The Unions Get Paid Off by the Democrats

There is a disturbing trend in the actions of the Obama administration when it comes to how they spend the money. There are at least four different examples which will highlight the trend.

First, the automobile industry bailout: Money was given to General Motors and Chrysler instead of allowing the companies to reorganize under a Chapter 11 bankruptcy. Therefore, public money was taken from auto workers in the south whose average salary is about forty three dollars an hour and given to United Auto Workers members in Michigan whose average salary is about seventy one dollars an hour. The Obama administration portrayed the action as helping the General Motors and Chrysler corporations. In fact, a chapter 11 bankruptcy would have been much more advantageous as it would have allowed renegotiation of the labor contracts and would have relieved the pressure of legacy costs to the companies. The money was really a bail out of the United Auto Workers, not the companies. It hasn’t worked and the two companies have shown no signs of changing fortunes.

Second, the school voucher program in Washington, DC: The voucher program in Washington, DC cost about $7600 per student. The schools at which the voucher students attended had 90% higher scores in language tests and 95% higher scores in mathematics testing. The interesting paradox is that the Washington, DC public school system spends about $13,000 per student. The omnibus spending bill removed funding for the school voucher program. The Democrats, in their infinite concern for children, cancelled a program which cost taxpayers half as much and resulted in markedly better school performance. Why would they do that? The answer is easy. The teachers union has been paid off for supporting Democratic candidates in the election. The Democrats are willing to screw over poor children and their families in order to pay off the union.

Third, the stimulus construction projects: The stimulus bill passed by the Democratic Congress and the Obama administration has a provision that stipulates that stimulus construction projects have to pay union wages to workers on stimulus projects. Why would that provision be in the bill? After all, it would result in less money to do projects and the ones that are completed would cost more. The reason is easy. Governments don’t build roads and bridges, private contractors do. Those contracts are awarded by bid. A non-union company can submit a lower labor cost bid than a union company. The raw materials cost will be the same. Therefore, the non-union bid will generally be lower. This provision in the bill is expressly for the benefit of union contractors to receive stimulus money contracts for infrastructure. The unions will receive money but the taxpayers will get less infrastructure projects completed for their money.

Fourth, the “Employee Free Choice Act”: This piece of legislation is close to criminal. The rules would change and take away the right of workers to a secret union election ballot. To organize a union, all that organizers would need is 51% of employees to sign a card and the union would be installed. The cards would be public and the period of time to have them signed in unlimited. This is like the mob in Chicago in the 1930s. Union thugs intimidating workers is not progress. The intimidation may not even be the worst part of the bill. In the event of non-resolution of a union contract, after a set period of time the federal government will set wages. Hmmm… with the Democrats in power, I wonder whose side would be favored? Therefore, people who are intimidated into a union will have their wages set by the federal government. This is an economic disaster of the highest magnitude just waiting to happen. It will lead to companies closing because they are no longer profitable and revival of the union thugs who have essentially gone away due to people's reluctance to embrace unions.

In all four examples, it is easy to see the pay off to the various unions by the Democratic Congress and the Obama administration. It is brazen and open. It is also going to massively harm the United States economy and prevent recovery. A recent poll which asked people if they desired to have their jobs converted to union jobs had only 9% say yes and a resounding 83% say no. This is the Democratic version of the organized crime “protection” rackets and is disgusting.

Now That They Get It, They Can’t Fix It

I have written a number of times previously about the source of the current economic crisis in the United States. To briefly review, the Congress and Clinton administration created policy which encouraged loans to low income individuals because they thought more home ownership would be good for the country. Freddie Mac and Fannie Mae bought a lot of the loans from primary lenders therefore leading the primary lenders to make more poor loans. The real problem came when Fannie Mae and Freddie Mac created securities based on the value of those bad mortgages and sold hundreds of billions of dollars of the securities to investment banks around the world. The current problem with fixing the problem is that there is no way to determine which mortgages are associated with which securities. Because there is no association, no one can determine how much each security is worth. Therefore, banks who own billions of dollars in those securities don’t have any idea whether they own securities of value or not. They are holding onto the solid money they have because they don’t really know how much they have in those securities. The US government is discussing how to get those “toxic assets”, as they are now known, out of the financial system to try to restore normality to the system. The administration and the Congress are still trying to figure out how to do it.

