The Bureaucracy That Dare Not Speak Its Name

To hear its proponents describe it, under a Single Payer system of national health care the government wouldn’t even be involved. Apparently, even though such a system designates the government as the eponymous Single Payer who would pay everybody’s health care costs from tax revenues, the private sector will still be fully in charge as the government will neither run the hospitals nor employ doctors as they do in those creaky, decaying socialist countries. In fact, the hand of the government would be as soft as the milky fingers of a sixteen-year-old Lithuanian Virgin on her wedding night.

You’ll hardly notice.

Now look, I don’t have a degree in economics and I don’t belong to a think tank where I am paid to shill my particular brand of public policy. On the other hand, I have a little common sense and have kept my eyes open.

If you were to get in a scrap with a mean old junkyard dog and he managed to sink his teeth into your scrotum, from that point forward the dog is totally in charge. You may have the complete use of the rest of your body and even though, from a real estate point of view, the dog has laid claim to a fairly small portion of your property, where that dog goes you will go and you heart, mind, and soul will follow willingly.

Money drives medicine. Not a nurse empties a bed pan nor a surgeon repairs a hernia without money changing hands. This is so obvious that it is almost insulting to mention it. And yet the proponents of a Single Payer system seem to believe that, although the government would have its teeth firmly embedded where it counts in every medical decision, nothing but good could possibly result. It seems, at last, that our ruling elites have devised a system of total control which is appealing enough to convince the ignoratti but from which no blame could ever be extrapolated to government (who don’t actually run the hospitals or employ doctors, you see) when things go south which they inevitably will.

South they will go because the premises of socialized medicine (which is what a Single Payer system is except for a minor technicality) are all wrong and will do nothing to correct any of the perceived problems of health care delivery, most of which are overblown anyways.

First of all, price fixing always leads to scarcity as there has never been a government in the history of the world that fixed the price of a good or service above or even close to the market price. If you don’t think this is true, ask yourself why so many doctors refuse to take Medicaid patients. The answer is simple; because the real cost to treat a Medicaid patient is often more than the government’s fixed price. In a Single Payer system, the government might not own the insurance company but this is about as relevant as the government’s non-ownership of hospitals or non-employment of doctors. Under the Axiom of the Junkyard Dog, the government has the important parts (the funds) clamped in its jaws and it can dictate terms to the insurance company (what they can charge) and the health care provider (what they can bill). Because money is also a scarce resource, the pressure on reimbursement will always be down with nothing to resist it. Certainly not any pressure from the electorate, most of whom want a free lunch no matter how much it actually costs them and who are pandered to shamelessly on a regular schedule of elections.

Decreasing reimbursements would be fine to the ignoratti, of course, as those rich doctors and capitalist-tool insurance executives would finally get their comeuppances but if you think it is hard to get an appointment with your doctor now, wait until your doctor’s economic incentive is completely removed and see how the system which currently can get a wino to the cath lab in about an hour and a half would slow to a crawl. This would be because a Single Payer system increase demand, as people will take more of anything if it is cheap or even free, without doing anything to address supply. In fact, the decreased reimbursements to health care providers that would certainly ensue as the dog ground its teeth would decrease supply at the time demand was increasing.

Does our country even need universal health insurance and will adopting it make us healthier and decrease expenditures for medical care?

No and no.

First of all, nobody is exactly clear on the number of uninsured, who they are, and the significance their lack of health insurance. Forty million is a number thrown around a lot but as most of the elderly are covered under Medicare, all poor children and those from the lower middle-class are covered (or can be) under Medicaid’s Children’s Health Insurance Program, and many of the poor themselves get Medicaid, the forty million includes a fair portion of people who make the choice not to buy health insurance, either because they don’t need it or because they make a rational decision to spend the money on something else.

As we are a charitable people and it would be demoralizing to our society to have people dying for lack of medical attention, we need to have the so-called safety net to take care of people who simply cannot, through some combination of bad luck and personal choices, take care of themselves. But what if this number is only 10 million, not forty? Rather than have the government suck up even more money for redistribution in a highly inefficient, wasteful, and nonproductive manner, why don’t we just identify the 10 million hard-core uninsured and give them all health insurance with no strings attached. Seems to me that this would be several orders of magnitude cheaper than running what amounts to fifteen percent of our GDP through the Federal sausage stuffer.

There has, in fact, never been a government program whose costs have not risen well beyond even the wildest speculations of its critics and Single Payer would be no different, with its proponents 10 years from now opining that we have too many aircraft carriers and that the several trillion dollars spent on health care is not enough.

As to improving the health of the nation, well, I get attacked as a heretic for saying this but there is probably very little correlation between access to health care and health, especially as people who make health care a priority are the kind of people who would take care of themselves even if they didn’t have health insurance. Having a nice government health insurance policy will do absolutely nothing to get people to lose weight, stop smoking, exercise, and stop using crack, which, along with other poor lifestyle decisions are what really drives health care costs through the roof. This is readily apparent to anybody who works in a hospital. If it wasn’t for booze, cigarettes, drugs, 64-ounce Colas, Big Macs, and sedentary lifestyles, we would be all out of a job.


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