Will government-run healthcare inevitably lead to euthanasia?

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Will government-run healthcare inevitably lead to involuntary euthanasia of the old and the handicapped?

That sounds like an inflammatory question. And "inevitably" is a very absolute word. Still, think it through.

Supporters of national health insurance -- or "government-run health care" or "a single-payer system" or "socialized medicene" or whatever you want to call it -- routinely describe it as "free medical care". They hold out the promise that if the government takes over paying for most or all medical care in the country, that this will mean that everyone will get whatever care they need whenever they need it. You will just walk into a doctor's office or hospital, and no one will ask how you intend to pay or whether you have insurance. You will promptly be ushered in to see the doctor who will then give you whatever medicene you need, or schedule the surgery, or whatever. The poor will get the same care as the rich. Everyone will be taken care of. And it will all be paid for by the government.

A moment's thought will show that this is a wildly optimistic fantasy. Let's ask one simple question: Where will the money come from to pay for it?

This whole discussion got started as people complained that medical care was getting too expensive. Supporters of national health insurance have added the argument that 47 million Americans are uninsured and thus without access to health care. So somehow the government is going to pay for the medical care of everyone who currently has insurance, indeed will give all of these people increased access to medical care, plus pay for tens of millions of people who are supposedly now without care, and this is going to cost less than we are spending now. Umm, how?

They say they will accomplish this by improving efficiency and eliminating waste. Worthy goals, but how about some details? Instead of insurance companies, hospitals, and individual doctors managing the money, it will be managed by government bureaucrats. Ah, that will do it. If only I had a dollar for every time I heard a business owner say that he just wished he could run his business as efficiently as the government is run ... I don't think I'd have any money. Does anyone seriously believe that government bureaucrats can run anything more efficiently than a private business can? Show me an example in the real world, please.

The money will, of course, come from taxes. If we're improving care for everyone plus making the taxpayers pay for the care of tens of millions of poor people and immigrants, plus adding in the cost of all the new government agencies who will be managing this -- one bill in Congress calls for 53 new government agencies -- the taxes will be far more than people are presently paying for insurance. This will lead to incredible pressure to find ways to control the cost.

And that's the point. How will the government control the costs?

They could cut back on the number of bureaucrats hired and the amount of paperwork done. I think we can pretty well rule that out as "not going to happen". Even if it did, the best it could possibly do would be to reduce the cost to an amount that is still more than what people are paying today. Remember that the taxpayers have to cover those 47 million uninsured, plus provide for expanded care for themselves. Even without the extra cost of bureaucracy and government waste, this plan will be expensive.

So that leaves only one other possibility: They can limit care. They can tell some number of people that the government just can't afford to give them the medical care they need. I can't think of any other possible alternative. If you have another idea, shout it out, because I'm sure we're all anxious to hear it.

Who will be denied? They've been preparing us for the answer to that question for years. We have seen studies agonizing over how much money is spent on people in the last year or two of their lives. Experts talk about the cost effectiveness of spending money to save the life of an elderly person who will surely die of something else within a few years, versus using that money to save the life of a young person who could go on to live for decades. They talk about how much the old and the handicapped contribute to society versus the contributions of the young and healthy.

The logic of the math is inescapable: They will ration care to the elderly and the handicapped, so that it can be saved to be used on the young and healthy.

It's hard to imagine how else this could turn out.

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Sept 29, 2009.

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