National Healthcare: Prescription for a Fool’s Paradise

Socialized Medicine and National Health Care

  • “National Healthcare: Prescription for a Fool’s Paradise”
  • “Government Watch: Is NYS the Next Target?”
  • “Government Watch: Americare–More Poison Offered as Cure”
  • “Government Watch: Socialism Lives in U.S. Health-Care Reform Proposals”
  • Groups fighting socialized medicine and national health care:
    The Ayn Rand Institute   &  Americans for Free Choice in Medicine

 

“National Health Care: Prescription for a Fool’s Paradise”

Copyright Salvatore J. Durante, DDS, FAGD, and Dianne L. Durante, 1991. Published in The Freeman, April 1991; reprinted in Prices and Price Controls,in the series The Freeman Classics, 1992.

Suppose I promise you health-care like you’ve never had before. When you visit a doctor or a hospital, all you’ll have to do is show a card, and someone else will foot the bill. You’ll never have to fill out another insurance form or wait for another reimbursement to come in. And, I promise, you’ll get the same quality of care you get now, and won’t have to pay more taxes for it.

Would you vote for me? Most people would. Would you get what I promised? No, because it’s impossible to deliver. This is the promise of those who advocate “national health-care” or “universal health insurance” (on either the state or national level). In either case, what is involved is extensive or complete government control of health-care: control of who pays for services, who provides them, and who receives them.

We have, before our eyes, an example of a very similar system that has been operating now for 26 years: Medicare. We aim to demonstrate here, by a detailed look at Medicare, that such government interference in health-care is harmful from the first to buyers and providers of health-care, and in the long run is disastrous. Government medicine, on the national or the state level, is a prescription for a fool’s paradise.

To understand the economic principles involved in government intervention in medicine, let us look at something less emotionally charged than medicine. Hats, for instance.

 

Basic Economic Lessons

Let’s say we all agree that hats are worth having, or even a necessity, and that all Americans have a right to them. We pass a law stating that the government will pay for everyone’s hats, through taxpayer dollars. What happens? First of all, hat sales skyrocket. I’m not particularly fond of hats, but if I can get them for free or below cost, why not?

Lesson One: there is no limit to demand, if those who get the product or use it are not paying, directly or in some way they can see. This is unavoidable. The freeloaders will try to get all they can, and most of the rest of us will want something to show for our tax dollars.

If such a law passed, most hatmakers would be delirious with joy. Everyone wants hats! They expand their shops and produce as many hats as they can. What happens next? The average price of hats shoots through the roof. Why?

There are two reasons. First, of the hats now being sold, the more expensive ones – the ones only a few people could afford before – will now be in much greater demand, since the individual hat-buyer no longer has to pay from his own, limited resources. If the latest style is a platinum-plated beret, anyone who wants one will now get it.

The other reason for the rising prices is competition: specifically, lack of it. New products, such as the first cam-corders or the first compact disc players, are usually expensive. Prices drop because more people want to make money from a product: they try to come up with cheaper and more efficient ways of producing it, so they can sell the product more cheaply and grab some of the market. Our unlimited government funding of hats has completely cut out the need for competition. Any hat maker can stay in the business, no matter how high his prices.

Lesson Two: prices will skyrocket if there’s no limit to how much people can spend on a product. If anyone who wants the product can buy it, price no object, there is absolutely no reason for the manufacturer to try to cut his prices, and no reason for the buyer to control how much he spends.

The government, and only the government, can give people virtually unlimited amounts to spend on a product. In short, it is not the greed of the manufacturer or the consumer, but the mere fact of the government funding of hats that is making hat prices exorbitant.

Next step: the government, and hence the taxpayers, are faced with enormous hat bills. Mrs. Smith may have confined herself to one hat, but Mr. Jones wanted five, and Mrs. Imelda wanted 52 Paris originals. The government knows it can’t continually raise taxes to pay for hats. Assuming it wants to keep the hat-program intact, it has two choices: restrict the number of hats any one person can buy, or restrict the price of hats. In political jargon, that means rationing or price controls.

