What Is A Right and Does Health Care Belong in That Discussion?

Recent political discussion has brought up the concept of the "right to health care". If you need something, is it the view of some folks that you have a right to it. In order to have a "right" first you need to understand what a right is.

For example, if you are hungry, do you have a right to food? You certainly do need it to survive. However, a right implies that someone cannot take it away from you and that someone is obligated to provide that right to you. In the current political discussion, that someone is the US government. So, getting back to food, if you are able to work and provide for yourself but choose to sit in a lounge chair on your front porch, does the government have an obligation to bring you meals? I am not talking about someone who is affirmed or disabled, but rather about someone who expects assistance because of the "right" to food. Obviously, there is no right to food. If you can provide for yourself, you are expected to do so.

Do you have a right to a residence? We certainly don't want homeless people wandering the streets but if someone is capable of providing for his/herself, does the government have an obligation to house that person? Once again, I am not talking about affirmed/disabled people. The answer is obvious, of course not. Therefore, there is no "right" to a residence.

Alexander Hamilton in 1775, said: ``The sacred rights of mankind are not to be rummaged for, among old parchments, or musty records. They are written, as with a sun beam in the whole volume of human nature, by the hand of the divinity itself;
and can never be erased or obscured by mortal power.''

The beginning of the Declaration of Independence reads "WE hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of
Happiness..."

Seems pretty straightforward, I suppose. The idea, in both quotations is that rights are not granted, they are things which cannot be taken away. However, that is not always true. Some rights are specified in the US Constitution (more about that below). There are times when individual rights are balanced against the community's. You would think the life part would be pretty simple in that no one can kill you. However, it can get complicated. For example, there is the question of what constitutes life? Are fetuses considered a human life? Not to abortion proponents but yes to opponents of abortion. If someone's heart is beating but the upper brain is not functioning, are they alive? Legally, the answer is no even if they can continue physical existence without assistance for a period of time. The protection of your right to life is an obligation of the state. However, in death penalty cases, someone's right to life is taken away by the state. In those cases, it is the considered judgment of the state that the crime committed was so heinous that taking away the individual's life is justified for the protection of society as a whole.

Liberty is a little tougher. The old saying is that your right to swing your fist ends at my face. Allowing individual liberty must be balanced with the good of society. The first amendment protects free speech but not speech inciting violence or endangering the public. Per the second amendment, individuals have the right to bear arms but those arms do not include things like cannons, 500 pound bombs or other mass destruction weapons. You can have consensual sex with pretty much anyone you want but not with children. Believe it or not, in many states, it is legal to have sex with animals. In Oregon, it is not a law violation to be in public nude, even in the presence of children. Liberty as a specified right cannot be taken away unless your exercise of that liberty is deemed sufficiently harmful to society as a whole. Those specific limits to individual liberties have been litigated for as long as the United States has existed, and continue today. Some liberties have even been stretched a bit. Nude dancing in strip clubs has been interpreted as free speech. I think if people want to strip nude and dance in an indoor club out of the view of anyone except those who went there to specifically see the dancers, more power to them. But calling that free speech is a stretch.

I have always found, the phrase "pursuit of happiness" pretty vague. To take away someone's pursuit of happiness is then also a vague proposition. We clearly don't want to do it but don't know exactly what it is.

Other specified rights are included in the Constitution; protection against unreasonable search and seizure, the ability to practice the religion of choice; petitioning the government for grievances; freedom of the press; no quartering of soldiers in private homes in peace time; no self-incrimination, a speedy trial, etc. However, what is important to realize is that the Bill of Rights really specifies what the government can't do to citizens rather than what it can.

With that as a preamble, is there a right to health care? Just like food, people can certainly need it, at times. As opposed to food, a majority of the time, most people don't need it. While no one wants people to die from non-treatment of curable conditions, I revert to the previous example. If someone is perfectly capable of providing care for him/herself and chooses not to, does the rest of society have an obligation to give them a free ride? Once again, I am not talking about people who cannot fend for themselves. If health care is a "right" then the government has an obligation to care for those who can afford to take care of themselves and choose not to. I have a tough time swallowing that argument. If you are ninety seven years old with peripheral artery disease, poor cardiac function, obstructive pulmonary disease, etc., and you fall and break your hip, does the government have to provide you a hip replacement? I am not talking about whether it is risky but rather is it a right? If you choose not to wear a motor cycle helmet or seat belt despite a law requiring it, do you have a right to taxpayer-funded health care if you choose not to buy insurance for yourself? If you gorge yourself up to 600 pounds and cannot leave your bed, does the government have to pay for your care or gastric bypass? If you choose to become a heroin addict and contract hepatitis via an infected needle, do you have a right to free health care from the government?