There are several possible ways to try to value those assets. The grindstone way is to look at every single mortgage which was bought by Fannie Mae and Freddie Mac to determine the value of the mortgage (solid, just getting by, or in default). Even if that monumental task was done (and it would take a long time), the question then becomes how to assign the individual mortgages to the securities. None of the owners of the securities want the worthless mortgages assigned to the securities that they own. In fact, the owners of the securities are looking for the government to get them their money back. That is patently ridiculous. The idea that taxpayers should make up money to speculators who greedily and hungrily bought those securities is insane. If I buy a stock and the value tanks, I don’t expect the government to refund my money. One way to assign mortgages which would seem fairer is to evaluate them all and to use the average value to calculate the value of the securities. That way, every institution that bought those securities will share proportionately in the pain of the downturn of the real estate market and none will be assigned entirely worthless mortgages. The problem with that approach is that a vague average is assigned and not the actual value of the individual mortgage. When assets are not based on a real value, there is a lot of uncertainty in the system. It is that very uncertainty which keeps financial institutions from freeing funds for lending.

The government solution currently seems to be to buy those “toxic assets” from the owners of the securities to resume normal operation of the financial system. There are several problems with this solution. The first is that by spending $750 billion on the first TARP (toxic asset relief program), a $760 billion “stimulus program” which had nothing to do with correcting the problem, a TARP II program, and then a $410 billion omnibus spending bill, the American public has caught on to the fact that the money has to come from somewhere. There is little, if any, patience left for another huge spending bill in addition to President Obama’s proposed 2009-2010 budget. The President is continuing to propose huge spending on social programs which are liberal politics and have nothing to do with fixing the problem. The cost of buying the “toxic assets” is staggering. I believe the current administration has misspent the political capital from the election on the huge liberal spending programs and now will have to deal with the resentment to their spending. The resentment and potential political backlash will likely prevent the spending which should have been the first priority, fixing the mortgage crisis. If the mortgage security problem had been originally addressed, the markets would have fixed themselves and several trillion dollars in government "stimulus" could have been saved. By taking political advantage of the crisis to put liberal social programs in place, there is nothing left with which to fix the crisis. The only option is to borrow from foreign countries and tax the people who actually earn money, therefore leaving them nothing to invest in the markets. It is self-defeating.

My guess is that they will inevitably screw the taxpayers by paying way too much for the assets in order to appear to be doing something and gain political points. The actual value of the assets will eventually declare themselves and the government (taxpayers) will be left holding the empty bag. The government will once again reward the speculators and failures at the expense of the prudent and safe investors. The same congressional representatives who screwed the pooch on oversight, regulation and then on spending will be the ones trying to fix the problem. When the government negotiates with people who are actually smart about financial matters and do it for a living, the government will always get hosed.

The Liberal versus Conservative Philosophies

I noticed that the Democratic Congress is talking about another bogus stimulus package. Everyone who paid attention knows that the first stimulus package was not intended for stimulus or, if it was, it was only a peripheral goal. The idea of that package was to use the crisis to advance liberal programs which would not have been passed through the normal appropriations process. By bundling them up in the package, the Democrats could get a lot of their long stalled programs into law. It was a total scam. President Obama used the Bill Clinton tactic of running as a moderate but has since shown his true colors as a far-left liberal. Let’s look at some of the fundamental differences in the philosophies between liberals and conservatives.

The overwhelming viewpoint of liberalism is arrogance. The view of liberals is that the population needs guidance and caring from the government. They are maternal in attitude. The liberals feel that the government has to be maternal because the liberal officials in government are so much smarter than the population. The fundamentals of conservatism include the concept that people can think and choose for themselves and that an individual or family will know better what they need for their own situation than program directors in the government. You will notice that states where there are large numbers of farmers, ranchers, and others who are used to living independently and making their own decisions are almost exclusively conservative and represented by conservative Republican or moderate Democrat officials. The states primarily in the north east and in the rust belt where people primarily live in large cities and depend more on government infrastructure tend to be Democratic. Much was made of the recent Democrat wins in 2008 but if you paid attention you would notice that a lot of the newly elected members of Congress were moderates, like Rep. Heath Shuler in North Carolina. I find the liberal attitude insulting and demeaning. The idea that someone who has never met me, knows nothing of my own or family situation, and has less education than I do, can tell me how to run my life because they are smarter than me is insulting and arrogant. The government is supposed to serve the people, not control their every day life. If you read the Federalist Papers, written by Alexander Hamilton, James Madison, and John Jay, it is clear that while there are clear reasons to have a strong central government (military, commerce, treaties, etc.) the Constitution is primarily there to define what government is NOT supposed to do. Liberalism thinks that the government should constantly guide your decisions because they know so much more than you do. It is offensive.

