Medical coverage for all — guaranteed. Income for all — guaranteed. Six months’ paid vacation for all — guaranteed. Ph.D. degrees conferred on all — guaranteed. Lifelong annuities of one million dollars per year for all — guaranteed. Couture clothes for all — guaranteed. Kids who behave for all — guaranteed. Everything for all — guaranteed.
And — at that rate — America bankrupt in less than six months — also guaranteed. Likewise, with an America brought to her knees:
(i) Chinese ascendancy — guaranteed;
(ii) Rise of Arab terror caliphates — guaranteed;
(iii) Putin impacting elections — guaranteed; and
(iv) The end of American freedom as we have known it for more than two centuries — guaranteed.
Reality imposes limits. Ever since we were kids, we all hated limits. Parents imposed limits. We could not have more than twelve milkshakes daily or more than eight twelve-ounce glasses of whipped cream with dinner. Never could understand why. The chocolate milk had to have some milk in it, too. Cholesterol? What’s that? Sugar? Diabetes? But, Mom — it tastes good!
Teachers imposed limits. When class was boring, we could not “go to the bathroom” every ten minutes. We had to raise our hands first.
Limits, limits. A world of limits dictated by a world of reality where there are no big rock candy mountains.
There is no question that our medical system needs improvement. If a person employed at Job 1 enjoys health coverage but contracts a severe chronic illness during the years working there, it is wrong and economically inefficient for a great capitalist enterprise like the United States that she thereupon must resist changing employment to a accept a better job elsewhere because the great health coverage at Job 2 will not cover her pre-existing condition. That is wrong and just-plain inefficient, causing skilled workers to contribute less productivity and to earn less than they can contribute and earn, and then they truly are motivated to contribute and earn.
Within our medical-coverage system, we can create economically sensible efficiencies for covering the health care needs of the comparative few who always responsibly have maintained health insurance but who subsequently, through no fault of their own, find themselves stricken with a severe disease: ALS, cancer, organ failure. The economic structure can be adjusted to externalize costs incurred by those relative few, spreading the coverage and risk among the greater population. Such a safety-net concept always has been at the heart of American kindness and decency, whether offered as crisis aid to states impacted by unexpected hurricane flooding, earthquake disaster, wildfire devastation. We cover such unexpected “Acts of God” when they strike people overseas. And we can and should find a formula for providing safety-net coverage for those stricken unexpectedly with perilous illnesses at home.
But the notion of providing free guaranteed wall-to-wall health coverage for everyone, though it sounds enticing, is a prescription for disaster.
First, under existing law, hospitals in the United States may not turn away seriously ill patients in peril. When a penurious patient is stabilized, private hospitals then may transfer the destitute uninsured patient to a public hospital. The American system as it now exists under capitalism does not allow people to drop dead in the streets. No private hospital will dare knowingly discharge an indigent patient who cannot be stabilized and safely transferred to a public facility; the liability and punitive damages it would incur for doing so deter them all.
On the other hand, if the Government institutes a system of free health care for all, there will be a huge increase in demand for health care because it then is free. That is human nature. Especially among elderly retired people with time on their hands, among hypochondriacs, and among others with empty days, such free care will populate doctors’ offices regularly with people who will burden medical workloads. The doctors will bill the Government, and the Government will reimburse. Middle-class taxpayers will foot the ever-spiraling costs with ever-spiraling taxes. “The Rich” always will enjoy access to skilled and clever tax attorneys and financial advisers who will assure that they escape the crux of the burden. As doctors’ calendars fill with appointments, it will become harder for truly ill patients to get an appointment to see that same doctor promptly when more urgently needed. Longer scheduling times will result in more illnesses among the public as minor ailments become more serious. In time, people will be compelled to give up long-standing personal health relationships they have enjoyed with their doctors and to seek appointments with less qualified doctors who, because of their generally weaker skills or more hostile “bedside manners,” are less in demand, less desired, and therefore can offer more calendar openings. In time, even their calendars will fill without their having to improve their skills or manner.
Because of the increase in medical appointments, and because the Government will be paying doctors at a rate lower than that of private insurance, doctors will have to see more patients each day to aggregate the same income, resulting in their providing less face time with each patient. The more timid patient who needs some extra time to explain a malady, a family history, or medications now being taken will not have the time to do so if perceiving that the doctor is in a rush. The doctor will be less curious to pause and inquire because she or he will have to move on. The quality of personal care will be compromised severely.
