Socialized medicine is bad and the “moderate” plan to have a public/private hybrid healthcare system only draws out the agony on the road to single payer.
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In Scott Adams’ Friday podcast, he noted that, while he’s aware of many attacks on Bernie’s and Warren’s “Medicare for All” plan (aka socialized medicine in an already debt-burdened society), he hasn’t heard challenges to a slightly different plan coming from others, most notably Biden and Buttigieg. This alternative Democrat healthcare plan promises “free Medicare for everyone who wants it,” while allowing those who prefer private insurance to opt-out and buy their own insurance.
To Adams, this second plan sounded kind of like the free market, with insurers competing with the government for customers. If the government could squeeze a low price out of drug manufacturers, Adams posited, wouldn’t that mean insurance companies could do so too? He hastened to add that he was just thinking out loud, rather than advocating for this “Medicare for All Lite.”
I’m glad Adams was just advocating and not thinking. When you start thinking about it, you realize that this is a recipe for worse care than we have now, plus increasing health care inequality for the American people.
Before going further, I should begin with my two strong biases against socialized medicine, because these biases inform my belief that even a hybrid system is a bad system: My first bias is that I don’t believe medical care is a right. I think it’s a wonderful thing. I’m tremendously grateful I live in modern times because I didn’t die from a massive cyst in my 20s or during childbirth. I’m also not consigned to a wheelchair or in perpetual pain from joint problems, nor am I rendered dysfunctional by chronic migraine syndrome, nor am I legally blind. Modern medicine has been very good to me.
Just because it’s good, though, doesn’t make it a right. Instead, the blessings of modern medicine are a product of the free market system. In America, the medical field has been given room to grow in extraordinary ways, both in terms of medical and scientific breakthroughs (which overlap, but aren’t always the same) and in terms of ease-of-access. That’s why those who say we have lousy medical care in America are talking through their hats.
On the subject of the quality of care in America, as Scott Atlas wrote in an article that should be required reading in every American high school and college, America has the best medical outcomes in the world. To conclude the opposite, you have to game the statistics in one of two ways. The first is to give a high value to factors other than a good medical outcome. This means arguing that the best medical care means seeing a doctor for free, even if it’s after an interminable wait and even if you die unnecessarily, are euthanized, live in constant pain, or otherwise never get any meaningful treatment. The second is to lie about the economic cost, as Elizabeth Warren did with her faulty, shoddy study that grossly overestimated medical bankruptcies.
But back to the point about healthcare being “a right.” Traditionally, in America, rights are freedoms inherent in all people and have nothing to do with government. Rights aren’t given by government; they need to be protected from government.
The only way to protect an inherent right is to amend the Constitution to state explicitly that “X” is a right inherent in all people, separate from government. Progressives talking about “rights” should therefore agitate for a 28th Amendment saying, simply, “Americans have a right to healthcare.”
The problem is that this amendment wouldn’t achieve Progressive goals. Enshrining the “right” to medical care in the Constitution means only that state and federal governments cannot prevent Americans from seeking healthcare. The Amendment, if it existed, could not impose on the taxpayer the obligation to pay for everyone else’s healthcare in a government-run system.
Put another way, Progressives aren’t demanding a right — that is, an inviolate area of human activity into which the government cannot intrude or can intrude only minimally. Instead, they are demanding a raw exercise of government power, beginning with the police power to take our money and extending to the financial and institutional power to control our bodies through a government managed medical system.
So that’s my primary bias. My secondary bias is that, aside from the poorer outcomes normative under socialized medicine (see a doctor; don’t get better), Europeans have another problem; namely, that the care they’re getting today is nothing like the glowingly wonderful healthcare they crowed about thirty or forty years ago. Back in the day, my parents, who had fantastic insurance through my Dad’s teachers union (awful salaries, great benefits), still envied their friends in Europe who told them about private hospital rooms, good hospital food, and free old age homes.
What my parents didn’t understand was that post-WWII socialized medicine in Europe succeeded for as long as it did thanks to us. We Americans funded Europe’s socialized medicine. After the war, America paid for much of Europe’s rebuilding, sparing the continent the cost of infrastructure costs. Additionally, throughout the Cold War, America absorbed Europe’s defense costs, leaving Europeans with more money to use for “healthcare for all.” (We still see this today, with Europe’s unwillingness to pony up NATO money, even though it’s in the geographic front lines of the benefits NATO confers.)
In other words, Americans worked like dogs and paid for their own healthcare, either out of pocket or through insurance, so that Europeans could enjoy “free” medical care. Of course, we didn’t pay for all of the costs associated with socialized medicine, which leads me to my second point about the decades’ long success of the European socialized medical system.
Up until the last 20 years or so, there was a strong social contract in once homogeneous European countries that everyone should pay high taxes when young and able, so that the government would care for them when they were old and sick. The social contract became very fragile when Europeans stopped having babies. By the 1970s, the post-war baby boom in Europe had vanished, and the European birthrate plummeted.
