Socialized medicine: inefficient, unfair

Recently a message was sent to President Barack Obama’s supporters under his name that urged them to get behind his proposal for universal health care and castigated his critics. I share with him a desire to reform our health care system, but along lines completely different from those which he only vaguely explained. It is not very helpful, as Obama did, to sum up health reform in terms of "core principles" (reduced costs, guaranteed choice, and quality care for every American) when the means employed to fulfill them are unspecified. Nor does it help to oversimplify the issue, as he did, by equating support of the dreaded "status quo" with "half measures and empty talk."

Obama stigmatized critics, moreover, for "spread[ing] fear and confusion about the changes we seek." And then he proceeded to spread genuine "fear and confusion" about "spiraling health care costs" and failed to acknowledge how much government programs such as Medicare and Medicaid have contributed to those rising costs.

The President told the story of his late mother's battle with ovarian cancer, "spending too much time worrying about whether her health insurance would cover her bills," which is very moving but also verging on exploitation. Ovarian cancer presents a major challenge which even the most lavish health insurance cannot mount. No government program can end these worries.

We are responsible for our health. I'm no less mindful than Obama of the persons without health care, but dealing with that deficiency does not require socialism. As his opponent, John McCain, advocated last year, substantial tax credits for health savings accounts will help people who lack employer or government plans.

Before there was massive government involvement in health care, and before third-party payers dominated the field, costs were actually more manageable. Forty years ago my oldest son needed surgery that cost us, a young married couple of modest income, $500. I am sure it would cost many times more than that today, not only because of inflation but because of the proliferation of third-party plans, which shield consumers from the true cost of their care.

In any case, there is no more reason to socialize health care costs than the cost of food, transportation or housing. Obama may not want us to know that what he is proposing is socialism, but many of us don't need to have it spelled out. It is not fear-mongering to point to the experience of nations that already have government care, which entails artificial caps on costs and rationing. Only a free marketplace can bring consumers and providers together and enable them to agree to reasonable terms.

The President is only worsening the current difficulties by proposing more of the same government intervention. We must oppose him in order to preserve, and even return to, the limited government bequeathed to us by our founding fathers.

As a friend of many years has reminded me, however, for millions of Americans justice is central to the health care debate. He wrote: "We will end up with ‘socialized’ medicine unless our people are convinced that justice and fairness are better served, and good medicine is better provided, in a non-socialized system of health care. Many good Americans are willing to accept lesser care (up to a point) if they are persuaded that the promised new system would be more just and fair for each and all of us."

I think he is right. Liberals believe they have a monopoly on justice and fairness, erroneously equating equality of condition with equality of rights. The truth is, the free market exemplifies reciprocity in exchange, a form of justice, as doctors and hospitals provide a service for which they deserve to be paid, and patients deserve a say over costs. They have that say now for virtually all other commodities (automobiles now conspicuously excluded, thanks to President Obama), which makes them largely affordable.

But there is no justice in making some Americans subsidize the health care of others, nor is it fair to deny people health care because some bureaucrat decides that their needs aren’t as worthy as someone else’s. Imagine if food production, distribution and sales were socialized, and the government determined what we ought to be eating!

The American idea of justice is not, as Obama evidently believes, "From each according to his ability to each according to his need." Rather, it is our right to govern ourselves. It is better, as the early Pilgrims learned the hard way, for each person and/or family to use their abilities to provide for their needs. Justice and utility are in perfect alignment.

Health care & education: Who chooses?

Apart from national defense, the two giants of the U.S. economy are health care and education. In terms of expenditure, number of employees, and importance to every American family they are unique. They are very similar in that both face mammoth challenges regarding cost containment and the equitable distribution of services.

Both are also very high priorities for a new national administration that clearly has a goal of dramatically transforming American society into the statist social welfare model that prevails in Western Europe.

It is however the systemic differences between American health care and education that are most instructive because they illustrate better than anything else the stark choices facing our country at what is obviously a critical turning point in our history.

To understand these differences it is best to view them via a litmus test of the varying levels of government control and union dominance in both industries.

Throughout the first three hundred years of American history education was largely a local affair constructed and run by private individuals. K-12 education was disproportionately the province of single women who read very well and were able to convey that skill to pupils who were thus empowered to read books on literature, history, geography, science etc. Post-secondary education was in the hands of older people possessing college degrees who for relatively modest fees were willing to share what they had learned with younger people who wished to acquire said degrees.

Throughout this period the influence of state government financially and otherwise was negligible, the federal role virtually non-existent. As late as 1949 a United Nations survey of international education described the U.S. system as the world’s leader in performance, freedom, cost-effectiveness, and particularly breadth and equity of access.