From a politician’s point of view, setting limits on the price of hats is the obvious way to go. There are fewer hatmakers who vote than there are hat-wearers, and it’s easy enough to paint the hatmakers as greedy exploiters of the hatless. So a new law is passed: no hats can be sold for more than $15, even if the buyer is willing to use his own money. The immediate result will be that the best quality, most expensive hats become unavailable. No more Paris originals.

Lesson Three: you can’t make a silk purse out of a sow’s ear. Good materials and good workmanship cost money. Yes, competition among manufacturers in a free market will cut prices in the long run. However, legislating a lower price for a product is not a short-cut to cheapness. It merely makes those who were selling more expensive goods go bankrupt, before anyone has time to work on price reduction.

We could try some complicated and devious maneuvers to lessen the effect of price controls. For instance, we could slap a $5 tax on shoes and use the money for the hat program. Then we could have a maximum hat price of $15, but still pay the hatmakers $20 per hat. That would mean, of course, that some poorer people wouldn’t be able to afford shoes, and the government would end up subsidizing shoes, too. Even so, price controls on hats will have to be instituted in some form, because demand is so high. Remember that it is government spending for hats that made the demand and the prices so high in the first place: nothing except removal of the government’s money will get the situation back under control. But let’s keep trying.

We’ve now legislated a maximum price for hats. Nevertheless, Mrs. Imelda has bought another 35 hats, and the rest of us are still trying to get our taxes’ worth of hats. Not surprisingly, the amount that taxpayers are shelling out for hats hasn’t significantly decreased, despite our price controls. The next step? Well of course, restrict the number of hats each person can buy: ration them. Now what happens? A lot of hatmakers go out of business, is what. They can’t sell hats for more than the maximum price, and they can’t make up for the loss in income through selling more hats. Bureaucrats demand forms in triplicate and slap fines on them at every turn. The best hatmakers soon leave the field in disgust. We are now facing a decreasing supply of hats, if not an actual shortage, because there are far fewer manufacturers.

But hats are a necessity, aren’t they? So we will have to pass a law forcing hatmakers to remain in business, whether they can make a profit or not. However, even a government order can’t make a business run for long at a deficit, whether it’s a hatmaker or a child’s lemonade stand or a bank. The hatmakers will go out of business, one by one.

The government will have to step in and make hats. Given the quality of most government products, you can imagine what kind of hats we’ll get. And given the efficiency of most government manufacturing operations, we won’t be surprised if we’re told we can each have one hat, in our choice of 4 styles, every other year.

What began as a seemingly praiseworthy law – to provide all Americans with hats – has ended up driving the hatmakers we know and trust out of business, and given us government-produced hats of considerably inferior quality and very limited numbers. This result is absolute, inevitable and non-negotiable: none of the economic rules above can be avoided, and they can only be temporarily circumvented by allowing the government to interfere in yet more private business.

Lesson Four: what the government pays for, the government has to control. Government funding of hats led to government control of hat prices, hatmakers, and finally everyone who is even remotely connected to hats. The only cure would be to end government funding of hats.

 

Back to Health Care

Comparing hats to medicine may seem even less appropriate than comparing apples to oranges, but the same economic principles apply, and precisely the same developments can be seen in the 26-year history of Medicare.

In 1965 the government passed Medicare legislation, providing basic medical services to the nation’s retirees. Physicians and hospital administrators were delighted. They built new hospitals and enlarged old ones. They began providing the medical equivalent of the best Parisian hats to all comers. Why not? The government encouraged physicians by asking them simply to send the bill to the American taxpayer. Patients, as well as physicians, no longer had to consider costs. Everyone demanded “the best” – price no object. Medical expenditures in the United States were 4.3% of GNP in 1952; by 1982 they exceeded 10%, and were still rising. In the same period the government’s share of these expenses nearly doubled, from 22% to over 40%. Here is Lesson One in action: with the government footing the bill for a substantial number of those receiving medical care, there was suddenly an enormous demand for medical services.

