The ideal of universal health care is anti-competitive and represents an unneeded step towards transforming America into a welfare society.
The Universal Health Care Ideal
The current acrimonious debate on “upgrading” the health care system in America is afflicted, first of all, by gaps in perceptions and reference baselines. The White House positions H.R. 3200 “America’s Affordable Health Choices Act of 2009” as a means of providing uninsured Americans affordable coverage (Congressional Budget Office, 2009). To a public that objects to a government role in health care funding and provision, “health care reform” is a stalking horse for making over America into a socialized nation, with all that this implies for lowered quality of health care and inefficiency.
It is not quite true, either, that universal health care courtesy of the government is the norm today in all industrialized economies and even some developing countries. What is extant in the UK and Canada today is “single-payer health care” where the government funds all health care in the form of the “primary care trusts”. Some privately-owned clinics have contracts with the UK’s National Health Service (NHS), attesting perhaps to the role private efficiency and expertise continues to have. However, the fact remains that the NHS funds practically everything, including psychiatric services and even such cosmetic surgical procedures as breast augmentation on the grounds of “mental anguish”.
Government is also the primary payer in so-called “multi-payer systems” found in France and Germany.
The peace of mind for the uninsured when they require emergency medical care is, of course, the prime benefit of publicly-funded systems. But there are no guarantees of efficient and high-quality care, either. To cite just one example, the UK has had to legislate the 18-week “Referral to Treatment Pathway” as a means of ensuring that patients referred by general practitioners are evaluated by a Specialist/Consultant within four-and-a-half months at the most. And this applies even to such highly contagious diseases as hepatitis.
“Obamacare” (aka “National Health Insurance Plan”)
The Three Legs of the Plan
In his personal Web site www.barackobama.com (undated), lauded for attracting Net-savvy young voters during the 2008 campaign, Mr. Obama seeks to marshal public consensus behind “health care reform.” In the Democratic party ideal of “health care for all”, we are asked to believe in promises of expanded health insurance coverage, the end of rising premiums and insurers who deny coverage as it suits them.
The second leg of “health care reform” consist of government-run preventive programs. It remains to be seen, however, how quickly otherwise-rational Americans can be encouraged to loss weight so as to reduce their risk of adult-onset diabetes and cardio-vascular disorders. For thirty years, as another example, the Surgeon General has inveighed against smoking but cigarettes remain commercially available and a gusher of “sin tax” revenue for state and Federal governments alike.
For the third leg, the president vows that the plan will fund medical research and, in the process, eschew ideology. This is an obvious reference to the Bush administration having shut off the funding spigot for stem cell research, on the grounds that harvesting stem cells from fetuses aroused the ire of conservative Americans who regard any elective abortion as murdering life in the womb. But one cannot wave a wand and conjure away public opinion. This is a case of wishful thinking and trading one “ideology” for another by a president who, in the case of the abortion debate, vainly hopes for a “meeting ground” between the abortion and “right-to-life” segments of the population – patently irreconcilable – in an attempt to bring everybody to the table. But this moral issue is subject of another discussion altogether.
The mental conditioning for “health care reform” includes wrapping the campaign logo in the American flag and holding out promises of “smart preventative care,” genetic screening, and better nutrition, the latter an obvious clarion call to Americans (whites and minorities both) who routinely overindulge and become obese.
The Deficiency and Problem Comprehensive Insurance is Meant to Solve
Certainly, there are gaps in a domestic system largely funded by private insurers and HMOs. The government-run Medicare is eligible only for those 55 years and up. Medicaid is restricted to low-income families, minors, the disabled, and pregnant women. Since private health insurance carries a steep price, Americans typically compromise by settling for lower-coverage plans and find themselves liable for “co-pays” when the time comes to settle hospital bills.
The Funding Problems
Finally, one wonders about the ability of Mr. Obama to marshal public opinion in favor of his plan so that a Democrat-controlled Congress can see clear to passing the measure.