I think is a rightful role of government to help the those who cannot help themselves due to disability or impairment but that if you have the ability to provide for yourself and do not choose to do so, you are on your own. Therefore, there is no "right" to health care and those who argue for it are doing so out of a desire to have everything provided to them without effort. Of course, if enough people go that route, no one produces anything and there is no care for anyone.

Health Care Insurance Reform Fallacies

Most of the political posturing about health insurance reform has now gone back to the old political methods of presenting heart-wrenching cases as justification for sweeping reform. It is much akin to how the media produces a sad case to promote their agenda. During the middle of the Bush administration, when the financial outlook was really good, liberal news outlets would find some obscure person somewhere and do a story on how terrible her situation was as a way of blaming the administration. It is common procedure. But alas, you will never see a story now about how bad the economy is but how well a particular person is doing somewhere.

There are ways to improve health care access and reduce costs that are fairly simple and a lot less costly than what is being proposed. I have previously written about removing state monopolies and other strategies. However, let’s think about health insurance generically and what it is supposed to do.

Back in the day, someone thought it would be a good idea to go to someone with money and sell “If you pay me some money up front and regularly, I will pay for your expenses if you have a catastrophe of some sort.” The concept would work for fire damage, severe weather damage, your herd dying of disease, your crops not coming in, and other property losses. With the invention of the automobile and the large investment required to buy one and the potential for expenses if you ran yours into someone or something, it seemed a good idea to have insurance against those expenses. The government thought it was such a good idea that laws were passed requiring insurance. Of course, mortgage holders also required insurance for properties that they held liens upon in order to protect their loan pay back. Legislatures are always willing to require insurance as: a) they are made up of lawyers; b) lawyers always pass laws that help lawyers; and c) insurance companies are quite willing to pay legislatures to support passing those laws.

As insurance companies grew, they thought of more and more things to insure against. Of course, health care cost was one of them. Somehow, the concept changed over the years for health insurance. Using the original concept, you would have insurance for catastrophic expenses. If you were injured severely or had a very serious illness, insurance would cover your expenses (or most of them depending on how much you paid up front). Somehow, the health insurance morphed into policies that paid for everything. Routine office visits, visits to the emergency room (even if it wasn’t an emergency), home health visits, cosmetic procedures, and hundreds of other expenses became covered. Of course, there is no incentive to restrain your visits when it doesn’t cost you anything. In fact, there is a tendency to want to “get your money’s worth” out of a policy for which you pay premiums. It is also inevitable that a policy like that cannot ever be financially viable for the insurance provider because the costs have no constraint. As costs rose, it became cheaper to buy policies as a group in order to average risk across a group of people. Since people generally can’t get together and form a group to buy insurance, would form these groups? Company employees. Thus began the employer-provided insurance plans.

With an employer-provided plan, there is exactly zero incentive to restrain costs for the employee. The employee only fills out forms and the employer pays all the costs. The employer goes down the tubes. Another financial innovator went to the large employers with this idea, “If you give me a certain amount of money each year per person, I will take care of their health care needs and you will have fixed costs. If it costs more, I will take the loss, if it costs less, I will keep the extra money”. Thus, the Health Maintenance Organization (HMO) was invented. Of course, the way HMOs make money is by doing as little for patients as possible. It is built into the contract. The paradox is that the companies compete by purporting to offer more services but the way they make money is by not providing them.

The real question is how health insurance veered off the normal insurance track. If health insurance was still using the same model as other types of policies, people would primarily have catastrophic insurance and would set their co-pays and deductibles by their level of risk and how much they were willing to pay in premiums. To reduce costs, there has to be incentive for people to do it. The only real incentive is to have people pay for what they use which isn’t catastrophic. For example, if you pay for an office visit, you will decide whether you really need to go before you do. If it costs six to ten times more to go to the emergency room than it does to go to your regular doctor, you will likely go to your regular doctor rather than fill the emergency room with non-emergency patients.