At the same time, prices for medical care soared. The legislation deliberately removed any incentive to keep prices low: in fact, removing concern about costs was the point of the program. Many of us can remember that prior to 1965 a few days in the hospital did not threaten to bankrupt the average middle class family, who could afford the state of the art in medical care as in everything else. Today, many find the cost of a hospital stay prohibitive, because the rise in medical costs has far outpaced the general inflation rate.

Why? Because of Lesson Two. Prices skyrocketed precisely because the government was providing unlimited funds for medical care. Consumers demanded the most expensive treatment, and medical facilities did not have to keep prices low in order to maintain a competitive edge.

By 1983, Medicare threatened to bankrupt the entire Social Security system. It was clear that something drastic had to be done to control runaway costs. Taxes were raised, of course, but this was not enough. Like the manufacturers in the hat illustration, health-care professionals were (and continue to be) denounced as the greedy culprits who had to be controlled; price controls were slapped on hospitals and doctors. Under this system, called Diagnosis Related Groups, all hospital admissions of Medicare patients are classed in one of 486 categories, and the hospital receives a set fee for the patient, regardless of his length of stay or the amount of care provided. When it was pointed out that this might lead to inadequate treatment and early discharges (“quicker and sicker” releases), the government responded by imposing further complicated regulations.

The federal government has also set a limit on what doctors can charge patients over the age of 65, and some states now refuse to license doctors who do not accept the Medicare fee as full payment. Just to receive the government-approved payment, doctors must comply with a bewildering, and sometimes contradictory, array of regulations from several different agencies. The process a doctor is required to go through to obtain payment from Medicare makes filing your tax return look like simple arithmetic, and your doctor does it many times per day, not once a year. Also, a simple error in filing that would result in no monetary gain for him, such as using an incorrect code for a diagnosis, can mean no payment at all on the claim, plus a fine of thousands of dollars.

Not surprisingly, doctors are leaving the profession and the number and quality of medical school applicants are falling. In 1974 there were nearly three applicants for every opening in medical school; by 1986 there were fewer than two. [1] What bright young college graduate would want to get involved with such a mess?

Lesson Three comes into play: you can’t make a silk purse out of a sow’s ear. In this case, you can’t get top-notch, dedicated individuals to enter and remain in the medical profession while controlling their activities and their earnings, and calling them greedy exploiters to boot.

And guess what? Costs are still rising uncontrollably, despite stringent controls on medical expenditures. (Given the fact that it was government funding that made prices skyrocket, and that the government is still funding medical care, the continually rising prices should come as no surprise.) The government is now considering more drastic measures, such as rationing and “universal insurance.” Massachusetts has already adopted such a plan, which led to the exodus of doctors from that state and contributed to its recent financial collapse and tax increase. Similar plans are under consideration in many other states, and even more appalling “solutions” have been proposed. The director of the Hastings Center, a bioethical think-tank in Briarcliff Manor, N.Y., recently recommended that, by law, no one past age 80 or 85 be given access to aggressive life-saving equipment and medication.[2] A medical economist from Tufts University has suggested legally banning all new technology: since not everyone can afford it, no one should have it. [3]

Here, as expected, is Lesson Four: what the government pays for, the government must control. In the very near future, if a physician tells you that your life could be improved with bypass surgery or a hip replacement, you will have to petition the government and take a number. Perhaps your petition will be approved, once all the appropriate government bureaucrats have debated its merits; perhaps it won’t.

Likewise, every aspect of a physician’s practice will have to be dictated and controlled: most of them are already. He’ll be told whom he can treat, and how, and what payment he’ll receive. His livelihood and his freedom will be in the hands of the same bureaucrats who hold your life and health.

 

What About Rights?

The final step in the process outlined above brings us to the most important reason that the Medicare and Medicaid programs should not be expanded or imitated, but must be scrapped. In the United States, we recognize certain rights: life, liberty, the pursuit of happiness. When those words were written, it went without saying that those were the rights to your own life, your own liberty, and the pursuit of your own happiness.