It will take longer to schedule a surgery date when needed. It will be harder to line up the surgeon desired. The quality of follow-up care will be compromised. More medical procedures and diagnoses will be delegated to less skilled physicians’ assistants and nurses’ aides. Because the Government will be paying, more necessary procedures will be denied arbitrarily by bureaucrats as medically “not needed,” more necessary pharmaceuticals will be denied as unnecessary or as not compatible with an idiosyncratic government list of approved uses. This is how the world actually works, even in current Medicare for the elderly. As the Government’s costs continue to skyrocket, new cost-cutting measures will be needed. More procedures will be denied, more medicine prescriptions denied, and older people will be deemed financially untenable to maintain alive with as much effort. Practical cost-cutting requirements will result in allowing octogenarians to die sooner, with less effort, denying many of them ten or more additional years of quality life.
One day, you will be as old as they.
If the goal of Medicare for All is to provide the “Non-Rich” with the same coverage provided to “The Rich,” that goal will fail as it always does. “The Rich” will not be disadvantaged for long. A private medical economy will develop, whether as an illegal underground “black market” or in transparent broad daylight. Concierge doctors will provide the best of private care for “The Rich” who will pay out of pocket for government-denied medicines, just as the cosmetic-surgery industry now works for those who can afford optional tummy tucks, cosmetic laser, and liposuctions. As but one example, certain lung ailments used to be treated with medicines likecyclosporine, tacrolimus, and cyclophosphamide. Those medicines cause severe side effects but then were the best known treatments. In time, the pulmonary medical community learned from medical science that an immunosuppressant that helps deter body rejection of organ transplants also sometimes offers an effective treatment for the lung ailments — only with substantially fewer adverse side effects than caused by the prior meds. Nevertheless, pulmonologists are furious that Medicare will not cover that drug, Mycophenolate Mofetil, when prescribed for treating interstitial lung disease because a government bureaucrat has determined that the drug is approved exclusively for organ-transplant patients. The Medicare list of approved uses of that drug has not been updated for a decade. Those in the medical community can offer dozens of similar examples where government-run medicine sabotages best treatment practices.
Despite best intentions, Government never works as well as private enterprise. That is why people turns to UPS, FedEx, and local mailbox stores at a mark-up even though the Government runs post offices. That is why people register their automobile documents at the Auto Club whenever possible even though the DMV exists for that purpose.
I personally lived under state-run medical socialism for two years in the mid-1980s. We were the laboratory for today’s vision of “Medicare for All.” We could choose from among a small number of political-party-affiliated health plans. But, really, it all was the same. Two images stand out these three decades later:
Whenever any of our family had to go to the doctor for any reason, we always saw this same elderly couple among patients in the waiting room. I once asked the doctor about them. He explained: “Oh, they are perfectly healthy. They just like to come by every day. Since it costs them nothing, and the Government pays for their doctor’s visit, why not?”
The Government was paying, and my income-tax rate was 70 percent for an income of $30,000 a year.
My other memory — far more serious. There was an outbreak in our community of Hepatitis A. The indicated vaccine to protect against Hepatitis A was gamma globulin. Everyone sought the vaccine. The doctors explained, however, that the Government saved money under socialized universal health care by restricting who may receive a gamma globulin vaccine. Under the guidelines of socialized medicine, the gamma globulin vaccine could not be administered until the percentage of local residents who contracted Hepatitis A reached a certain percentage of the population. Only then would the Government guidelines regard the situation as “epidemic,” thus eligible for community vaccination. As soon as the required number of outbreaks was reached, only then could he administer the vaccines under the rules of universal health care. However, he assured us — small comfort — that we soon would hit the outbreak threshold, raising us to “Epidemic” status, and then everyone could be vaccinated.
We endured the grim daily ghoulish ritual, waiting each morning to learn who next had been infected. Only 18 more to go. Only 13 more. Only 9. Only 7.
My friend and neighbor, Dan, flew his entire family to the United States of America to visit with his wealthy parents — and to get everyone a gamma globulin injection that his parents would pay for. Others who could afford to do so hired private doctors, paying in black-market American dollars for the vaccine. And those who, like most of us, could not afford private care in an economy where the cost of government health care led to such high taxes that we had no spare cash, just waited. Only 4 more to go.
Someone very dear to me was one of the last three to get infected before the magic “epidemic” number was hit. That person got hit with it hard. It was not life-imperiling, but it was debilitating for several months. That person had been earning a very good salary, was a star employee at work. For the next several months that person no longer could work. Under the impact of Hepatitis A, that person could not make the long daily commute to work, nor work the long hours. After consuming vacation days and sick days, that star performer was terminated. That person’s income ended. The entire family was financially devastated and needed to go on the public till. One Government program feeding into to the next, all taxpayer funded.
That, too, is the reality of Medicare for All. Compassion leading to epidemic and depriving dignity. Socialism always results the same.