That’s why, also starting in the 1970s, the Europeans began importing cheap, young labor from Turkey, North Africa, and the Middle East. It seemed like a great idea at the time. Europeans would get their free healthcare, 35-hour work weeks, eight weeks of paid vacation, year-long maternity leaves, etc., while all those nice, brown-skinned people would do all the jobs Europeans didn’t want to (and could no longer) do.
What Europeans hadn’t accounted for was that the nice brown-skinned people didn’t think this was a good social compact — especially if they were Muslims. Muslims, after all, believe that the kafir (nonbelievers) should be working for them, rather than vice versa. So it was that more and more poured into Europe seeking, not work, but Europe’s extraordinarily generous welfare benefits (made possible in part by America funding their defense costs).
Even before the disastrous summer of 2015, when Angela Merkel extended an open invitation to military-aged men from all over the Muslim Middle East and Africa to come to Europe and taste its welfare sweets, the system was beginning to fall apart. That, not concern for the sick, was why Europe began embracing euthanasia as a sophisticated, humane approach to medical treatment.
As Dan Bongino repeatedly explains, everything is finite, including potable water. The only way to allocate finite things is through the free market (pricing) or through rationing.
One of the beauties of the free market is that it encourages creativity and invention, thereby making things somewhat less finite and therefore cheaper. I remember when my husband first brought a flash drive home. It was 512K and was a clever substitute for a 3 1/4″ floppy — only it cost several hundred dollars. Today, you can get ten 2GB flash drives for less than $25.
The same is true for Fuji apples. They appeared on the scene in the 1980s as a high priced luxury fruit for the Japanese market. When apple growers realized there was gold in them thar’ apples, competition increased, quantities expanded, and prices dropped.
Under rationing, the people in power of the product determine who gets what and how much they get. When there’s lots of money (as was true in Europe with U.S. capital investment and Cold War funding), those in charge can afford to be generous. As the money dries up, which inevitably happens in a non-market based economy, the people in charge of the product start rationing. They never ration themselves, of course. They just ration other people.
Twenty-five years ago, Europe moved to euthanasia, ostensibly to spare terminally ill people from suffering. They recently extended euthanasia to depressed children. A doctor in Holland was acquitted just the other day for killing a demented 74-year-old woman as she fought to stay alive:
A Dutch doctor has been acquitted of breaking euthanasia laws in a landmark case over ending the life of a 74-year-old woman.
The unnamed doctor had been accused by prosecutors of failing to consult the woman who had Alzheimer’s.
But a judge today ruled that a declaration written by the patient four years earlier had sufficed.
The Hague District Court heard that the patient had to be held down by her family after a lethal dose of a drug was administered by the doctor.
This reminded me of Terri Schiavo’s case. She was the young woman in a coma whose husband wanted to remarry, but could not divorce her because Florida’s law required her consent . . . which she could not give. Her parents, who cared for physical needs, didn’t want her to die. The matter went to court and the judge said, “pull the plug.” At that time, I wrote the following, which I still stand by:
Many years ago, when Holland first enacted its euthanasia law, NPR ran an interview with a Dutchman who explained why euthanasia was a good idea in Holland, while it would be a terrible idea in America. The secret to Holland’s euthanasia, he said, was socialized medicine. The man explained that, in America, where medical costs could bankrupt families, those with terminal illnesses could be actively or passively coerced into turning to euthanasia in order to save their family’s finances.
Put another way, this man and the NPR host who interviewed him were both certain that Americans, when given the choice, would cheerfully throw Grandma from the train in order to save some money. Europeans, the Dutchman explained, with their cradle to grave care, would never be pressured into killing themselves. The beneficent state would pay all the medical bills, so money would not be an issue when it came to life and death decisions. The only thing that would matter in Europe, said this Dutchman, was the terminally ill person’s wishes.
History has revealed that this Dutchman was absolutely and completely wrong. In America, people have willingly bankrupted themselves to save beloved family members. Mammon becomes meaningless when an extra treatment might give your child or a young mother a few more days, weeks, or years of life. People have hearts and souls. They connect to others, especially to those in their families.
It’s very different in socialist states, where euthanasia is the name of the game, often without the patient’s, or her family’s, agreement. England had the scandal of the Liverpool Care Pathway. It was meant to be a national hospice program that provided palliative care to the terminally ill in their final days. What ended up happening, of course, when the National Health Service started running out of money is that thousands (even tens of thousands) of elderly patients who were terminally ill, but weren’t anywhere near death’s door, were hastened to their deaths. They had become too expensive or just too difficult to manage.
It turns out that, twenty-odd years ago, when I heard that Dutchman speak, he had failed to consider two pertinent facts: First, socialist states invariably run out of money once they finally destroy their productive class; and second, the state has neither heart nor soul. To you, Patient X is your beloved mother, or brother, or child. To the state, Patient X is an unnecessary cost to an already strained system.