The “right” to hats or to medical care is fundamentally different. Such a “right” depends on the efforts of others, those who make the hats or study medicine. If we declare that citizens have a right to hats or to medical care, we are declaring that the hatmakers or the doctors are obliged to provide it, no matter what the cost, somehow, and that if they do not do so willingly, the government will force them to do it.

Although your own life is of enormous value, you can’t use that fact to justify taking someone else’s life, unless he threatens to kill you first. “But the Medicare laws don’t kill doctors,” you say. “They just tell doctors what to do and take away some of what they earn.”

If you locked up a dachshund, forced it to obey contradictory commands, and fed it at unpredictable times and in continually decreasing amounts, you’d have a mob of government officials and animal rights activists at your door. Killing the dog quickly, they’d say, would be kinder than this long-drawn-out torture. The same treatment has been applied to doctors for many years now, and few voices have been raised in their defense.

When you take away a man’s right to think, to act for himself and to keep what he earns from that action, you make him at best a slave dependent on your good will, and at worst a corpse. Thinking for oneself, acting on those thoughts and keeping the fruits of one’s effort are what allow one to live, whether one is a physician, a teacher, a garage mechanic or a stockbroker.

One hundred twenty-six years ago we finished fighting a bloody civil war to make slavery illegal throughout the United States. Twenty-six years ago, with the passage of Medicare legislation, we sanctioned it again – not on the basis of race, but on the basis of the dedication and skill and intelligence it takes to become a medical professional.

It is still slavery. It is still immoral. And that is why the Medicare system and all such government programs that interfere with the free market in medicine must be dismantled: not merely because they do not work, but because they require that the men and women who literally save our lives be made into slaves.

The same is true of any government-funded program of medicine, whether based on the Canadian or British or Swedish or Soviet model. Government funding of medicine ultimately results in the enslavement of doctors, and is therefore immoral.

 

The greatest good for the greatest number?

Perhaps you are thinking that violating your doctor’s rights is acceptable, in return for assuring that you and the rest of his patients are able to afford medical care. Think again. What you’ll be getting if you violate his rights is not care from the type of doctor you know and trust. The traditional kind of doctor, who went into medicine for the challenge of using his mind and working independently, will find it impossible to work under such a system, and will gradually disappear.

When the government controls health-care, it will attract a new breed of doctor: the kind who is content to work 9 to 5 for a fixed salary, following all the rules in a government code, and is more than happy to let bureaucrats instead of his patients tell him what he’s doing right and wrong. If I must undergo surgery, I want it to be at the hands of someone who can observe the facts of my case and is not afraid to make his own judgment and take action on it – and who will answer to me if he makes an error, not cite his compliance with section 1052, paragraph 13, in some government manual.

Government control of medicine means, in short, that the bureaucrats will be telling you what services you are allowed to have, and when. If what you want is the best care for the most people, any government-funded medical program is impractical as well as immoral.

 

Free-market medicine

The only way to assure the highest quality of medical care is to return to the free market. You can have choice only if you are willing to take the responsibility of paying for it. For most of your working life, you have probably been covered by a private insurance company. It worked. In fact, it worked incomparably well until the government’s intervention in the health-care market caused prices to shoot through the roof. If health-care providers have to compete for our business again, the prices will go down, precisely as they do for new electronic gadgets.

Today, no private insurance company will cover anyone over 65, except as a wrap-around policy for Medicare. Let the private insurance companies get back into the business. Let individuals set up the equivalent of IRA’s for medical care, if they wish, with the same or even higher tax incentives as IRA’s. Let each of us take back into his own hands how much he spends on medical care, when he spends it, and what he gets for it. (Check out Americans for Free Choice in Medicine, at http://www.afcm.org/)

What about those who cannot afford even minimal health insurance? There are many, many physicians and hospitals who provide medical care for free. They don’t brag about it, and they are usually ignored when the surveyors collect statistics on the uninsured. Yes, it does mean that the poor would have to ask for charity, rather than receiving care as a matter of right. Yes, that would be embarrassing: asking for something in return for nothing usually is. But enslaving doctors and putting the health care of all citizens under the control of government bureaucrats is simply too high a price to pay for avoiding embarrassment.

