Sunday, December 19, 2004

Nationalizing compassion: The Canadian Free Lunch

Say what you will about the evils of price rationing in the context of the health care market, but it does offer two huge advantages: It imposes discipline on the consumption of health care and it yields incentives for providers to continue providing in the long run. We do, after all, care about the children, do we not?

Actually, a close look at the hard reality of the bureaucratized health care system in Canada (and the UK and elsewhere) reveals that they care about the kiddies a good deal more than they might care to admit. Resources are limited. Ditto for government budgets. And so choices have to be made, notwithstanding the dual fictions that health care is "free" and that those who need it will not be denied. Someone has to be denied, and guess who that is increasingly: the elderly. Why "waste" expensive procedures and devices and medicines on someone who is going to some eternal reward relatively soon when a far more deserving (read: politically defensible) patient also is on the waiting list?

Alas, it does not, it will not, it cannot stop with the elderly. "Free" health care in Canada means that waiting lists are long, patients deteriorate while waiting, such "cheaper" devices as plastic artificial knees are used in place of aluminum ones, and those who can travel and pay for medical care go to the U.S. And those who cannot? Well, they suffer. As day follows night, health care will be denied the mentally ill, the desperately tiny prematurely born, those whose prospective "quality of life" in someone's politicized view will be inadequate. That is the tragic road toward which nationalized compassion inexorably will lead. This is not because the system is afflicted with correctible inefficiencies or because budgets are not fully funded or because doctors/hospitals/pharmaceutical producers/insurers/bureaucrats/name your goblin are greedy/corrupt/uncaring.

It is because "free" health care cannot overcome the basic and eternal condition of mankind: Wants exceed resources. And that in a nutshell is why a Canadian-style system is not the answer for the U.S. health care problem, notwithstanding the romanticized illusions now prominent in many discussions.

Nor is improvement to be found in a continuation of the creeping bureaucratization of U.S. health care. Instead, ways must be found to discipline demand. The Medical Savings Accounts incorporated in the recent Medicare reform bill are a step forward; they move somewhat toward a system in which people purchase health care services not with Other People's Money, but with their own. More such movement toward market mechanisms is the path toward true reform, which will serve the broad long-term interests of consumers, in that a "cheap" but huge medical sector leaves fewer resources and thus higher prices for everything else.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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