Free Medical Care

by Sharon Mahler

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Advocates of government-run medical care hold out the promise that they will give all Americans access to all the medical care they need without having to worry about being bankrupted by a serious illness.

Opponents predict all sorts of dire consequences.

We could study the details of laws that have been passed or proposed. We could ask the authors their intent. But this is likely to be tedious and unproductive. Supporters of a policy are going to paint it in rosy terms.

But policies have inevitable consequences. Just because supporters say that they intend only goodness and light, even if they are being completely honest about their motives, doesn't mean that it will happen that way. No matter what good outcomes someone plans, wishing doesn't make it so.

Some want to see a "single-payer system", that is, all medical bills are paid by the government. Present laws (as of April 2010) allow private insurance to continue to exist but the government will mandate what medical care must be covered and what rates may be charged. Either way, any government-run medical care system will inevitably involve government bureaucrats deciding who gets what care. It has to happen, because there is no alternative.

In case that's not obvious, I will explain.

There is no way that government care will give every American any medical care he wants any time he wants. Take an extreme case. Suppose someone walks into a hospital and says he wants a heart transplant. "Oh," the receptionist says, "Who is your doctor?" "I don't have a doctor," he replies. She asks, "Did you have a heart attack?" "No," he says, "But I'm getting older and I don't have the energy I used to, I thought a heart transplant might help." Do you think they will give him a heart transplant? Should they?

Or suppose a hypochondriac assumes that every headache he gets is a brain tumor requiring immediate surgery. Or a panicky parent demands a battery of expensive tests every time her child has a runny nose.

Yes, those are crazy cases. If the government is paying the bill, of course it is going to have to set reasonable restrictions on what it pays for. Anything else would be unfair to the taxpayer. We certainly can't expect the taxpayer to foot the bill for unnecessary medical procedures or frivolous requests for care. If the government isn't paying directly but is setting rate and coverage requirements for insurance companies, the net effect is the same. Whether the citizens pay for unnecessary care through taxes or through government-set insurance premiums makes no practical difference.

I think few would quarrel with that. Except for one thing. Who decides what is "reasonable" and what is "unnecessary" or "frivolous"? Well, I just said: It will have to be a government agency.

Sometimes these decisions will be obvious, like my crazy examples above. But there will inevitably be many cases that are highly debatable.

For example, for many years now, doctors have encouraged women to have mammograms every year beginning at age 40. In 2009 a government committee announced that women should only have mammograms every other year between the ages of 50 and 74, only in special cases below age 50 and not at all after 74. Many doctors say this is a mistake, that the old standard was better.

In a government-run system, a government agency will have to decide when mammograms are covered and when they are not, whether that's every year or every other year or only for women identified as "at risk" or whatever.

Suppose the government goes with the committee report and decides once every two years after 50 is sufficient. Your doctor adheres to the old recommendation that you get a mammogram every year. You agree. Too bad. Under a government-run system, bureaucrats will decide when you can get mammograms and that will be the end of the story.

Much has been made in the last few years of how much money is spent on medical care for dying people. One recent study found that 22% of a person's medical expenses are incurred in the last year of life. The point, sometimes clearly stated, sometimes just subtly implied, is that a lot of this is futile expenses. Wouldn't it be so much more efficient to let these sick old people just die and save the money for people who have the potential to actually recover and lead useful lives?

Many sick and elderly people face the difficult decision of when to give up on further medical treatment and go home to die in peace. Many family members of people in a coma face the even more difficult decision of when to pull the plug on grandma or grandpa and let them die.

Under a government-run plan, people would be spared the burden of making these difficult decisions. Government bureaucrats will decide for them.

I'm sure they won't call them "death panels". They'll be called the "Health Benefits Advisory Committee", the "Qualified Health Benefits Plan Ombudsman", the "Accountable Care Organization pilot program", or the "Center for Comparative Effectiveness Research Agency". Hey, I didn't make those up, those are real names of some of the 50 to 160 new government agencies (depending on who counts and how) created by the 2010 health care bill.

If the government gives something away for free, the government will, inevitably, have to decide who gets it, when, where, and how much.

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April 18, 2010.

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