Today’s most serious health problem is government intervention in the health-care system. Because the government’s spending has driven prices up, we are forced to make do with less care now. Because of the controls the government has imposed, we are losing the best minds in the field, and our hope for cures to diseases such as AIDS and cancer are vanishing with them. The only cure is to return to the system that made American health-care the envy of the world: a free market, completely exempt from government intervention.

 

References

1. “Disaffection of Doctors is Discouraging Medical Students and Potential Ones,” Wall Street Journal 4/10/87, p. 10.

2. A. Otten, “Ethicist Draws Fire with Proposal for Limiting Health Care to Aged,” Wall Street Journal 1/22/88, p. 29.

3. R. Greene, “What Price Life?” Forbes 1987 (140:45).

 

“Government Watch: Is New York State the Next Target?”

Copyright Salvatore J. Durante, DDS, FAGD, 1991. Published in GP: The Journal of the New York State Academy of General Dentistry, March 1991.

Doctors are under siege by politicians, government bureaucrats, and the media. One cannot read the newspapers and magazines or watch television without being told repeatedly that medicine in the U.S. has serious problems. Usually the solution proposed is more government intervention: price controls, rationing, universal insurance, “Canadian socialism” . . . But this ignores the fact that the cause of medicine’s fundamental problems is government intervention.

In the past, the public was told that the elderly and poor deserved subsidized care. When taxpayer-subsidized health care for the elderly and poor led to higher demand and higher prices for everyone, politicians “solved” the new problems by fixing some prices, passing laws to support managed-care plans (HMOs), and installing professional review boards at every U.S. hospital that accepts government funds. Price fixing was sold to the public as a way to curtail the “greed” of doctors and hospital owners, and governmental professional review boards were passed off as quality-control boards. The public was told that it would receive higher quality at lower prices.

In reality, price fixing–and capitation–encourage hospitals and doctors to do as little as possible, as those who have joined HMOs know. Those who consistently aim to provide high quality care soon find themselves in a financial bind.

Well, prices are still rising and the Medicare budget is still ballooning. The ruling intelligentsia is still calling for national health care, on the grounds that even fewer people can afford good medical care. The next “solution” would be government rationing of all medical services and comprehensive price fixing. Oregon has instituted rationing of Medicaid services, and officials there have stated openly that they hope to provide the model for rationing all health care to the middle class. Congress, meanwhile, recently received its Harvard-Hsiao “relative value scale” of doctors’ fees, which it commissioned. This could be used to “fairly” set the prices of all medical services. Should Congress presently prove too shy for this, individual states can be counted on to show the way.

Everyone knows about Massachusetts’ fiasco with state health insurance, which contributed to that state’s recent economic collapse and hike in taxes. West Virginia recently attempted to reduce government costs through “Omnibus Health-Care Cost Containment Legislation” that creates three classes of physicians. The first consists of those doctors who participate in the state medical-sponsored PPO. The second includes non-PPO doctors who agree to charge the patient no more than110% of what the PPO doctors can charge. Doctors in these first two classes must agree to devote 15% of their practices to Medicaid patients. The third class consists of all doctors who would like to charge more than the 110% and/or not treat their “fair share” of Medicaid recipients. These doctors are now forbidden to treat any state-insured patients, even if the doctor does not bill the state, under threat of imprisonment and fines that start at $25,000. (Legislative Investigation Fund Effort, Inc., LIFE, an organization of physicians, is fighting West Virginia on constitutional grounds.)

Illinois is considering a Canadian version of socialized medicine that would prohibit insurance companies from providing insurance for Illinois residents after December 31, 1993. The state would control all patients and most providers, and a “Universal Health Care Board,” appointed by the governor, would “negotiate” reimbursements with hospitals and medical societies representing physicians. As in Canada, doctors would strike periodically, and many patients who could otherwise afford care would die because politicians disallowed services.

