Opinion Forum

Health Care and Government

December 7th, 2009

Robert J. Samuelson takes an interesting look at health care spending. Does government control health care, or does health care control government?

President Obama’s critics sometimes say that he is engineering a government takeover of health care or even introducing “socialized medicine” into America. These allegations are wildly overblown. Government already dominates health care, one-sixth of the economy. It pays directly or indirectly for roughly half of all health costs. Medicine is pervasively regulated, from drug approvals to nursing-home rules. There is no “free market” in health care.

What’s happening is the reverse, which is more interesting and alarming: Health care is taking over government. Consider: In 1980, the federal government spent $65 billion on health care; that was 11 percent of all its spending. By 2008, health outlays had grown to $752 billion — 25 percent of the total, one dollar in four. …

The rise of health-care nation has confounded America’s political and intellectual leaders, of both left and right. No one wants to appear unfeeling by denying anyone treatment that seems needed; no one wants to endorse openly meddling with doctors’ independence. It’s easier to perpetuate and enlarge the status quo than to undertake the difficult job of restructuring the health-care system to provide better and less costly care.

Obama’s health-care proposals may be undesirable (they are), but it’s mindless to oppose them — as many Republicans do — by screaming that they’ll lead to “rationing.” Almost everything in society is “rationed,” either by price (if you can’t afford it, you can’t buy it) or explicit political decisions (school boards have budgets). Health care is an exception; it enjoys an open tab. The central political problem of health-care nation is to find effective and acceptable ways to limit medical spending.

Democrats are no better. Obama talks hypocritically about restraining deficits and controlling health costs while his program would increase spending and worsen the budget outlook. Democrats congratulate themselves on caring for the uninsured — who already receive much care — while avoiding any major overhaul of the delivery system. The resulting society discriminates against the young and increasingly assigns economic resources and political choice to an unrestrained medical-industrial complex.

Health care cost must be brought under control, at least to the point where annual increases approximate increases in the costs of other goods and services. As a civilized society, we also have to ensure that the least capable among us has access to adequate health care. But we can’t do that without some pain in terms of restricting the almost open-ended health care now available to most Americans.

We aren’t going to improve things by passing the hugely expensive, complex, and voluminous bills now in Congress. The process is too partisan, and the politicians are too self-serving. As expensive as the system may be, we might be better off just leaving things alone. Primum non nocere.

Articles written by Tom Carter
Tags: costs, deficits, health care reform
Categories: Economics, Politics | Comments (9) | Home

9 Responses to “Health Care and Government”

Brian Bagent | December 7th, 2009 at 5:41 am

Tom, the truly needy can be adequately served by charity. The indolent, whose ranks continue to swell, are not my problem.

I save my compassion for those that are unable and for those that go out and bust their asses every day, not for the lazy. I hear people talk about social justice from time to time, and all I can think is “What greater form of social justice is there than liberty?”

Tom | December 7th, 2009 at 6:34 am

I don’t think the truly needy would be adequately served by private charity. I doubt you can point to a time in our history when that happened in any comprehensive sense, beyond limited examples in small towns and rural communities. Where was all that private charity during the Dust Bowl days — remember The Grapes of Wrath? Where was it during the first half of the 20th century and before, when inner cities were teeming with poverty-stricken people?

I don’t have a lot of respect for lazy people, either, but I’m not willing to let them — and more importantly, their families, including children — suffer and die as punishment for their indolence. The reality, I think, is that not nearly as many of the poor are simply lazy as some might think. It’s like the classic “welfare queen” driving around in a new Cadillac — useful to make a political point, but hard to find in reality.

One doesn’t have to be a believer to heed this ethical imperative — and please note that it doesn’t say anything about whether the poor are lazy:

“There will always be poor people in the land. Therefore I command you to be openhanded toward your brothers and toward the poor and needy in your land.” — Deuteronomy 15:11

Brian Bagent | December 7th, 2009 at 7:17 am

How about watching people with food stamps buy steaks when I have to buy ground meat, chicken and peanut butter. It happens nearly every time I stand in a grocery line. How about people on public assistance that have cable TV, cell phones, flat screen TVs, IPods, PS3s and XBox360s, most of which I cannot afford?