Both liberalism and conservatism attempt to improve the financial standing of the general population. There is a great difference in the ways that the two philosophies go about it. In general, conservatives feel that the road to economic success lies in opportunities and restricting the amount of personal or business income that the government takes from the population in the form of taxes. The idea is that people, when provided opportunity, will improve their own situations based on their merit and work ethic. By allowing individuals and businesses to achieve success based on their own ideas and effort, people have incentive to work harder and innovate. By allowing people to keep more of what they earn and by providing opportunities for people to succeed, those at the lower income levels can improve their situation with hard work. Liberals go about this differently. Liberals feel that people of lower incomes are “victims of the system”. The way that liberals will improve the plight of those at the lower end of the economic spectrum is to take income away from the upper income earners and give it to the lower income group. It is denigrating to those who would like to improve their situation on their own. It is tantamount to saying that those without success are incapable of achieving it on their own. It is a philosophy of victimhood and once again shows that the overarching liberal philosophy is that they are smarter than everyone else. Conservatives want to raise the lower end of the economic spectrum and liberals want to lower the upper end by giving their earnings to the lower end. They call it “fairness”. It is a disincentive to work and innovate. How many times have you heard someone say, “Why work? The government is going to take it, anyway.” Of course, the liberal philosophy leads to socialism and eventually communism. The only difference is how far you are willing to go.

Recent program proposals by the current administration are evidence of the differing philosophies. The proposal for government-run universal health care demonstrates the arrogance of the liberal elected officials. I have written a number of pieces about it. The idea is that in order to reduce costs, the government is now going to tell physicians how to practice and to take away the right of successful earners to individualize their coverage. It is demeaning. While everyone agrees that reduction of carbon emissions is a worth while goal, the last ten years have shown a cooling trend on the Earth. Despite data to the contrary, the current administration wants to put in place a “cap and trade” system which will substantially impact the American economy. Their justification is “global warming” despite all data to the contrary. It is because they are smarter than the scientists.

The real common thread of liberalism which differentiates the philosophy from conservatism is control. Everything about liberalism allows the government to obtain power over the population in their daily lives. Once again, the reason that they want that power is because they truly believe they are smarter than the population and therefore should tell the population how to live. If you look at the very populations that the liberals have identified as those they are "lifting up" in the last fifty years, there is little to no evidence that the liberal policies have done anything other than to further the dependence of those same people to government assistance. It is a Bernie Madoff scam of the highest order. Conservatism allows people to be left alone and gives more individual freedom to the population and therefore cedes control away from the government.

The idea that people are incapable of taking care of themselves, working hard and earning based on their own merits is arrogant and insulting. I am constantly amazed how liberal politicians can routinely insult people and still manage to acquire their vote by buying them off. It certainly is easier to just sit back, claim to be a victim, and have the government give you some free money that someone else earned, than it is to work hard for yourself. The problem with that is that if enough people do it, no one is left to earn. Then the economy collapses and you end up in the Soviet Union. Conservatism is the philosophy which drove people from Europe to the United States and drove the movement of people during the western expansion of the United States. It is a fundamental quality of the American people which will prove popular if elected officials who purport to be conservative would actually govern as conservatives once they are elected.

Bringing Down Health Care Costs

This is another in the health care discussion continuum. I am hearing a lot of ridiculous statements from politicians. Let’s look at some ways that would actually reduce health care costs and if we really want to go there.

I spent a lot of time discussing universal health care, the built in inefficiencies, and how it will lead to poorer quality physicians and care in an earlier entry. I am clearly convinced that universal government-run health care is a disaster and will make mediocre care available for everyone. As I said in that piece, 40 million Americans have poor care now but universal health care will make sure everyone does.

Rationing Care – We could do what the British and other socialized medicine care countries do. They don’t call it rationing. They call it an effective use of resources to deny care to significant portions of their population. The way they do it is with actuarial tables. For example, if the median age of death in the country is 74 and you are 76, no matter your medical health state, you are a bad investment for medical resources. If you prescribe to those statistical methods, you probably also believe that when you reach a certain age, you should just jump off a building or head on down to the Soylent Green plant for processing. Additionally, under mandatory universal health care, someone like Warren Buffet with a billion dollars earned, gets the same care as John Q. Suckerfish, who had lived his life on welfare. A system like this will set up generational war where the younger members of society will hoard the health care dollars despite having no where near the need for them. Do you really want to see your parents and grandparents denied care, even if they are in good health, based purely on an actuarial table? I don’t think we want to go there.