A similar proposal for sweeping changes in how New Yorkers buy medical services is now under consideration. It is called UNY*CARE, Universal New York Health Care, and it would take control of New York State doctors and patients. In the foreseeable future, all New Yorkers could be at the mercy of politicians when it comes to obtaining health-care services. Prices would be fixed, as they are under Medicare; services would be rationed, as they are in some states under Medicaid; people who cannot leave the state would die while waiting on ration lists, as they do in other countries that have socialized medicine; more of the best doctors would flee the profession or New York, or both, and even fewer bright students would choose medicine as a career.

“Free” health care will be the politicians’ carrot; the duty to serve those in need and the alleged right to health care will be their clubs. Patients will be told that they’ll simply present a little card to the doctor instead of money, and receive the same care as in the past. There won’t be any forms to complete and they won’t have to wait for reimbursements from insurance companies; the doctor will do all the waiting and fighting with the new sole payor–New York State. Doctors who object to the new system will be reminded that they are government licensed “public servants” who had better learn to take orders. Taxpayers who would prefer to tailor their own insurance plan or carry no insurance at all will be told about the “virtues” of egalitarianism and the “evils” of individualism. (See “Irrational Ethics” and “The Fallacy and Danger of ‘Public Service’,” Salvatore J. Durante, Publications: Dentists as Public Servants.)

The history of government medicine in the United States illustrates a time-tested technique of government bureaucrats: impose so many regulations that it is nearly impossible to provide services; then accuse the providers of inefficiency; then assert that the government must take control of the entire industry to “fix” the problems. NYC did this decades ago with mass transit, and does it today in piecemeal fashion with housing. Governor Cuomo did it recently when he seized the Shoreham nuclear power plant and threatened to do it with the entire Long Island Lighting Company. In medicine, “reformers” cry for change in health-care delivery in the United States, the government poises to seize final control of doctors and patients after piling layer upon layer of crippling regulations during 25 years of Medicare and Medicaid, and doctors and patients stand by in utter confusion and dismay.

No one will defend us, doctors; we must begin doing it ourselves. We must stand up to politicians and interest groups who trample our legitimate right to decide how we live our lives and form associations with our patients.

 

“Government Watch: Americare–More Poison Offered as Cure”

Copyright Salvatore J. Durante, DDS, FAGD, 1991. Published in GP: The Journal of the New York State Academy of General Dentistry, September 1991.

“We don’t need to have a health policy. We are stumbling in the right direction,” says Princeton economist Uwe Reinhardt. “At the end of the 90s, [we will have] 40% of health care paid for by the government and 60% paid by the private sector through an insurance industry that is private only in name” (Med Tribune 3/21/91, emphasis added).

Unfortunately, he may be correct. On June 4, speaking before the Annual State Medicaid Directors’ Conference, Health Care Financing Administration (HCFA) Administrator Gail Wilensky said that Medicaid expansion should be considered as a possible way of “improving” the health-care system in the United States. Senator Bob Graham (D-Fla.) said, in a separate statement, that he intends to introduce legislation that would expand the role of government in the health insurance industry through Medicaid.

In a report released the same day and in testimony before the House Committee on Government Operations, the General Accounting Office (GAO) recommended that features of the Canadian health-care system should be adopted by the U.S. Among the features praised were single-payer national insurance, and system-wide spending controls including uniform fee schedules for physician services. Translation: the GAO wants the government to be the sole seller of health insurance, to ration procedures, and to fix prices. (Comptroller General Bowser admits that Canada has problems, such as a scarcity of high technology, but hastens to add that this presently is not a problem in the U.S. He doesn’t mention that this would change if the U.S. does adopt a Canadian-style program.)

