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.
A man of faith in a godless age is hitting Americans where it hurts.
Mr. and Mrs. American Spectator Reader, let P.J. O’Rourke talk sense to your kids.
In Britain, defending your property can get you life.
The debacle of this president’s administration is both a cause and a symptom of the decline of American values. Unless Congress impeaches him, that decline will go on unchecked. An eminent jurist surveys the damage and assesses the chances for the recovery of our culture.
It won’t take long for conservatives to scratch this presidential wannabe off their 2008 scorecard.
The American Christmas, like the songs that celebrate it, makes room for everybody under the rainbow. Is that why so many people seem to be hostile to it?
Was the President done in by the economy, or by the politics of the economy?