Improving efficiency – Everyone always talks about improving efficiency in health care. You might notice that they always do it in generalities. President Obama continually talks about the “billions of dollars we can save by improving efficiency in health care” but the only specific he ever mentions is electronic medical records. I have addressed the problems with those in an earlier post. When people talk about improving efficiency in generalities, it is a sure sign that they have no idea what they are talking about. It is a straw man. It is like saying “I am for better schools” or “I am for a strong defense”. Unless you have specific proposals, you reek of fecal matter from male cows when you discuss it.

Get Out of My Emergency Room – One method of reducing costs which has been widely recognized for years is moving people back to seeing their family primary care physicians and physician assistants. The same office visit which costs $75 at the family physician office costs $600 at the local emergency room. I have worked in many emergency rooms where every Sunday night, mothers bring in their children with minor complaints of colds, fevers, etc. to inquire whether their children should go to school tomorrow or not. It is major waste of health care dollars. If a family physician or pediatrician held office hours Sunday evening, the emergency room would only have half as many patients and the cost would be reduced by a factor of ten. The reasons that emergency rooms exist is because doctors historically did not want to have to work twenty four hours a day. Since internists and surgeons would be called in at all hours of the night to see patients, they came to hire physicians to man the medical facility at night. That eventually led to the creation of the emergency medicine specialty.

Many people now use the emergency room as their local clinic. Part of the reason for this is that emergency rooms are not allowed to turn away patients. Therefore, a person can choose not to pay for health insurance and just show up. Who picks up the cost? The taxpayers of the local area. In an analogous manner to the emergency room physician, why not have physicians or practitioners man clinics at night to allow primary care to be done at the clinic rate rather than the emergency room rate? If people use their existing health policies to make office visits instead of using the emergency room, huge savings are possible.

Private Health Insurance – Over the years, business interests have put in place laws which severely restrict which health care plans people can purchase. For example, in most places, you cannot buy a policy across a state line. If you live in Maryland, for example, you cannot buy a policy from a health insurance company in Utah. The system was set up by the local legislature after lobbying from the local health insurance company to set up a monopolistic system. The system guarantees no competition and therefore no reason to improve policies or reduce premiums. It is the same as universal health care in that the system is bloated and inefficient. To reduce costs almost immediately, those state line restrictions should be dropped. This must be done in combination with the next section to induce competition among health insurance providers. A family will buy the health insurance policy with the best benefit package and lowest premiums available if those plans are in competition.

Third Party Payers – This section goes hand in hand with the prior one. Companies always complain about runaway health care costs as the reason they are unable to make a profit. It many cases, it is true. No one who has company-provided health care cares what it costs because they never see the premiums. As long as you can get care for your family and keep your job, there is no reason to care about the premiums. I believe one answer is to get rid of third party payers. If your employer gives you, as part of your pay and benefits package, money to buy health insurance instead of providing a policy, you then have a vested interest in knowing what it costs and finding the best policy available for the best price. A system like that would provide a lot of flexibility. It would be like automobile insurance in some ways. If you are a young healthy person, you could opt for low premiums with higher co-pays (deductibles) because the likelihood of having a serious illness in your twenties or thirties is fairly low. As you age, you can adjust your policy for higher premiums with lower co-pays because the likelihood of your needing medical care increases. If you have an individual or family policy that you own personally, you can take it with you if you change employers. Since you would buy the policy while you are young, you would not run into the problem of changing jobs in your late forties and finding the new premiums prohibitively expensive. If any policy anywhere in the country was available, people would shop for the best policy around. Insurance carriers would then be forced to compete with better benefits and lower premiums in order to attract customers. This is the way that free markets always improve services for customers.

Did you ever notice that when you buy a slice of pizza in New York City that it is really good? There is nothing genetic about the people in New York that makes them better cooks and the ingredients are the same as everywhere else. Why is that? It is because if you don’t make a good pizza slice, there are three more places down the street that do and you go out of business. That is the way competition works. If competition in the health insurance industry is opened, policies will improve and prices will improve. People will be able to maintain their policies no matter where they move and if they change their job. The market will fix the problem if we let it. For those unable to purchase policies due to physical or mental disabilities, the government can help them. No one has a problem with that. The prices will be less expensive to the government because of the competition in the industry and it will cost less in tax dollars. I should point out that I do have a problem with providing tax money for health care to able-bodied people who choose not to work or buy a policy. They have chosen their own fate as people in the United States are free to do.