The next day, Senate Majority Leader George Mitchell (D-Maine), along with Sens. Rockefeller (D-W.Va), Kennedy (D-Mass.) and Riegle (D-Mich.), introduced a bill that would also greatly expand the presence of the federal government in health care. Extortion–called “pay or play” by the senators–is part of the bill. They would require employers to either provide health insurance for an employee or pay a tax so the employee would be covered under “Americare,” a new federal program that would replace Medicaid. Because Americare would be subsidized by taxpayers, the initially lower cost to employers (currently estimated to be an 8% payroll tax) would virtually guarantee large enrollment levels in the government’s new plan. The incentive to employers would be to opt for Americare and let taxpayers foot most of the bill.

The Democrats’ plan would also establish a new federal agency called the Federal Expenditure Board to establish expenditure limits in total and by sectors of the health-care industry, as well as separate goals for specific states and regions. Like Canada’s bureaucracy, this agency would “negotiate” with representatives of hospitals, doctors and other providers in setting fees.

Professional groups, such as the AMA and ADA, long ago endorsed “universal access” to health care, and therefore, in principle, the eventual government takeover of health care. Yet, they pretend to themselves and their members that they protect us from government intrusion. For example, the AMA endorsed Congress’ recent move to set limits on physicians’ fees. Why? Because the AMA thought it would have input and could help arrive at a “fair” fee scale. Hmmmm . . . price controls are okay because we would help set the prices? What is wrong with this picture? When Congress finally revealed its fee-fixing scheme earlier this year, the AMA was outraged and vowed to resist the new plan. Another case of too little too late.

After being hit on the head as many times as they have, one would think that organized medicine and dentistry would get it by now. Perhaps a simple analogy would help. If a thug grabbed you by the arm and said he was going to sever your thumb, would you haggle over where to make the cut? Would you volunteer to make the cut for him at the first knuckle and hope that he doesn’t demand the rest of your thumb, or hand? Or would you say that the thug has no right to any part of your thumb, hand, arm, etc., and fight for your life? Unfortunately, our leaders have not yet learned that compromise on matters of principle leads to full surrender.

In 1989, the ADA stopped lobbying for expansion of Medicare because of the controls placed on physicians through that federal program. However, the same year, the ADA started lobbying Washington to expand Medicaid. The AGD, this past July, adopted a position paper calling for increased government control of insurance companies, employers, employees and doctors. (Your New York State AGD delegation overwhelmingly opposed the position paper.) On the local level, the Dental Society of the State of New York (DSSNY) continues to fight to expand Medicaid. Also, DSSNY voted against state mandated continuing education (CE), but agreed to establish guidelines for mandatory CE. What?! We don’t want them to cut off our thumb, so let’s sharpen the knife for them?!

Organized health care–its major leaders, anyway–have not come close to taking a stand against government interference. All believe that some government meddling could be turned to their benefit, if only their particular group had more influence. They all endorse government control, and so more poison just keeps coming out of Washington. How much more the patient can endure is anyone’s guess. But the cure–a principled, unwavering stand against government interference in people’s lives–cannot be expected from our professions’ leaders at this time. They need more encouragement from their members.

CALLOUT: “It is hardly lack of due process for the government to regulate that which it subsidizes.” US Supreme Court Wickard v. Filburn, 317 U.S. 111, p.131, Oct. 1942

 

Government Watch: Socialism Lives–in U.S. Health-Care Reform Proposals”

Copyright Salvatore J. Durante, DDS, FAGD, 1992. Published in GP: The Journal of the New York State Academy of General Dentistry, March 1992.

The Berlin Wall is down. The USSR no longer exists. Former champions of an all-powerful glorious state have admitted they were wrong (even if they have not admitted that they are, in part, responsible for the suffering and death of millions). Statism does not lead to prosperity. Sacrifice “for the good of society” is not a virtue–if happiness is your goal and life is your standard of value. “From each according to his ability and to each according to his need” has been exposed as a slogan of human sacrifice and tyranny. In the war against collectivism, coercion, suffering and death–individual rights, freedom, prosperity and life have won. Or have they?

