Campaign For Liberty 
Wednesday, July 29, 2009
Albert Einstein supposedly defined insanity as “doing the same thing over and over again and expecting different results.” Indeed, if Einstein was correct, then the U.S. Government is about to embark on a course of insane medical care in the name of “social justice,” “morality,” and “fairness.”
As one who believes that insanity should not be equated with “social justice,” I would like to place myself firmly on the side that believes that we need less government control of medical care, not more. Unfortunately, we have a lot of people, including individuals masquerading as “economists” that are claiming that government control of medical care will result not only in more access to care, but also will create a greater supply of it.
One of the most vocal advocates for “universal” care has been Paul Krugman, the 2008 Nobel Prize winner in economics who has a twice-weekly column in the New York Times. Krugman, who teaches economics at Princeton University, claims that government care actually will increase the availability of medical care, making it less costly and higher-quality. He recently laid out  how that would be done:
“Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition.”
He goes on to explain what he means by each. Regulation would be a set of rules forbidding private insurers from denying coverage due to an individual’s health conditions. (It would be like ordering State Farm to insure you upon request, even if you had a dozen traffic accidents on your record.)
Mandates would involve a requirement that everyone purchase insurance. Those who could not afford the rates would receive subsidies from the government paid by individual taxes and heavy new business levies.
Competition would be the creation of a new government “insurance” plan to “compete” with private insurers, something that Krugman claims “would help hold down costs.” The idea would be that this new “plan” would provide a benchmark of service that would “encourage” the insurers to be more generous.
As one who has studied other “universal” medical policies in other countries, I have a different set of descriptive terms for the program that Krugman outlines: command, control, coercion and contraction. In fact, what I have listed is the hallmark of “universal care” elsewhere, and the idea that the American political classes can create a similar “plan” and avoid the pitfalls that plague those systems simply is insane, if we use Einstein’s definition.
I shall explain each of my points:
* Command: Government mandates are commands from above, usually enforced by the criminal code. Thus, we will have the situation in which government will be ordering plans not only to accept whoever applies, but also to include coverage for things that currently are not covered in private plans. Obviously, this is a prescription for bankrupting these plans, which I believe is one of the goals of those who would implement these policies. It is obvious that whole new bureaucracies would be created to enforce these policies, and insurers and medical professionals would be forced to come up with whole new series of documents to satisfy the horde of bureaucrats that would descend upon them (on top of the horde of bureaucrats that already are “regulating” the system).
* Control: Once government has managed to force insurers and medical professionals to adopt policies favorable to the political classes — under threat of criminal prosecution — then the government essentially has control of the system. Although Ted Kennedy in his recent Newsweek essay  claimed that this program would not be “socialism,” indeed, that is exactly what it would be. We also can be assured that once this system is implemented, any private exchange at all would be criminalized, just as it has been in other countries with “universal” care.
* Coercion: In a free market, medical care is built upon a need followed by voluntary exchange between the person needing care and the medical professional. In this Brave New World, however, voluntary exchange would be out, and coercion would rule the system. Not only would individuals and businesses be forced to pay for something they rather would not do, but they would face fines and possible prison sentences if they refused or tried to “game the system,” as Krugman likes to claim.
* Contraction: This is the final but inevitable step in government program like this. The idea that this “plan” would result in greater availability of medical care is ludicrous. If that were so, Americans would be crossing the border to Canada for their medical care, not the opposite, as what is currently happening. As the hand of regulation becomes tighter and harder-fisted, medical professionals will drop out of the system altogether, and the capital that has given us the miracle of modern healthcare would deteriorate and ultimately fall into disuse.
For example, Montreal, a city of more than three million people, has only three MRI devices, while Allegany County, Maryland, which has about 80,000 residents, also has three MRIs. The reason for the disparity is simple: an MRI in Allegany County is capital for which the use provides an income for its owners, and doctors like to use it because it provides a relatively-inexpensive way to do exploratory surgery without having to do anything to the patient.
In Montreal, however, because all medical services are “free,” an MRI is not an asset but a liability, an expense for which there is no compensation given to its owners. Thus, if one lives in Cumberland or Frostburg and needs an MRI exam, one is available within a day, while in Montreal and other parts of Canada, one waits six months or longer.
As John Stossel recently has pointed out , the “contraction” of the system means that people wait and wait for simple care because no legal alternatives are available to them. No doubt, when the lines begin to grow long — and they certainly will if this “new” system is imposed — Americans will be told that the wait is because of “incompetent and greedy doctors” or something else that is untrue.
There also will be another development, one that will have even more impact on American freedoms (which are dwindling by the day). For-fee medical care will be made available in places like India and Latin America, where trained professionals already reside and where new investment into medical capital will be poured, and many Americans will take advantage of it. When that happens — and it surely will — there will be an outcry led by the political classes and the statist media against “medical tourism,” and laws will be passed criminalizing leaving the USA for any medical care that allegedly is available here. Thus, the government effectively will build its own “Medical Iron Curtain.
Americans do not need to destroy their healthcare system in order to “save” it. There is another path we can take, one in which we restore the free market and get the government out of the healthcare business altogether. Soon enough, this system would be the envy of the world, but it seems that the envy of the political classes is such that free markets in medical care are not in the political cards.