Tort Reform – Many physicians are now required to practice what is known in the sector as “defensive medicine”. What that amounts to is getting your ducks in a row before the inevitable frivolous lawsuit. Extra expensive radiology studies, laboratory tests, and follow up visits are the norm to prevent litigation. In the obstetrics field, there are two kinds of baby births: perfect and lawsuit. It doesn’t matter if the birth mother is a crack-smoking alcoholic who performed as a professional wrestler while eight months pregnant, if the baby isn’t perfect, the Ob/Gyn is getting sued. That is because there are law firms that do nothing else but sue physicians and hospitals. In Pennsylvania, the same malpractice insurance policy for a general surgeon that costs $37,000 a year in premiums in Virginia, costs $135,000. Why is that? Are surgeons that much worse in Pennsylvania? No, it is because the tort laws in Pennsylvania are set up for lawyers to make money. You will find this to be true in every Democratic state. Since the Trial Lawyers Association is the biggest single contributor to the Democratic Party, you will never see tort reform in one of those states. About 36% of the general surgeons in Pennsylvania have left the state. They cannot afford to practice there. They have to make $135,000 before they make a penny to keep. The does not include paying office staff, leases for offices, supplies, administrative costs, licenses, continuing medical education or any of the other routine costs of running a practice. Therefore, they move or stop practicing. Pennsylvania screws itself. Of course, that won’t stop the legislators from complaining about the situation, even though they caused it. It is a lot like Christopher Dodd and Barney Frank talking about the housing crisis. Next time you think medical care is too expensive; go to see your lawyer to get that coronary artery bypass surgery. I’m sure he can hook you up.

In summary, there are a number of ways to reduce health care costs which are far preferable to government-run universal health care. I have pointed out a few but not all. I am sure I will visit this subject again.

Democratic Selective Memory

Let’s start with a fact which is beyond dispute: The Democratic Party has been in the majority, and therefore in control, of both houses of Congress since the 2006 elections. In most of the recent discussions seen in the media and by Democrats themselves, that fact seems to get lost.

Part 1. When discussing the current economic condition of the United States, President Obama and all his surrogates constantly remind us that “this administration inherited this crisis from the previous administration”.

More facts: Article I, Section 7 of the US Constitution states, in part: “All Bills for raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other Bills.”
Article I, Section 8 of the US Constitution, states, in part:
The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;
To borrow Money on the credit of the United States;
To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;
To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;
To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;
To provide for the Punishment of counterfeiting the Securities and current Coin of the United States;
To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the Acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings;--And
To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

I deleted a number of lines which don’t have to do with finances. I think you can get the drift of these two sections of the US Constitution. The Congress owns the money and determines where it goes. How it is it, then, that the Democratic Congress has nothing to do with the current economic situation when they have been running both houses of Congress since 2006? It seems they forgot.

Part 2. The $410 billion omnibus spending bill which is currently under consideration contains about 8600 earmark spending projects. The current administration campaigned on and constantly disparage the placement of earmark spending projects. Their excuse for the current bill is that that Congress did not pass a budget at the end of 2008 for fiscal year 2009 and this is a leftover from the Bush Administration. Therefore, the earmarks in the bill are a product of the Bush Administration. Let me review: The Democratically controlled Congress did not pass a budget in the fall of 2008. The Democratically controlled Congress inserted about 8600 earmarks into the current bill. The Democratically controlled Congress raises the baseline spending in the budget by about 8%. Somehow, all of that is the fault of the Bush Administration. That is insane.

Part 3. When describing the housing downturn and banking crisis in the United States, Democrats blame the Bush Administration. The Senate Banking Committee, which regulates banks, is chaired by Senator Christopher Dodd, Democrat from Connecticut. Not surprisingly, Dodd received the largest amount of political contributions from Fannie Mae. Senator (at that time) Obama, received the second most. The House committee regulating banking and housing is chaired by Representative Barney Frank, Democrat from Massachusetts. When approached by the Bush Administration and Senator John McCain about increasing regulation of Fannie Mae and Freddie Mac several years before the crisis, it was Barney Frank who prevented the increased scrutiny and declared boldly during a committee hearing that “There is no crisis at Fannie Mae and Freddie Mac.” The Securities and Exchange Commission was run by Christopher Cox, a Republican appointee. Let me review: The Democrats controlled both of the committees which regulated banking and housing. Therefore, one can argue that there is plenty of blame to go around, but to blame the Bush Administration exclusively is insane.