Our own nearly all-powerful, if not glorious, government continues its statist march toward total control. In fact, 1992 promises to be a banner year for the collectivist-statist ideal in America, if not elsewhere. As an example, consider that OSHA will begin enforcing its new regulations this year. As if this were not enough, some in New York have decided that the Office of Professional Discipline (OPD) should team with OSHA to target unincorporated dentists who might otherwise be spared harassment. (OSHA applies to employees only, and does not affect self-employed dentists, as “employees.” OPD can regard infection control as a question of professionalism and thereby reach the unincorporated dentist that OSHA cannot.) A new “civil rights” bill that encourages more lawsuits and harassment of employers takes effect this year. Also, the Americans with Disabilities Act will expand the state’s power to regulate, drive up costs, further lower everyone’s standard of living, and generally increase the power wielded by politicians and bureaucrats. (See “The Americans with Disabilities Act” earlier in this issue–Publications: Americans with Disabilities Act.)

The ugly truth that our “leaders” have learned next to nothing about statism vs. freedom could not be clearer than in the proposals for health-care reform. The last Government Watch, “Americare: More Poison Offered as Cure” (above) covered one Democratic plan that would complete the government takeover of health care that was begun with the introduction of Medicare and Medicaid in 1965. Americare would greatly expand the role of the federal government. As one measure, it would establish a new federal agency called the Federal Expenditure Board to establish spending limits–i.e., a rationing board. Patients would bargain with bureaucrats for their care, just as doctors’ representatives would negotiate with politicians for their fees. Since then, other Democratic plans have been proposed. The immediate increase in the amount of government control varies among the plans, but all agree that more government control is needed.

Keep in mind that today’s “crisis” in health care is the result of government interference, which began in earnest in 1965 with the enactment of Medicare and Medicaid. Steadily increasing government funding and control over the succeeding 25 years have turned routine medical care into a high-priced luxury item, and independent doctors and patients into slaves and wards of the state.

Republican proposals would only fuel the process that makes Democratic schemes appealing to so many. Namely, tax breaks for medical expenses would further drive up the cost of medical care and insurance, and increase cries for the government to take control Now! President Bush concedes that “something” must be done to control costs; Democrats suggest the Federal Expenditure Board. Republicans want to delay–not reverse–complete socialization of medicine; Democrats suggest that we finish the process this year and be done with it. What a choice voters have.

Today’s politicians buy votes by selling the legitimate rights of the less vocal and less numerous. They say medicine is a “right.” That means a doctor’s labor belongs to others, regardless of the doctor’s wishes, and the state must decide how to distribute this societal pool of services and talents. That is socialism; and it will not work here any better than it has worked elsewhere-and it has not worked elsewhere.

The only rational alternative to socialism and collectivism is capitalism and individualism. If politicians are truly interested in solving the problems of medical care delivery today, then they must remove the cause. Government must admit that it has no proper role in providing, funding or regulating health care, and must begin immediately phasing out all interference. (Those over 65, who have been led to believe that they could rely on government money cannot be cut off, but those under 65 should be told that there will be proportionately less money for them when they turn 65 and should start planning accordingly.) Doctors, hospitals, insurance companies, and patients would be free to enter into voluntary arrangements. The taxes formerly collected would stay with their rightful owners, to be spent as they decided. Those who chose not to buy medical insurance would have to live with that decision; they could not cry to politicians who would then force others to pay for their mistakes. True charity cases would have to rely on private charity, a system that proved itself in the past. And, of course, bureaucrats and regulators would have to seek productive employment.

 

CALLOUT: ‘I quit when medicine was placed under State control, some years ago,’ said Dr. Hendricks. ‘Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent . . . .

Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it–and still less safe, if he is the sort who doesn’t.’ Ayn Rand, Atlas Shrugged (1957)

 

 

For more articles on free-market medicine, see the op-ed pieces sponsored by the Ayn Rand Institute, at http://www.aynrand.org and the web site of Americans for Free Choice in Medicine, at http://www.afcm.org/

 


Politics of Health Care