The Threat of Socialized Medicine
by Ari Armstrong, February 20, 2007
"Health care needs to be provided by a single payer, be universal and comprehensive."
The threat of socialized medicine is real. While most Americans and (I think) most doctors do not want socialized medicine, the minority that does want it vocally pushes that agenda. Most people have only a vague sense of apprehension about socialized medicine. They do not explicitly or consistently advocate individual rights as applied to medicine, and so they are unable to argue against incremental "reforms" or offer a coherent alternative.
The advocates of socialized medicine reframe the debate with seductive euphemisms and push through their program piecemeal. They blame the allegedly "free" market for the problems caused by previous and existing state interference in medicine, thereby generating a cycle of control that creates crisis that spurs calls for new controls. Unless this cycle is disrupted by advocates of liberty and individual rights, the end game is completely socialized medicine -- and the way has already been prepared.
On January 12 I sat through part of a committee meeting organized by Colorado's Blue Ribbon Commission for Healthcare Reform. The purpose of the meeting was to evaluate public comments about the commission's "Solicitation for Proposals." The commission plans to revise that document as needed based on public commentary. The commission's web page currently states, "The Solicitation for Proposals invites the public to submit proposals for comprehensive health care reform to the Commission by 5:00 p.m. on April 6, 2007. By May 18, 2007, the Commission will select three to five of the proposals submitted for professional analysis and evaluation."
At the meeting, commissioners distributed a 32-page document titled, "Draft Solicitation for Health Reform Proposals: Compilation of Comments Received." Anyone could submit comments, and the document simply compiles them. I do not intend to summarize the entire document, which contains comments from numerous perspectives (including a call to "[p]lease keep the government out of the Doctor/Patient healthcare equation"). I am going to focus on a couple of comments that are similar to various others. (The opening line is taken from the comments of Carol Heinkel.)
Elinor Christiansen (or "Christianson;" both spellings are provided), MD, advocates medicine that is "universal," "comprehensive," and "publicly funded."
By "universal," Christiansen means to "include everybody from birth to death, everyone residing in Colorado." By "comprehensive" she means to include "all medically necessary services including prevention, acute and chronic care and long term care; mental health, dental care, prescriptions and medically necessary equipment."
In other words, Christiansen wants the government to provide medical services to everyone for everything.
Well, not quite everything. She implicitly recognizes that medical care that's "free" to the users will create greater use, and so only those services that are "medically necessary" will be provided. And who will determine what's "medically necessary?" The only possible answer is some combination of politicians and bureaucrats. The necessary and inevitable consequence of tax-funded "comprehensive" care is rationing.
Arnold Kling offers an important distinction of "insulation vs. insurance." Insurance provides protection against unforeseen emergencies; it is something we buy and hope that we never need. Kling writes that "insulation reimburses even relatively low-cost services, such as a test for strep throat or a new pair of eyeglasses. Insulation pays for treatment even if it is commonplace or discretionary." By analogy, insulation in auto insurance would be a policy that covered oil changes, tire replacement, tune-ups, paint jobs, and the like. Insurance insulation drives up costs in two main ways: it breaks the link between costs and use, and it adds considerable processing expenses.
Glenn Pearson, MD, openly advocates insulation (without calling it that), not through insurance but through direct tax subsidy. He complains that out-of-pocket expenses for routine care, even "high copays and deductibles," "encourage people to avoid seeking help when an illness is in an early more treatable phase."
As a general rule, Pearson's prediction is false. If I have a high-deductible policy and pay for routine care out-of-pocket, my incentive is to pay for needed health care in order to avoid having to pay the maximum deductible or anything close to it. I also have an incentive to take reasonable steps to stay healthy, because my medical expenses will be lower and my quality of life will be better. To a very large degree (though obviously not in all cases) our health is in our own hands. We can control our diet, our exercise, our inhalation of tobacco smoke, and the riskiness of our activities. Insulation may increase the incentive to make more trips to the doctor and buy more drugs (probably without improving health), but it decreases the incentive to stay healthy.
The consequences that worry Pearson are the result of the very insulation he advocates. For example, some people avoid routine treatment because it costs money, while they are guaranteed by government mandate "free" emergency-care treatment.
What's truly ridiculous is that advocates of socialized medicine pretend that their policies can be consistent with some meaningful sort of "choice." Real "choice" means that people are free to associate voluntarily on mutually-agreeable terms, within governmental institutions that protect individual rights and free markets. The "choice" of socialized medicine is similar to the choice of which bread line to stand in under the old Soviet regime.
Yet Christiansen believes that universal, comprehensive, publicly funded medicine is somehow compatible with "[p]atient choice of physician and hospital." It is true that a patient could likely "choose" between Socialized Medical Clinic A and Socialized Medical Clinic B. But free-market clinics will be mostly driven out of the market if not forcibly shut down. In addition, the patient will be able to get only those services deemed "medically necessary" by agents of the state, under the mandates and controls that "universal" tax funding will foster.
Christiansen claims that, under her plan, "Treatment decisions [will be] made between patient and physician without outside interference." I'd call her claim laughable, if the realities of socialized medicine weren't so frightening. Public funding is "outside interference." Specifically, it means that government agents will force you to pay into the socialized system, leaving you with fewer resources to take care of yourself. If you don't pay the tax, ultimately men with guns will come to seize you and lock you in a cage and take your property. The central planners who are to decide what is and what is not "medically necessary" likewise constitute "outside interference." They will and must decide the terms on which doctors and patients interact.
Socialized medicine means that agents of the state control your medical care. Christiansen and other advocates of socialized medicine live in a fantasy land in which the blunt force of the state is seen as the means to free "choice." But the initiation of physical force necessary to achieve socialized medicine inherently violates our liberty and our rights. Saying that up is down or black is white or force is choice doesn't make it so.
Thankfully, against the medical socializers, at least one Colorado doctor has taken a stand for liberty. Those who value their health owe him a debt of gratitude.