If you listen to MSNBC or other liberal media outlets, every day there is some story like: “Today a woman in Podunk, Missouri was run over by a toddler on a tricycle while searching for her lost cat. Democratic Senate Majority Leader Harry Reid stated today that lack of regulation of toddler tricycles by the Bush Administration is to blame for the accident.”

At some point, people are going to realize that the Democrats have run Congress since 2006 and will hold them responsible for their action and inaction.

Universal Health Care

Health care costs in the United States are rising at a rate significantly higher than the rate of inflation. Corporations which provide health care to their employees are hammered by those increases. There is much discussion about how to slow the increase and improve efficiency. The Democratic Party has been pushing for government-run health care since the Clinton administration. Since it a huge agenda item for the Obama administration, let’s look at some of the issues involved.

Let’s start first with the people who actually provide health care. I will talk mostly about physicians but one must remember that in a private practice environment, if the physician makes less money, everyone associated with that physician makes less money also. One of the things which is coming out of the administration spokespeople is that they want to reduce waste, improve efficiency, and reduce payments to physicians. Let’s talk about reducing payments to physicians. I am a physician and I can honestly say that I don’t know a single physician who went in to the practice of medicine exclusively to make a lot of money. That being said, for those readers who might not know what is involved in becoming a practicing physician, let me give you a clue. I spent the requisite twelve years in public school getting good grades. Because my family could not afford to pay for college, I did an enlistment in the Navy to obtain Veterans Administration benefits. Using, those benefits and working full time, I obtained a chemical engineering degree in five years. I spent four years in medical school on a military scholarship and with loans because I could not afford medical school without them. I then spent five years working about 110-120 hours a week with virtually no days off to finish a surgery residency. I spent two more years completing a trauma/critical care fellowship. If you add that up, that is twenty eight total years of education. I paid for the scholarships with years of my life. Is it reasonable to think that after all those years of effort that I should be financially secure? Should I be held in contempt because I expect my efforts to be rewarded? I am not rich by any stretch of the imagination. With all of that education, should I make the same salary as a bank clerk, automobile mechanic, carpet installer, or ice cream vendor? It is an interesting question. In fact, should I be salaried at all or should I be paid by the services I provide? If I am a better surgeon than the guy down the street, should I make more money? I don’t make one tenth of what a professional baseball player makes. Is a baseball player more valuable to society than a surgeon? To place fixed salaries on any profession is to encourage mediocrity. If all baseball players make the same amount of money, there is no reason for anyone to try to become a star. There is no incentive. If you reduce incomes of physicians to the same level as any profession that requires one-year training program or a college degree, where is the incentive for someone to go through what I went through? I love taking care of patients but I am not a financial masochist. It took me sixteen years to pay off my medical school loans. Government-run socialized medicine is a one way ticket to mediocre physicians. Smart people will find something else to do.

What are people entitled to? There is discussion about whether health care is a right. Is everyone entitled to everything at any time? In an ideal world, that would be possible but in a real world with fixed resources, it is not. If it is not possible for everyone to have everything, who decides who gets what? The Democrats want the government to decide. That is happening in England now. They use actuarial tables to decide by your age what health care to which you are entitled. For example, past a certain age, if you having a failing heart valve, the government will not pay for a valve replacement because they have decided that it is a bad investment. It certainly does save costs. They do the same for interventional radiology, transplants, x-ray studies, etc. It is only another small step for the government to decide who lives and dies. It will be like planned obsolescence. You reach a certain age and you will be considered useless to society and we find ourselves cast in Soylent Green. Another government, years ago, went through these logical steps: why spend a lot of money on people who don’t contribute to society; why allow those people with genetic defects or insanity to reproduce; why spend money housing those people who aren’t reproducing anyway; why not terminate those people because their life is worthless and miserable, we would be doing them a favor. They called the science eugenics and it led to millions of deaths. In the current American system, decisions are made with your physician based on your individual story. I make these decisions all the time. A socialized set of rules will lead to philosophical questions. If you are a fifty year old award-winning teacher, do you deserve less care, based on an actuarial table, than a twenty-five year old crack dealer who was shot committing his fifth violent felony? If you are sixty five years old and are an active member of society, you have different options than a sixty-five year old in a skilled nursing facility who is completely unaware of the surroundings and has multiple chronic debilitating diseases. Is that cruel or is it just a better use of resources? While private insurers do limit treatment payments, the individual has a voice in choosing the limits of their coverage by the premiums they chose to pay. In a government run system, the rules will be fixed in concrete and the individual circumstances won’t be considered. The fixed salary, robotic doctors will practice under constraints and algorithms which will take decisions away from the doctor, patient, and family and leave in the hands of government health care administrators. That will lead to a dual system of medicine: a fee for service upscale system for the wealthy and a government-run mediocre system for everyone else. It is another step on the road to mediocrity. The Democrats argue that currently 40 million people have poor health care. They want to make sure everyone has equally bad health care.

