Tuesday, October 21, 2008

NATIONALIZING HEALTH-CARE



Without the ability to filibuster, the Senate would become like the House, able to pass whatever the majority wants.

The threat of 41 committed Senators can cause the House to modify its desires even before legislation comes to a vote. Without that restraining power, all of the following have very good chances of becoming law in 2009 or 2010.

Medicare for all
-- Wall Street J., “A Liberal Supermajority,” October 17, 2008

If Obama wins with veto-proof majorities in both Senate and House, doubts and discussions about health-care will be ended. We will have "Hillary Health Care" with minor revisions to mold it to Obama health-care. That means universal health-care with a single payer as in Canada , where it is widely recognized as a failure but never changed.

Obama wants employers to provide health-care insurance -- many now do -- for all their employees, or pay a fine. A parallel system, probably government-run, would arise for workers in firms that do not provide insurance. That is what Obama wants. He also wants the same type of insurance as is available to Congressmen and federal employees. That alternative would be good but unlikely. He has never given it more than ten words.

What does this mean? Individuals presently insured by private companies would shift to the government company, which, being subsidized, is cheaper. The number of insured would rise from 32 million to 52 million. The public would be insured against the diseases they don’t want and will never need, but which the government thinks it should have.

There will be huge waste and exorbitant overspending. The government will become the single payer. In time, taxes will have to rise or services be rationed or both. Our system be in the same position as the nationalized Canadian and European systems.

In an unexpected win by Senator McCain, not all those things will happen, as Senator McCain’s plan is not likely to be wholly embraced. He would like to shift from employers’ seeking an insurance policy for their employees, to the individual employees’ getting their own policies. They would select only what they want. McCain would subsidize everyone with an initial $2500 per individual or $5,000 per family, which individuals would use for their basic care, adding any extras out of their own pockets.

A basic difference in health-care plans is whether the emphasis is put on minimizing cost or maximizing coverage. Senator McCain’s focus is on cost. Obama’s focus and Hillary’s are on coverage. They want universal coverage, scarcely ever mentioning costs. Hillary would mandate everyone be included. Obama declares he would initially mandate all children and later “would expand the program” (to include adults).

If the nationalized Canadian and European systems are to be our model, Congress should recognize that they lead to shortages. There are over 825,000 Canadians on waiting lists for surgery and other treatments. There are one million Brits waiting to get into the hospital.

Should Congress require employers to provide health-care insurance for their employees? It is an anti-growth policy. Hiring a new employee who has a family is expensive so the requirement would militate against attracting new businesses or expanding existing businesses.

Employers can buy insurance cheaper than individuals because they can pay with tax-free funds. This unusual arrangement was created to get around President Roosevelt’s wage and price freeze. McCain’s approach is to require employees to pay with after-tax funds, to even-out the situation with non-employees. (That may be what Obama refers to when he accuses McCain of taxing employees for health insurance.)

It is often forgotten that nationalized health-care has been a failure wherever it has been adopted. Bureaucracy and irrationality combine with monopoly power to reach unhelpful decisions for patients. Besides long waits—time to die in—a monopolist is able to invent excuses for not paying claims. In England , a Yorkshire resident was refused the drug Avastin to fight her breast cancer because her house was in the wrong postal zone. When she volunteered to pay for Avastin herself, the National Health System threatened to bill her $30,000 for the treatments she had received.

York resident Leslie Howard, 77, has macular degeneration. The National Health Service said he could not have the drug to save his sight till his sight is permanently gone from his good eye.

In Australia , Nellie de Bomford has cataracts. One was removed in 2004. The other was scheduled for the 20-minute procedure in 2009.

In Newfoundland , a four-year-old had cancer of the kidney. The kidney was removed. The nationalized health service scheduled him for an MRI in 2 ½ years to see if the cancer has spread.

A Quebec resident had an appendicitis. Five hospitals, one after the other, were too busy to take him in.

The important criterion is, how well does nationalized health care serve the people? The average time for bypass surgery in New York City is 17 days; in the Netherlands, 72; in Sweden, 59. A study by the medical journal Lancet Oncology found that the U.S. has the highest five-year survival rate for 13 of the 16 most prominent cancers.

Such, such is nationalized health-care. The conclusion is inescapable. Shortage of doctors and hospitals is inevitable. Demand for doctors is increasing while supply of doctors is decreasing, as fewer young people are willing to go into nationalized health-care.

By Natalie Sirkin
c2008
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