The second half of the 20th century however saw U.S. education moving in an accelerating downward spiral in which performance, and accountability sagged while costs soared. Coincident with and the major cause of this decline was the growth of government control and labor union membership from minimal levels to positions of overwhelming dominance. Thus today while an ever-shrinking private sector still exists it is fair to describe American education as a system of “government schools” where teachers belong to unions much more interested in member benefits than in student achievement.

American Medicine grew from the tiniest acorn into the mighty oak of the global pre-eminence it enjoys today. In the 17th century doctors were few and far between. When possible veteran doctors shared their knowledge with aspiring young physicians. The latter however were greatly reliant on their close study of classic medical texts.

“Hospitals” as that term is properly understood did not appear until the late 18th century. Formal medical education first put down roots in the 19th century.

Only in the 20th century did American medicine evolve into what we can call a “Health Care System”. By gradual stages medical education, hospitals, research, and insurance came together to produce constantly improving patient care for an ever growing proportion of the population.

Though significant government monies went to research, education and insurance in recent decades, the overall enterprise remains largely in private hands. Standards for professional competence, hospital effectiveness and research probity remain essentially and successfully within the province of the medical community. In effect while government offers support, it does not control governance, and unions while present-mostly among lower ranking employees- are decidedly not dominant.

Perhaps the starkest difference between our educational and our health care systems is seen in who has choices and who does not.

In government controlled schools, not surprisingly the government makes the choices about what’s available, where, when, and for whom, and also supports a system of quality control that essentially grants veto power to labor unions.

In our health care system patients get to make important choices regarding their doctors and treatments. Unlike education money follows client choices, and quality control is firmly in private non-union hands and is committed to the high standard of patient well-being rather than the low standard of employee convenience.

In sum, for both education and health care a citizen’s right to choose goes hand in hand with both quality service and customer satisfaction. Government control and union dominance are hostile to both.

Very soon citizen choice in both health care and education will face major tests against the power of government and unions. It is hard to exaggerate how much is at stake.

William Moloney’s columns have appeared in the Wall St. Journal, USA Today, Washington Post, Washington Times, Philadelphia Inquirer, Baltimore Sun, Denver Post, and Rocky Mountain News.

Bad mix: Unions & health care

A friend of mine is a card-carrying member of the California Nurses Association. She is not a union supporter in theory, but cannot practice her profession at the hospital where she's employed unless she is a member. I spoke with her recently about a nurse that testified before Congress several months ago against the card-check proposal, saying she was harrassed and bullied at work by union organizers that attempted to strong-arm her into signing on.  My friend commented that she receives a magazine from the union each month.  She has often written to them to dispute an issue or present an opposing point of view.  The magazine has no space alloted for letters to the editor or forum whereby members can debate, or even ask questions.  Her union dues are taken from her paycheck and spent in ways she does not know and if she asks, her inquiry is ignored.  Her voice is irrelevant and silenced.  Her option is to continue or find another job at another hospital that also is most likely a union shop.  At 60 years of age, she is not in a position to give up nursing and pursue another career. In checking the website of both the California nurses union and that of the same organization in Colorado, there is a very different tone.  The Colorado website is professionally done and does not carry an obvious tone of hostility.  On the other hand, the California union nurse website is rather radical, if not almost militant about their support for one-payer nationalized or universal healthcare.  Their online store even includes the opportunity to buy Michael Moore's movie, "Sicko" and "Sicko" surgical scrubs and t-shirts.  My friend told me when "Sicko" was about to be released, nurses in her hospital sat at tables during the workday, handing out brochures about the movie, sold the t-shirts and veiled the entire propaganda campaign as being some type of health fair.  They did free blood pressure screenings, talked with employees, patients and visitors about the idea that if we are to be truly healthy, everyone should get onboard with a government regulated healthcare system.  The most outrageous part of this campaign came when my friend received more literature in the mail from the union, along with a return postcard which listed the movie theaters in the area that would show "Sicko".  My friend, and other union nurses, were urged to check which theater they would see the movie, along with the exact date and showtime.  This would allow the union to organize people to make sure each showing at each theater was sold out.  Their idea that Michael Moore is an expert in healthcare delivery was surpassed by the notion that if in the first days the movie was shown, it played to packed houses, that would create interest across the country, getting millions to go see it and ultimately buy into his notions.   The concept that average, hard-working nurses had the time and financial resources to put forth the aggressive promotional campaign of Moore's movie is not credible.  My friend pays about $1200 per year in union dues, but she feels much of that goes toward an ongoing mass mailing and workplace literature distribution regarding the different political policies they promote.  Where did all the money needed to try and send Moore's movie to the top of the ratings come from? 

California nurses union officials are in a brutal war of words with the powerful SEIU (Service Employees International Union.   Frankly, any connection between the words, "union" and "international" in our country gives me reason to fear. ) The SEIU is on the march with their own unionized agenda, attempting to sign up other hospital workers such as nurse aids, medical tech personnel, maintenance, housekeeping and food service workers.  The SEIU endorsed Obama for the presidency and funneled significant amounts of money into his campaign.  The California nurses union is fearful that the SEIU will be able to siphon off some union nurses into their organization.  

