What I Want for Election Day: A Health Care Plan

I haven’t seen any results from New Hampshire yet, so this is probably a good thing to write about politics. I’m going to try really, really hard to keep this short. I am very much encouraged by the increased voter turnout thus far, both in Iowa and New Hampshire. I hope it is a trend that continues. More involvement and less apathy will be good for all of us.

What do I want to see in a health care plan? I’d like to see health care:

• Universal
• Free Market
• Limited Regulation and Bureaucracy

Of course, anyone with any knowledge of politics and economics can tell me I’m not going to get all three of those, as there are contradictions in them. So what do I think I can get?

It’s something like the little Marilyn Monroe song (later by Madonna as well, I believe) in which we find the lines:

a yacht
that’s not
a lot

The yacht is a lot, but we’d like to think otherwise. It’s the function of a candidate to convince us we can have the yacht without paying for it; once elected, he’ll make us pay for it, but never provide the yacht. This occurred to me as I was reading the few health care plans that the candidates have put forward. For what it’s worth, I congratulate those campaigns that have gotten specific on this issue.

First, I think it’s time for us to have some kind of universal coverage, or at least to head that way in this country. At the moment we have too many people using emergency rooms for primary care, and guess who pays for that. You and I do, sometimes in taxes, sometimes in our medical bills. Further, emergency room care is excessively expensive. But I’m not here to get into the details of emergency room care.

What emergency rooms tell me is something simple. When we are confronted with someone in dire need of medical care, we are not willing to just let that person die. That’s why emergency rooms have to take people in who can’t pay and provide them with a minimum of care. Unfortunately, the same moral compass that leads us to expect care for these people doesn’t seem to lead us to pay for it.

Second, however, and conflicting with the first, medical care is an economic good. It’s not in unlimited supply, it doesn’t just happen. Somebody has to produce it. When we declare that someone has a right to medical care, we’re also by nature implying a duty by someone else to produce that care. When the issue is someone dying of fatal injuries, however, we want to ignore the issue of precisely how the thing to which that person has a right is produced.

This leads me to suggest that we build a system that is as private as possible and use a minimum of government intervention. There are certainly some ways to reduce costs. These include moving more primary care to providers such as nurse practitioners. I don’t have statistics on it (I’m going to do more research) but I believe it will also be valuable to put some kind of restraints on malpractice lawsuits to alleviate fear of using people with less than a medical degree plus a specialty to actually see patients. Personally I think we will be better off, on average with the nurse practitioners providing primary care.

Those items, however, are going to be minor. One thing I noticed in the health care plans I read was a great deal of optimism about saving money. It is very rare that government regulations can be set up to enter an industry and reduce overall costs. Again, it’s a topic for more research, but I am extremely suspicious of the savings numbers given by any of the candidates. It seems to me that the promise of large monetary savings and no new bureaucracy is a bit like “the yacht is not a lot” but yet the time will come when folks have to pay.

Further, there is a good reason why savings don’t ever seem to accomplish what is promised for them. Even wasted money goes into the economy somewhere. If it is used more productively there will be an improvement, but fired government workers, for example, were buying groceries whether their work was productive or not. Overpaid executives put their money in banks where it can be used for investment. In general, when we state either losses from fraud and waste, or savings from eliminating it, we get the idea that more will be accomplished than will actually happen.

So where do I end up? With a compromise. I’d be pretty happy with a private system that nonetheless mandated some level of health care coverage with a safety net program for those who are unable to pay for it. I know that safety net programs tend to become entitlements, but I do not want to see anyone left without basic (that needs to be defined, but not today) coverage, or anyone forced to provide free service. I think this one needs to be taken care of nationally.

PS: To find out why I’m almost certain to be disappointed, read Bureaucracy, by Ludwig von Mises. If you’ve read (or tried to read) Human Action, don’t worry. Bureaucracy is an easy read.