I am not saying people who are destitute should not have access to care. The government should help the poor and people who are unable to work. People don’t have a problem with helping people who are incapable of working. People do have a problem with paying for people who choose not to work or providing free care to affluent people who don’t need it. To reduce health care costs, the exact wrong thing to do is to make it “free”. The real answer to the problem is to go back to basics and review what health care insurance is supposed to do and the best and most efficient way to provide that care. Trying to cover everyone with “free” care and reducing physician payments until there are few doctors left is clearly not the answer.

Using Health Care Reform To Control Everything

The current administration is talking about the health care "crisis" and is prepared to spend over one trillion dollars to insure about 16 million people (of their estimated 40 million without insurance). That works out to about $62,500 per person. Why not just buy them a policy at a few thousand a year and save a bunch of money? Because that is not what this is about. I wrote an earlier article about the differences between the liberal and conservative philosophies and how the liberals always think they are smarter than everyone else and therefore want to determine how everyone else behaves and lives. Health care is the ultimate weapon of control. How can that be, you may ask? What is wrong with insuring people who have no health care now? Nothing, on the surface. Let's look a little closer at some of the issues.

President Obama said he wants to remove waste and overcharging by physicians. This is a straw man argument. There are already massive amounts of regulation and remedies for physicians who do that, in the way of both regulatory and criminal statutes. It is total nonsense to say new programs are needed. Kathleen Sebelius, Secretary of Health and Human Services stated that she wanted to protect physicians from liability if they practiced with (paraphrasing) "accepted standards". There in lies the rub. The entire idea here is that the government will financially twist the arms of physicians and hospitals to dictate care. They keep repeating the mantra that physicians should be in charge of medical care. Physicians will be free to make their own decisions. The only problem is that if the government disagrees, the physician doesn't get paid. Sounds like Chicago in the 1920s. Capone would be proud.

The government in the United States has a several hundred year history of taking good intentions and totally screwing them up. One of the reasons for this is that they try to write centralized regulations for currently about 300 million people. It is impossible to do and consider individual circumstances. Even much simpler issues (drug policy, transportation, weapons, etc.) have varying circumstances in different states. What you end up with is exception after exception added to the rules until you have the United States tax code (which no one, even the Internal Revenue Service, understands).

If a doctor decides a patient needs a drug and the government wants the patient to get another one, no payment. If your doctor tells you that you need surgery and the government disagrees, pay for it yourself. Actuarial tables will be used to determine who gets what. If you are over a certain age, head on down to the Soylent Green plant because you aren't getting anything that costs money.

But alas, it gets worse. Because the government decides who gets paid benefits and how much, it is easy to creep forward in logic. For example, if you engage in a dangerous activity (skydiving, scuba diving, bungee jumping, etc.) it is easy for the government to say you have to pay more for premiums or we just don't cover you. Okay. But it isn't a big step to say, if you smoke or are overweight, the same thing applies. There is already use of cigarette taxes to fund stop smoking programs. Hmmm. If you stop in McDonalds, you will pay a surcharge to cover the health care cost of eating a cheeseburger or french fries. There can be a dessert tax. You can get a break depending on what kind of car you drive, what kind of groceries you buy, what kind of hypoallergenic make up you use, if you take vitamins, if you are in a monogamous relationship, or if you limit yourself to two beers at the Fourth of July picnic. But how can we tell who deserves these premium benefits and coverage additions? Well, clearly we have to keep track of what people are doing so the government will know who to benefit. The government can track your vehicle registration, your purchases at the grocery store, your exercise log, your sex partner registration, your fast food purchases, if you bought condoms, or if you ate a second piece of cake at the birthday party. It's for your own good. I am from the government and I am here to help you.

Government will tell automobile manufacturers what kinds of vehicles they can make (already happening with General Motors). Government will determine which restaurants can stay open and what they can serve by imposing "unhealthy food" fees. Government will tell you which hobbies you can and cannot have and when you need to lose weight. It's okay though, because it is for your own good. Because anyone who is not liberal or progressive is too stupid to realize what is good for them individually, it is the government's responsibility to make decisions for them.

It is easy to take those steps in logic, just like it was easy to go down the path of eugenics in Germany in the 1930's. That didn't work out very well. Is this something we really want to do? Like they said in The Incredibles, "When everyone is super, no one will be". Take anyway people's right to individual decisions about their life, and there is no freedom and some would argue that it isn't a life worth living because we become cattle. The very basis of this nation's founding will have been killed. This is not about health care. It is about control.

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.

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.