Will the radical agenda and determination to drive policy and shape delivery of care as seen in the California model spread East?  There is a strong movement to do just that. They are outspoken in their criticism for the current stimulus plan, as it does not give them the desire of their hearts--government controlled delivery of healthcare ASAP.  They are calling for a plan entitled, "Medicare for All". They believe every American, regardless of age or ability to pay or not pay, should be signed up for this new Medicare plan which would be operated in much the same fashion as the one we already have that is a bankrupt ticking time bomb about to go off, plunging us further into the morass of eternal debt and obligation.

 In promoting the new Medicare plan, the nurses don't explain how they intend to pay off and clean up the current Medicare nightmare.  One of their current mantra's is that the government needs to fix healthcare, for in doing so, that is the last best medicine for the economy as a whole. These folks also don't discuss their plan to solve the huge debt obligation California carries within it's Medicaid system. Millions upon millions continue to be spent around the country, California in particular, for health services dedicated to the care of persons in this country illegally. As for that issue, the California nurses union believes ALL persons should have full access to every type and style of healthcare in our country. Additionally, nurses should be able to demand through their union whatever salary they believe to be fair and have that amount paid. They believe the culprits in our healthcare system are hospitals, insurance companies and pharmaceutical companies. Any attempt by those three industries to break even or make a profit is wrong and greedy.  It is only the nurses that are to be paid and profit at their desired level, and patients that should be given all healthcare services at little to preferably, no cost. 

Those in our families, circle of friends and communities that believe there is "free" healthcare waiting for them if only this particular stimulus package is passed are in for a sudden and rude awakening. If our healthcare is moving toward a system that is completely taken over by unions that actually believe Michael Moore is an authoritative voice regarding our care, may Heaven help the rest of us.

Three threats to our liberties from BHO

After considering Obama's campaign promises and policy statements, one can make these disturbing prognostications. They are related and inescapable if we are to believe what the President-elect and Democratic Leadership claim as their goals. I believe them. Number 1. Criminalize fee for service. Universal health care has implications and consequences that are seen and unseen. Adding the claimed 47 million "uninsured" to our non-emergency system will dictate rationing of care and when any service is rationed, wealth and power work to over come the ration. Politicians will not participate in the rationing of care so only wealth will remain as an alternative mechanism. Prevention of that option requires that the government criminalize the acquisition of medical services by those with the ability to pay. As soon as universal health care is crafted by Congress, hidden within will be the end of American medical excellence.

Number 2. When President Obama signs into law the rebuilding of our nation's interstate highway system he will include a user fee technology that will tax all private cars based upon highway miles and mpg. The case will be made that global climate change and auto industry bailout mandates dramatic action to change our methods of travel and private automobile use. Technology will give the Federal government the option of tracking every mile of interstate highway and transferring a tax statement to private car on the system. Gone will be the free movement of Americans across our own land.

Number 3. Global warming is a fraud. It is not happening. Debate would demonstrate that but the forces of President Obama will foresware any and all debate. They will claim debate has been heard and time is now. Carbon Cap and Trade will be installed. With that Federal mandate, 5 million new "green" jobs will be required as union employees and they will be a voting block directly attached to the fraud of green house gas. With 5 million additional votes there will be no option for coming national elections. The governing class will be forever installed.

Hospital fees are the wrong answer

The revelation that Colorado Governor Ritter is conspiring with the Colorado Hospital Association to levy fees on hospitals to fulfill his political campaign promise to deal with the uninsured is a massively badidea. It falls short on three points.

First, there is no proof that hospitals have excess profits. Such fees would be internally cost shifted to patients and represent a hidden and covert tax. Medicare and Medicaid reimbursements are fixed and insurance companies negotiate discounts. That means only the sick, self-pay patient, who is already billed 27% more than the average would bear the brunt. It's regressive. We are trying to reduce cost shifting, not increase it.

Second, any extraction of additional monies so as to channel it back to pay for the costs of care of the uninsured is inflationary. Health care hyper-inflation is directly related to the steroidal injections of financial subsidies for various "needy" groups. It has distorted and destroyed any semblance of a marketplace in health care.

Finally, either mandates forcing people to buy health insurance or tax-based subsidies avoids the real need in health care reform. We need to re-institute disciplining forces, be-it competition or regulation, take your pick, to reverse the seemingly never-ending upward trend of health care inflation. In a time of recession we need the health care system to become more productive and efficient. Their costs need to decline, not superficially inflate.

The political establishment and the trade association lobby, continually obfuscate and avoid the real need in health care. There is no magic bullet. It is old fashioned efficiency improvement and quality. Maybe we should be consulting Toyota on health care.