Therefore, your position is rendered mute. And that is all I have to say other than government cannot make you buy anything. When or if this farce comes to pass millions of citizens, including myself will say make me(btw our ready funds will be well hidden away), will relentlessly test the system everyday, and eventually will prevail as folk heroes if the mainstream press dares to cover it. You, sir, are an idiot because you really wish for this bloodbath that will come. Government cannot make you buy anything according to my reading of the Constitution.

Liberal Reader| 3.17.10 @ 10:16PM

Folk heroes. Right.

Anyway, I think you mean Bob's position is rendered "moot," not "mute." "Mute" makes a certain sense, but I think "moot" is the word you're looking for.

Liberal Reader| 3.17.10 @ 9:52PM

Every Democrat who ran in 08 ran on a platform of some kind of health care reform.

The fact that Congres will pass this bill -- it will, believe me -- is simply the result of our political process working properly, which is to say, in chaos and squalor and confusion. What you WORRY about are governments that DON'T operate in such a way.

If the people decide they don't like these reforms, they'll vote people into Congress who will rescind them.

That's America, folks. It's the way we DO things here. Personally, I love it. I can see how people with authoritarian mindsets might not like it. But that's just too damn bad.

somnolencde| 3.17.10 @ 11:02PM

No dummy, the way Congress operates properly is obeying the laws of the U.S. Constitution and by following the demands of the American people. WE are their bosses and so far a clear majority of us have voiced a negative opinion toward this bill. Please show me a clause or anything remotely resembling such within that hallowed document which upholds this action. You speak of rescinding it with newly elected legislators. That isn't going to be that easy even if the constitutional premise is approached by attorneys properly and you know it. Eternal vigilance, folks, eternal vigilance.

Liberal Reader| 3.17.10 @ 11:49PM

somnolence

The Constition allows for much more flexibility than you allow. The Congress has rules -- rules long considered within their power to have created -- and those rules are being followed. Or not, and if not, the matter will go before SCOTUS where it will be decided definitively.

My point is simply that the government is now working pretty much as it always has. Don't listen to the black-helicopter people. They may weaken your judgment with their insane enthusiasms, but in the end they'll just lead you astray.

I'm not saying you should bow down or give in. I say fight your best fight. Trial by fire.

But the hysteria and despair, the calls to arms, the prognostications of doom and disaster, are silly, ungrateful, and ridiculous.

Ultimately the Democrats now in office are not so different from those in office 50 years ago (with the exception of civil rights). The Republicans are not so different from the Republicans 50 years ago. More saliently, the Republicans and the Democrats are not so different from one another. This is sometimes iritating as hell for all of us, yet we should remember that it is also the grounds upon which the most stable and enduring western democracy in history is built.

Nick| 3.17.10 @ 11:55PM

Marxist Reader,

You should know better by now.

We are a Republic, not a democracy.

Liberal Reader| 3.18.10 @ 12:03AM

I suppose you're saying this as a joke, unless you haven't looked it up, as I've many times suggested.

To say we are a republic, not a democracy, is a little like saying you caught a trout, not a fish.

Read any opinion by Scalia. He makes reference to our system as a "democracy" constantly. It's the basis of his originalist theory of constitutional interpretation.

DEMOCRACY describes any system of government in which representatives are regularly subjected to the will of the people by means of authorized elections.

(This is different from DIRECT DEMOCRACY, in which eligible citizens vote immediately on laws, etc.)

Now, there are many KINDS of democracy. The kind of democracy we are is different from the kind of democracy the U.K., for example, is, or Sweden, or Canada, or Israel.

We are a democracy that is variously described as a republic or "constitutional republic," but we do -- as the world knows -- live in a democracy.

Liberal Reader| 3.18.10 @ 12:09AM

Just one last thing, and then I'll stop kicking your behind on this question, Nick. The average educated person with any Greek in the late 18th century would have recognized the etymology of "democracy" in "a government of the people, by the people, and for the people." The Greek word "demos" simply means the people; the Greek word "kratos" (if I remember correctly) simply means rule, government, or political power.

Liberal Reader| 3.18.10 @ 12:12AM

And yes I know that this is Lincoln's line, but he is beautifully and perfectly summing up the spirit of '76 in his immortal address. There's an end on it. We live in a DEMOCRACY.

Nick| 3.18.10 @ 7:26AM

Marxist Reader,

You're like a one-legged man at a butt-kicking contest!

We live in a REPUBLIC.
Where the rights of the individual reign supreme over the will of the majority. At least it is supposed to be like that. You liberals have done a good job destroying our foundations to try to make us a democracy.

We hardly do anything by democracy.
We elect representatives and senators by majority rule. That's about it. And senators used to be picked by the state legislatures.

We don't pick the president by majority rule. One juror can hang a jury. In congress, it takes a super-majority to do many things. The rule of the minority stops many bills, i.e. ObamaCare.

The Constitution requires that the States have a REPUBLICAN form of government.

The Founders knew what they were talking about.
Too bad you don't, Marxist Reader.

Nikki| 3.19.10 @ 10:57AM

So, are you suggesting that employers stop providing health insurance as a benefit of employment? If that is the case, then health insurers will be able to deny even more people with pre-existing conditions. Group policies seem to provide a certain umbrella of protection, in many cases.

And I'm not sure what you mean by "eliminating state-mandated benefits." Are you talking about existing programs for the less-insurable, such Medicare? But that wouldn't make any sense since in the next line you write that we need to provide for the poor and uninsurable. Or did you mean we should stop passing laws that protect consumers from discriminatory insurance practice?

You made some great points in your article. Maybe you can expand it to include more, and clearer, alternative solutions.

Terry| 3.19.10 @ 8:26PM

Someone always brings up auto insurance as a comparison to the manydate for health insurance. These are completely different. As someone else has stated you don't have to drive. But additionally the cover two very different things. In auto insurance you are required to have liability insurance. In otherwords, you have to have coverage to cover hurting someone else or their property. They do not require you to have comprehensive coverage, which would be far closer to a comparison. Health insurance covers health care that happens to you, not someone else.

Terry| 3.19.10 @ 8:40PM

Nikki,

Here is an alternative to what they are currently proposing for pre-existing conditions. First, require insurers that they have to cover pre-existing conditions, but after an initial signup period of say six months to a year when the insurers will have to cover pre-exising conditions immediately, they can then begin having a period of say a year before they would have to cover those costs. This will help ensure that people won't wait to sign up until they have a health problem. Second, allow the companies to charge different rates based on lifestyle choice risk, bascially things that you are choosing to do that have a shown effect on raising or lowering your health care costs. What comes to mind is smoking, being obese, exercising. This would ensure that people with genetic issues or have accidents are covered, but people who are not taking responsibility for their own health have to pay more, while people who do the right things will pay less. Third, allow insurers to charge different prices based on age and sex. This will ensure that young people aren't priced out of the market and old people aren't getting more then they deserve. Fourth, allow insurers to sell across state lines. This will ensure that people aren't paying for state mandates that they don't want to.

There are other things that we could do as well, but as a start, this would be far superior to what they are currently proposing.

Nikki| 3.19.10 @ 11:05PM

Terry,

That sort of reform would be wonderful! Although, I would worry that certain age/gender categories might be priced out. Pregnant women, for instance.

Thank you for taking the time to respond and for mentioning that bit about insurers not currently being allowed to sell policies across state lines. I was not aware of that. It always seems like my health insurance is based in another state due to an employer's corporate headquarters being located out of state. That is why, even though my state has insurance laws that are favorable to my needs, I still cannot claim those rights. I would like to see health insurance companies held accountable to the laws of the states where their customers reside.