Any government program has inherent flaws. The first is trying to write rules that apply to 300 million people and address all circumstances is impossible. Whenever it is tried, like in the tax code, it leads to tens of thousands of exceptions that no one can understand. It never works. Another generic problem with the way the United States government works is the way that money is handled. In private industry, the people who do the work own the money. Private industry will invest money in order to save money or improve efficiency any time they see a chance to do so. It is those investments and improvements which drive the economy and fill market niches. In the government, the people who own the money and the people who use it are separate. The government puts that system in place to try to control expenditures. The problem with that system is that the people who dole out the money don’t understand the work being accomplished and the only way that they can look good is to spend less money. Therefore, every year the money people have the goal of restricting spending no matter the outcome. There is no better example than the military supply system. It is onerous and unwieldy and the deck plate workers can’t understand the system or find what they need. Anyone who has ever worked in a government program knows that the program always asks for more than they expect to use. They also save money until the end of the fiscal year in case something comes up. If they spend less than their budget, the budget will be reduced the following year. Therefore, the left over money at the end of the year is always spent on something, no matter how redundant or unnecessary. If you plotted spending by month, you would find every government agency spends huge sums in September before the close of the fiscal year. It is built into the system. It wastes vast sums of taxpayer money. Universal government-run health care will be inefficient and wasteful. All government programs are. Any one who says differently has no experience with the government.

Pharmaceutical companies, medical equipment companies, medical service companies, and health care in general, is better in the United States than anywhere else in the world. I have heard the arguments using statistics about longevity and birth rates deaths, etc. But sensible people vote with their wallets. Does anyone leave the United States for anywhere on the Earth looking for higher quality care? People go all the time for cheaper care but not for better care. Pharmaceutical companies and medical equipment companies are not altruistic. They are in business to make a profit. Most of the advances in medicine, prosthetics, and equipment are developed in the United States and marketed around the world. If you take away the profit motive, those developments will slow to a crawl. The only reason that pharmaceutical companies invest so heavily in research and development is that they stand to make profits when successful drugs are marketed. If that profit potential is taken away, only government research, funded by tax money, will continue.

The very basis of the success of the United States is the market system. It is the best system ever developed to provide incentive for hard work and new ideas. The fact that the individual who works hard or develops a better product receives the benefits of his/her hard work or ingenuity is the thrust behind the success. People do not work hard when there is no incentive to do so. It is the reason communism and socialism always produce poor economies. If I work twice as hard and receive the same benefits, it is only a matter of time before I work down to the lowest level which allows me to keep my job. It brings up more philosophical questions. If I have been a producer, worked hard my entire life, and contributed to society in good behavior and tax revenues to the government, am I entitled to more benefits than the person who did not work and lived off the government (my earnings)? If the Democrats answer is no, why would anyone work? If everyone gets the same thing no matter whether they work hard or not, welcome to the Soviet Union. Some people will say it isn’t fair to have some with more benefits than others. I believe it isn’t fair to those who work hard and produce to be restricted in their benefits to the same level as those who don’t. At the same time I say that, I also say that there is clearly some base line level of care that all citizens should be receiving. Notice I said citizens. No one who is in the country illegally is entitled to a dime of publicly funded health care. It is insane to provide that kind of incentive to people to sneak into the country.

In summary, universal government-run health care will lead to poorer quality physicians, lesser paid assistants, rationing of health care based on broad-based rules not on individual needs, less new products and medications, and inevitable inefficiency and waste. It is a terrible idea and flies in the face of the very system that made the country great.