Less than nine months into his term, Mr. Obama’s approval ratings have already stuttered and begun to slip, principally because of unrelenting bad news about a recession with no end in sight, lay-off’s that ravaged 650,000 more households in July on top of millions already laid off earlier in the year, homes being repossessed, residential values falling below what they were mortgaged for, and a general credit crunch. The White House tries mightily to put a positive spin on broken campaign promises such as closing down Guantanamo (the solution being to transfer the presumed terrorists to friendly countries or return them to the tender mercies of Iraqi police) or “bringing the boys home” (troop reductions in Iraq but many more added in Afghanistan).
Earlier in the year, the stimulus bill launched at the tail end of the Bush term passed with the price tag upgraded by a Democrat-controlled Congress to $1 trillion. Another $750 billion was doled out in loans and asset buy-outs to a financial sector whose singular lack of ordinary prudence and moral hazard had caused the collapse of the residential mortgage market. It did not sit well with the public that many bank boards subsequently voted themselves hundreds of millions in executive bonuses for performance in 2008. Next, Congress arranged to bail out Detroit’s Big Three on the argument that if they failed, their extensive supply chains would cripple large sectors of the economy. All these are coming out of deficit spending, not current savings of the Federal government. And now, health care reform is revealed to have a price tag of over $1 trillion in the next ten years. Democrats insist there will be no deficits but Republicans point to tax increases being foisted on an American populace battered by recession and uncertainty. All these put in question whether the President has any political capital to expend on getting approval for “health care reform.”
Unless things change markedly to obtain bipartisan and general public approval, HR 3200 will be funded by a combination of new taxes on the well-off, increased government spending (meaning more deficits), and required purchase of insurance (at this time, the chief vehicle appears to be income tax incentives or deductibles). In net, Congress presently claims, the net addition to the Federal deficit might not be the top line of $1 trillion but about $239 billion for 2010–2019. Even at just $25 billion per year, however, HR 3200 definitely increases the Federal deficit (Congressional Budget Office, 2009).
The cost-benefit ratio simply does not balance. A sanctimonious program to benefit the 15% of the nation unable or unwilling to pay for private health insurance entails spending deficit spending of a trillion dollars all by itself
The requirement to persuade those who already have health insurance that reform will benefit them too is a formidable one. After all, the Wall Street Journal reports, opinion polls reveal that many policyholders are eminently satisfied with their health coverage. And such better-off Americans know it is the taxes they pay that will ultimately pay for the coverage of the tax-exempt who have no coverage. And if no new taxes can be raised, then the government must issue debt instruments to countries like China that will surely ask for a qui pro quo in the areas of human rights, intellectual property and product safety violations.
The Ethical and Political Issues
An essentially Democrat-led advocacy group has worked at least since 2005 to try and resuscitate the ambitious health-care plan last proposed in the presidency of Mr. Clinton. Nonetheless, public resistance remains substantial and the party cannot even present a unified stance in Congress because of vociferous opposition back home.
As far back as 2005, those advocating the current health insurance overhaul had already run into a great deal of skepticism from the public. Under the umbrella of the Herndon Alliance, a grouping of liberal medical practitioners, unions worried about the ability of private employers to continue paying insurance premiums for increasingly costlier health care, and advocacy groups for non-affluent patients did public opinion research to test the concept of a “public option”. Told that this meant a government-operated medical insurance plan competing with private insurers and HMO’s, respondents expressed a great deal of skepticism. Essentially, voters who already have medical insurance worry that granting 46 million uninsured Americans Federally-subsidized coverage will somehow raise premiums or degrade care for themselves (Weisman, King, and Adamy, 2009).
References
BarackObama.com (n.d.) Health care: The current situation. Web.
Congressional Budget Office (2009). Preliminary analysis of HR 3200. Web.
Weisman, J., King, N. & Adamy, J. (2009). Wrong turns: How Obama’s health-care push went astray. The Wall Street Journal. A4.