The fact is that, as Milton Friedman pointed out, the one thing that has declined since the advent of legally enforced “social justice” is charitable giving. Charity dried up in the dust bowl because of what the Federal Reserve had done. I’d say that what they did was classic Hegelian Dialecticism.

The poor in the inner cities of the early industrial revolution were vastly better off than they had been before the industrial revolution. I believe Brianna dispelled that fallacy rather nicely just a few days ago.

People tsk about the horrid working conditions and the long hours that those people worked in those days. And I ask “as opposed to the way they worked their guts out for those same hours for the same number of days a week to eke out a living on a farm?” And as a point of fact, it is still true today as it was back then: the industry with the highest per capita rate of serious injury is hands-down agriculture. And up until around 1900, about 95% of the population worked in agriculture. Today, around 5% of the population is involved in agriculture.

I would also ask what government “charity” has done, with the trillions of dollars it has spent and is going to spend, to ameliorate poverty? I’d submit that it has exacerbated poverty.

As I have repeatedly pointed out, it is a contradiction to assert that neither you nor I have any right at all to steal, for whatever purpose, but we somehow have the right to confer that on government employees. Theft is wrong or it isn’t wrong. How does one do an immoral thing to accomplish a moral thing?

I sincerely hope that this is confusing, because it should be.

Tom | December 7th, 2009 at 7:30 am

I think the thrust of your argument goes to inefficient, poorly planned, and poorly executed public assistance programs. I won’t disagree. But I also won’t accept that the least among us should be left to suffer in silence, unless some good Samaritan happens to come along and gives a little help.

Taxes, some of which go to helping poor people, are not theft. The only alternative to living in a society that taxes its citizens, in part to help other people, is to find some place where one can live in a state of nature with little or no social organization. Sounds nice, but it doesn’t exist.

Gotta go — I’ll be researching “Hegelian Dialecticism” for a while….

Cristla | December 7th, 2009 at 8:10 am

Brian- What you seem to be forgetting about or have not researched is the single parent with 3-5 children, they can make 2500-2700 a month and still qualify for food stamps and medicaid if they do not have insurance at their job. If they choose to eat steak over chicken and hamburger then so be it. The money will just run out faster. As for having electronics, why should they not be able to buy them as well as people that do not qualify. I am sure that most parents on food stamps want to be able to provide the same toys as the children not getting help. Who’s to say they bought it new, it could have been a gift or bought on ebay or some other site. Tom–I agree with you on the fact that taxes that go to helping the poor is not theft. Brian- I am guessing that you have been fortunate enough never to have needed help by anyone. If you have ever taken money food clothing or a vehicle from someone, that is considered charity even if it isn’t from the government, so unless you have always been able to take care of yourself and family with no help at all then you should not throw stones because other people may need a bit of help themselves. Yes there is the fine line of needing help and abusing it.

Brianna | December 7th, 2009 at 9:47 am

Tom – it’s not just that most assistance plans are poorly planned and executed. It’s that, under government, assistance plans can not be anything BUT poorly planned and executed. People think that you just need to tweak the system to make it work. It simply cannot be done. You say that health care right now is open-ended, not controlled by restrictions of any type. Well you’re absolutely right, it is open-ended, because government can’t say yes without going broke and can’t say no without people going nuts. That means we have two choices. We can either let the government take the system under total control and watch the government start to say no as it sees fit (no mammograms for women under 50, for example) or we can put health care more firmly back in the private sector and have individual people say yes and no as they see fit. And yes, before you ask, that would include the charity of individual doctors, voluntary charitable organizations, and individual financial donors. I cannot be sure of this because I haven’t actually researched it, but I have reason to believe that most hospitals had charity wards before government got involved, even as early as the 19th century. Was it as good as the care the rich got? No. Was it care? Yes.

