Liddick: The smoke and mirrors of ‘Medicare for all’ (column)
October 23, 2017
Colorado's Senator Michael Bennet has teamed up with Virginia's Tim Kaine to save Obamacare by offering a new "public option" based on Medicare that they — and the Democrat party to the left of them — hope will replace the badly flawed and dying Affordable Care Act. Their proposal doesn't go as far as Vermont Senator Bernie Sanders' "Medicare for all" plan, but give it time. When ThinkProgress and others on the further shores of the socialist movement the Democrat party has become tout the Bennet/Kaine plan as "a path to single-payer that simply does not exist right now," one realizes the endgame, and understands the rest is just tactics.
When questioned, Senator Kaine said he and Senator Bennet "… don't blow up the existing system, we maintain the system." But as Virginians know, Tim Kaine has a problem with the truth. He illustrated that problem once again when he accused President Trump of sabotaging Obamacare; what the president actually did was cancel an unconstitutional subsidy in the program. Doing so he challenged Congress to arrange payment in a legal manner, which they are now attempting.
Both senators admitted their proposal was necessitated by serious flaws in Obamacare which produced skyrocketing premiums and a dearth of insurers in local and state exchanges — both predicted by the plan's opponents from the beginning. In its place, they suggest a program which would "lower premiums because it would lower administrative costs and not pay large executive salaries" in addition to offering lower payments for services. Which is another proof that progressives do not understand, or do not accept, the laws of economics. They prefer smoke and mirrors instead.
One of the worst problems with Medicare is that providers who will accept the payments it offers for services are not plentiful. This is due to an inconvenient truth at the heart of medical care in the United States.
Modern medical care is a scarce commodity and as it becomes more advanced and complex it grows ever more expensive. It is hedged about by regulations from all levels of government and from the private associations that allocate licenses for medical practitioners. It is prone to litigious interference, both warranted and frivolous. And it is at least partially a hostage to the pharmaceutical companies that create lifesaving drugs and treatments. As a result, our health care system, though the world's most advanced, isn't cheap and it has a bias toward those who can pay for treatment.
Medical care is also preferentially distributed geographically; it is more common in urban areas than in rural. In some degree this is a product of the location of support services, but it also partakes of the taste of well-heeled medical practitioners for urban amenities rather than rural quietude. Both these can be overcome, but that takes money — as rural communities can attest.
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There are several responses to this situation. All of them can potentially resolve some of these challenges, but none of them are without costs and all will potentially make other problems worse.
We might embrace a Libertarian solution that would warm the cockles of Senator Rand Paul's heart: Use economics to unemotionally distribute medical resources, and rely on the character of medical professionals to offer treatment to poor patients gratis. This would increase the distance between the "haves" and "have-nots" in society, and would necessarily lessen the quality of care available to those who cannot pay. Call it a pre-1965 medical care system.
Alternatively we could embrace single-payer, in which medical costs are controlled by, and monies are collected and distributed by, government. But since medical treatment is scarce, this would mean some would still receive more care, and others less, based on criteria established and enforced by bureaucrats. Eighty years old with a heart condition? Probably not the best of odds: There are all those 40-something knees to fix, and the money has to come from somewhere…
Or we could be rational, with government payments only for the truly "medically indigent" in the original meaning of the term and everyone else making their own decision about the level of medical treatment for which they should insure themselves — or pay directly. With means to sort out those who could not pay from those who merely don't wish to, this would decrease the expense of both Medicare and Medicaid, And it would re-emphasize the American expectation that one is expected to take care of one's self.
Which is why, sadly, it is the least possible of outcomes.
Liddick writes a weekly column for the Daily.
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