The debates go on and on and we are still more than fifteen months away from election day. The candidates all have “plans” for fixing the various problems the country faces and most of these plans are exceedingly ambitious. Which is to say … expensive.
We hear about plans for “fixing” health care by instituting what some candidates are calling “Medicare for All.” In some versions, this comes down to an absolute end to private insurance. If you like your current plan … well, hard cheese. You don’t get to keep it. Welcome to Medicare for All.
The various plans have been analyzed and criticized and defended until the ordinary voter is thoroughly mystified. The numbers are all over the place and we never really know what any of these great government schemes will truly cost until it comes time to pay up. Which is, inevitably, too late for us to change our minds.
Under a Medicare for All system, many people will not get everything they want. Or, even, everything they need. Scarcity is one of the unfortunate facts of life. There is never enough of the things we desire most. A heart transplant, for instance.
If there is only one available donor for two patients in critical need … somebody lives and somebody dies. So do we go with the younger, healthier patient? What if the older patient has Jeff Bezos kind of money and is willing to pay anything? It wouldn’t be fair, of course, to let him get ahead in line, just because he can pay more. And, by the way, he will be paying more, even if it doesn’t put him first in line for a new heart. All these plans depend on robust taxation of the wealthy.
Since there will never be enough money for everything that people desire and will come to feel entitled to in a “Medicare for All” system, rules and regulations will be necessary. What procedures will be covered? Does any eighty year old with painful joints get a knee replacement? Or does he have to get by on ibuprofen and ice packs?
And just who will make the rules?
Bureaucrats, of course, working under the nominal supervision of those we elect. But the administrative state will be the real power when it comes to deciding just what symptoms are necessary before a patient can be declared eligible for some specific treatment or procedure.
There is no formal system of guidance in these matters. The process will be ruled by politics, which means by pressure groups. People who need certain therapies and treatments will mobilize and lobby for increased funding, mission-specific facilities, and the like. It is easy to imagine that old people will gain the upper hand in the struggle for resources. First, because they suffer more conditions requiring medical treatment and, then, because they are old and there are fewer distractions in their lives. There is a reason the AARP is one of the most powerful lobbying organizations in the country.
Even if there were money enough to provide treatment to everyone for all possible maladies – an impossibility – there would still be problems with totally politicizing health care. There would, for instance, be questions of certification. Who, precisely, gets to be called a physician? How will it be determined who is a quack? What therapies are ruled legitimate?
The headline over a recent Wall Street Journal article reads, “Facebook, YouTube Overrun With Bogus Cancer-Treatment Claims.”
Well, the people peddling those treatments might organize and lobby and get the political sanction necessary to be covered by “Medicare for All.” No reason some quack couldn’t bring back the use of leeches and claim this treatment should be covered. And if that is extreme, consider some of the therapies out there that have devoted patients and practitioners. Acupuncture. Chiropractic. Aromatherapy. And many more.
What should be covered by Medicare for All is one big question.
The next is how much will it cost.
And the biggest is … where will the money come from?
Washington doesn’t seem to have a problem with that one. It just votes the money into existence, a trillion at a time. The spending is defended as necessary and essential and so forth. Nothing, of course, could be more necessary and essential than the health care system. All of us would put our own heath care high in order of relative importance. Or maybe not. People take a lot of foolish, non-financial actions which impact their own health. Eat too much. Drink too much. Smoke. And so on.
Yet they figure that treatment for the woes brought on by their own irresponsible behavior is the responsibility of the government.
Health care, we are told over and over, is a right.
And ultimately, just maybe, a responsibility?
Geoffrey Norman is a former editor of Esquire magazine and is a regular contributor to the Wall Street Journal, Weekly Standard and National Review. He has authored more than 15 books and remains active shaping public policy discussions. He lives in Vermont.