No Such Thing as a Free Ride

There are two maxims that have held true for time in memoriam, "Nothing in life is free" and "You get what you pay for". Nowhere are these two principles more true than when it comes to health care. Politicians are selling "free" health care to the American people, knowing that the word "free" will tickle our ears. It sounds SO good. But in real life, medical care is expensive. It won't stop being expensive just because the government mandates it to be so. "So let it be written, so let it be done." (From the Ten Commandments--ask Pharoah how that worked out for him.) Let's delve into these two ideas.

Nothing in life is free:

I touched on this in my last post, but there are lots of people that get "free" health care in American right now. (Just because I'm bringing this up doesn't mean that I'm necessarily against it, but we have to deal in realities here.) The government has mandated that all patients that come to an Emergency Room must be treated, whether they can pay or not. This government mandate doesn't make the care free, it just forces hospitals to provide care. Those who cannot or will not pay are still treated. So does the cost for their care just disappear? No. It's paid for by everybody else who does pay. Illegal aliens who use the ER as their primary care provider cost Americans millions of dollars every year. Many hospitals in southern California, Arizona and Texas are struggling to keep their heads above water because of these costs. Their health care is free to them I suppose, but the costs to everyone else are very high.

Medicare and Medicaid are not free, other taxpaying Americans pay for these programs. And the government has managed to screw up and bankrupt these programs nicely. It was reported this week that Medicare/Medicaid will be insolvent by 2016, closely followed by Social Security in 2017 (see http://news.yahoo.com/s/ap/20090513/ap_on_bi_ge/us_social_security). How is it possible for anyone to think that government health care will be managed better than Medicare/Medicaid? It defies logic. So, if the few people that still pay taxes are then required to pay for health care for all of America, how long do you think it can last? It will be bankrupt from day one.

The only choice that will follow the government's inability to pay for this "free" health care will be either to increase taxes or cut health care. More than likely both things will happen. This isn't a new idea, it is in fact, a failed experiment all over the world. Ask Canadians, Britains and other Europeans about their health care. In Great Britain, they pay about 60% of their income in taxes and then they have two choices. They can take their chances and see what they get with their "free" health care in public hospitals or they can pay for high quality health care in private hospitals. Britain cannot afford to provide medical care for all its citizens, so a governing board makes decisions about who is worthy of treatment or not. Women in Britain that are deemed too old are not treated for breast cancer because the system can't support the cost. It makes no difference how early the cancer is caught. Or, if you are over a certain age, you will no longer receive dialysis, because the system can't afford it. So, a governing board of bureaucrats has decided that the older generation is not valuable enough to keep alive and they let them die. Now that's the kind of health care I want.

The reality about "free" health care is that it has to be funded somehow. There simply aren't enough tax dollars to support government health care, but they will try. The ideas they are currently discussing include a variety of ways to create new taxes attempting to hide the cost of your "free" health care. One idea is to eliminate the tax exemptions for employer paid health insurance. If you currently have health insurance through your employer, you do not pay income taxes on the premiums you pay, neither does your employer. Those dollars have been protected from taxation to encourage people to carry health insurance. If they succeed in pulling this off, I guarantee the quality of your insurance will lessen because employers will have to make up the tax costs by cutting coverage. Or you will have to pay directly for the increase through higher premiums. In the end, most employers may end up dropping health insurance altogether. Either way you will pay, pay, pay.

Other ideas include nationalizing the soda tax that they already have in good 'ol New York City. They levied a special tax on sodas with sugar. What happens to their tax revenues when people all start drinking diet? Another possibility is the cigarette tax. Even nicotine addicts will reach the breaking point on the cigarette taxes. When smokes are $100 each, people will stop smoking. Where will the government get their funding then? What about restaurant taxes? Why not tax high calorie foods? foods with sugar? cheese? pizza delivery after 9:00 pm? overweight people? diabetics? Where would it ever end? Taxes cannot pay for free medical care, it is simply unsustainable.

When they have wrung the American people dry (technically they already have with the deficit we're facing) the only choice will be to limit services. Government workers will be making treatment decisions, rather than doctors and patients. We'll be right up there with the rest of the world--year long waits to see any doctor, serious emergencies go in the queue with all the hangnails and coughs and it's anybody's guess when you might be able to get a needed MRI or chemotherapy. It sounds better and better, doesn't it?

You Get What You Pay For:

If the government succeeds in taking over health care, two things will happen almost immediately. Medical school enrollment will drop drastically and doctors will be forced to make tough decisions. Who in their right mind would go to medical school right now? With Pres. Obama's promise to "squeeze" doctors and hospitals, or in other words to screw them out of more payment money, why would anyone go through the medical training gauntlet? Furthermore, they will lose any control they have left over patient care. Medical practice will become a set of checklists and governmental guidelines. They will have little or no say in how they practice medicine. There will come a time that the expense and grind of medical school will not be worth the rewards; nor will the frustration of fighting government bureaucracy be worth it. The rewards include the satisfaction of really helping someone by improving their quality of life and the salary. And yes, I believe doctors deserve the rewards--the salary. It is a big sacrifice to become a doctor and they have earned the right to be rewarded for their hard work and sacrifice. If you take that away, what will we be left with? Fewer doctors, longer waits.

I'm fairly certain, that any doctors close to retirement will throw up their hands and cry, "Uncle." The government has already made it so difficult to practice medicine that if they can afford it, they will be done. That will remove even more doctors from a declining medical population, exacerbating and increasing wait times for patients.

The worst consequence of a government takeover, would be the divide it would create between rich and poor. If there's a problem now, it will be a cavernous void under gov't control. The best doctors will go into private hospitals. The only way you will be able to afford their care is through private insurance or in cash. The people willing to pay for it will get very high quality health care. If you can't afford either, you will be forced to deal with what's left. If the best doctors are in private hospitals, what are the public hospitals left with? That problem will worsen each year with retirement and decreased med school enrollments. Often, those holes are filled with international doctors that may or may not have the same level of training the doctors in America receive. The poor will have no say in who their doctors are or what kind of treatment they want. We will get what we're paying for. That is a stab in the dark I'm not willing to try. Are you?

Now, someone may say, "Well, the government should pay for med school then, so it will still be an attractive profession." There are two problems with that idea. 1) Salaries capped/dictated by the government will still not make the grind of medical training worth it. I don't know very many doctors that would do it all just to make $40,000-$60,000/yr. It's a livable income, but does not make up for the lost years of retirement savings. And, why go through it if you can make more money doing something else? That will be the choice college grads will be forced to make when contemplating a medical career. In the end, it will become purely a business decision and there will be easier ways to provide for a family. 2) "Free" medical education presents the same problem as "free" health care. Somehow it has to be paid for. Even if the government picked up the tab, med school faculties still have to be paid. We're faced again with a funding issue. Where will the money come from? You. Nothing in life is free--especially not if it comes from the government.

The good news is that this hasn't happened yet. Pres. Obama's deadline to make it happen is July 31, 2009. The other good news is that he can't do it without the approval of the legislative branch. Our only hope is to let our representatives know how we feel. If we sit back and let this happen, we will come to rue the day in ways we may not be able to imagine. If it becomes a reality, it will take years to undo what has been done. We must not allow it to happen.