This is what will happen to government health care, inevitably, if we let the government completely take over:

http://www.youtube.com/watch?v=G2EFSKVo0rs

Tom | December 7th, 2009 at 11:02 am

I’m not sure the real alternatives are either total government control or returning most health care to the private sector (I’m not really sure what that means). In any case, we have a mix of public and private now, and I think that can be tweaked to work better, with some cost control, and with better access. Of course, the plans now in Congress aren’t the right answer.

You’re right, there were charity hospitals and charity wings in the past. Perhaps the most famous, Charity Hospital of New Orleans, was operating right up to the point that Katrina wiped it out, and it’ll probably never open again as a hospital. I spent much of my youth not too far from New Orleans, and I knew many people who went to Charity Hospital. As I remember, you paid what you could, or you didn’t pay at all if you couldn’t.

But we’re back into another discussion, really. Things are what they are now, the country and life in general are much more complicated, and the clock can’t be turned back.

Brianna | December 7th, 2009 at 11:39 am

It would mean phasing out medicare and medicaid, equalizing tax conditions for private health insurance through employers and private health insurance purchased by individuals, scrapping restrictions against competition between insurance companies across state lines, and capping emotional damage awards in malpractice suits (note that I did not suggest capping economic awards, merely emotional damage awards that cannot be proven or objectively determined). The reason I say “phasing out” as opposed to “scrapping” medicare and medicaid is because the government made a promise and has to follow through, but just because it can’t dump current patients doesn’t mean it has to take on new ones.

In the 1960’s the government spent between 10% and 20% of health care dollars in this country and most of it was for veterans (the one form of government-provided health care I do NOT object to, because our veterans hve EARNED it). Most people paid out-of-pocket, few had insurance, and from what I’ve been able to find so far there weren’t very many people who were not well served by this system.

What many people who complain about health care “rationing” in our current system do not realize is that in government-run health care systems, there would still be rationing, it would just be on a different basis and there would be no court of appeal. What they don’t realize is that in Japan, which supposedly has such a wonderful free health care system for everybody, there are people who are turned away from receiving even emergency treatment, because the hospitals simply do not have the room or resources for them. There was a town in Canada that held a doctor lottery (no Clarissa, I am not making this up; I wish I were) to assign primary care physicians to families, and only a fraction of them actually got one. Where do the rejected go afterwards? Nowhere. There’s nowhere left to go. But nobody seems to object to people being turned away this way. Nobody seems to care. Why? Personally, I think it’s because when someone gets a better result through merit, it creates resentment; when someone gets a better result through chance, nobody cares. A free system creates better results for different individuals through merit, and constantly increases the quality of those results for all concerned because merit rewards ability, productivity, and innovation. A government system awards different results for different individuals through chance, and almost inevitably finds that as time goes on, the amount and quality of results that they are able to award decreases because, quite simply, the people who produce those results cannot live and produce if they are not rewarded for it.

People say that the poor and needy would get turned away a free system. And they’re partially right, there would be some people who would not be able to get as good care under this system than they do now, because they would not be able to afford it. But I think that very few people would be completely turned away and that it would not happen nearly as often as most people seem to belive, and that the level of charity care they received would be better than most people think. People can be a lot more generous than most realize when they are not being forced to contribute as a duty, and charitable contributions are not viewed by the needy as a right.

Terri | December 7th, 2009 at 12:42 pm

Brianna- You are so right about the health care in Canada. The health care for everyone there maybe “free” but it is rationed. Unfortunately I am afraid if the United States continues the way we are today it will be our future. I agree with your statement “But I think that very few people would be completely turned away and that it would not happen nearly as often as most people seem to belive, and that the level of charity care they received would be better than most people think.” I do think that they may get care but i am not sure that they would get the quality care that is needed for every American