Another problem with rationing is that it’s a downward spiral, creating more shortages. As the money runs out, innovation dries up, and doctors find that there is less they can do and that they’re getting paid very poorly, all for the same long hours and stress as before. With those disincentives, they drop out of the practice and fewer go to medical school. Four years in college, four years in medical school, one year as an intern, two years as a resident and then, for specialties, another one to eight years of study — all of that just isn’t worth it for a mediocre wage in a demoralizing workplace with increasingly limited resources and a bureaucrat looking over your shoulder saying, “She’s old; let her die.” The same holds true for nurses who have one of the most brutal undergraduate curricula in college.
Put simply, socialized medicine is as system in which finite resources eventually vanish — hospital beds, available space, treatments, new medicines . . . they all goes away. And then, suddenly, you’re in a Cuban-style hospital with 18 dirty beds in a single open room, and a doctor saying in a tired voice, “Take him home so he can die with his family around him.”
So my bias is that socialized medicine cannot and does not work. Once it burns through whatever money is initially lying around, it reduces medical care and destroys good outcomes.
But back to Scott Adams’ query: Even if we accept that socialized medicine is a bad thing, won’t we alleviate many of those problems if we allow private insurance to co-exist with it? After all, if the government can bully drug companies into giving low prices, why can’t private insurance do the same?
To answer the last question about pharmaceuticals first, the reason it won’t work is that, if the government is going to force (yes, because of its size it will force) drug companies to give it low prices, that doesn’t mean the drug companies will negotiate those same low prices with insurance companies. Instead, the drug companies will try to recoup from private insurance the money they’re losing to the government. This will force insurance companies either to raise premiums to impossible heights or to stop covering all but the most basic generic meds. Eventually, those people paying for private insurance will be forced by ridiculous premiums or impossibly expensive meds to ditch their insurance and turn to the public option. The same analysis holds true for medical devices such as stents or sutures.
The next domino to fall will be the insurance companies themselves, for they will have to close shop once too many customers are priced out and reluctantly turn to the public option. Once everyone is back in the government’s belly, things won’t get better. Without insurance companies and/or privately insured people to subsidize drugs and other medical supplies, the companies that make them will either end innovation (bad) or go out of business altogether (really bad).
It takes time, of course, for the collapse I described to happen. What will happen first will play out like a medical version of public versus private schools — because when you think about it, what the so-called moderate candidates are calling for is the equivalent of public school, with a right (if you have the money) to opt out for private school.
America’s public schools are not healthy. They are modeled on Henry Ford’s assembly line because Progressives in days of yore admired that efficiency. Except the assembly line is broken and our schools do not turn out new, shiny, educated students. Instead, they turn out kids who are remarkably ill-informed and incapable. Moreover, while public schools were meant to be places free from political indoctrination, the militant, unionized, college-educated teachers in way too many schools look on those sweet young faces before them and think, “They’re so easy to indoctrinate when they’re young and malleable.”
In theory, people can opt out of public school. In fact, that’s not so easy. We’ve all paid for public schools through our taxes (property taxes for local schools, state taxes for school boards, and federal taxes to the Department of Education). If you’re not rich, having spent once for your child’s education, you’re not about to spend twice — so you end up sending your children to public schools, no matter that they’re gang ridden, that the teachers are incompetent, or that the facilities are broken down. As a product of San Francisco public schools, I know whereof I speak.
Even my kids’ affluent Marin County schools left a lot to be desired. I would have preferred sending them to Montessori, but having already paid many thousands in property taxes . . . well, my kids got factory educated. I’ve written reams about the fundamental problems with traditional public school education, so I won’t repeat it here. I’ll simply say that uneducated teachers (and that’s what so many are, even at the best public schools) and lousy teaching methods produce uneducated students.
What happens is inevitable: those with enough money put their kids in private school. In essence, they can afford to pay twice for their kids’ education — once through taxes, once through tuition. Pulling these kids out makes public education worse because the kids being pulled out are the ones whose parents are most committed to education, which means these are the students most likely to work hard and contribute to a classroom. It’s a brain drain. The inequality continues into college, as the private school children do better on tests on and essays, making them more attractive to colleges.
We’ll inevitably see the same thing with a hybrid medical system. The rich will get fancy private insurance and be in nice hospitals. Everyone else, having already been taxed up to here and beyond, will get Cuban-style medical care. Eventually, though, as I described above, there won’t be enough rich to enable insurance companies to compete with the government behemoth and its marketplace bullying. They’ll fall by the wayside and we’ll be right where Bernie wanted us to be all along: Socialized medicine in America, with all of the rationing problems I described above, not to mention the death of freedom over the most important thing we possess: our own bodies.
Image credit: I found the collage of Cuban hospital care at PoliNation.