Final Solution

This is a revised version of a previous post.

Over a decade ago, the Clintons attempted to socialize medicine and were decisively rebuffed by the American electorate in the mid-term congressional elections of 1994. The push for government control of the medical industry was finally over. Or so it seemed at the time.

Unfortunately, this is not the case. In addition to President Bush expanding the role of the government in medicine via his prescription drug program, large corporations are complaining that higher health care costs are wreaking havoc on their bottom lines. Many of these firms have been trimming benefits packages for their employees. One giant, Wal-Mart, simply encourages its lower-wage workers to sign up for Medicaid.

With Republicans and corporations adopting big-government solutions to the problem of spiraling medical costs, it should be no surprise that a new push for government control of the medical industry is afoot. Since outright socialization of medicine would be too politically difficult to accomplish, some have proposed thinly-disguised fascism -- private ownership with government control -- instead. They're calling their approach Universal Health Care Vouchers, or UHVs.

Recently, in Washington Monthly, Ezekiel Emanuel and Victor Fuchs made a detailed pitch for UHVs. They claim to have "Solved!" the health insurance crisis, but a closer examination of their remedy shows it to be worse than snake oil.

Conceding that "free" government medical plans in such countries as France or Canada do not provide the same level of care as our present system, the UHV advocates claim that their plan will preserve the efficiency of the American system, continue to permit consumer choice, and rein in the spiraling costs of medical care. But will it achieve any of these things? No.

In this program, every American household will receive a voucher entitling its members to enroll in a private plan of their choice. These private insurers will be forced to "guarantee the basic features of what most Americans now receive from their insurers: doctors' visits, hospitalization, pharmaceuticals, and catastrophic coverage." Furthermore, since the program is to provide universal coverage, "Those with preexisting conditions or high medical costs will ... have guaranteed coverage with any plan they choose," because the value of the vouchers will be adjusted for such variables.

This plan will fail if put into practice.

Emanuel and Fuchs claim that our insurance companies will be required by law to maintain the high level of service that many American employees now see through their health plans. This is to be paid for by a type of sales tax called a value added tax (VAT). But suppose people start visiting the doctor at the drop of a hat since they're only out a copayment. Or suppose that nothing is done about the malpractice crisis. Or drug liability. What then? Either the VAT will be raised (even for those who don't milk the system for all it's worth) or services will have to be cut (again, for everyone). So much for a legally "guaranteed" level of service, and, for that matter, reining in the cost of health coverage.

This leaves choice. Would the system really allow us to make our own medical choices? Emanuel and Fuchs propose that the UHV system be monitored by a new government agency modeled after the Federal Reserve Board and called the Federal Health Board (FHB). The FHB will "issue decisions on what new drugs or treatments to require insurers to cover." Translation: You choose your physician, but the FHB calls the shots on what your insurance will cover, no matter which company you use.

And speaking of what gets covered: By what standard is something judged worthy of coverage? Would the FHB mandate coverage of life-saving gastric bypass surgery for the morbidly obese or cancer treatment for heavy smokers, passing the costs of their unhealthy habits on to the rest of us? If not, why not? Certainly, citizens would be free to pay for such treatments on their own. But if that's the case, why not just let everyone have their own money to spend (or not) on medical coverage to begin with? What need is there for the government to basically hand out money stapled to ration coupons to be spent for what the almighty FHB (rather than you) deems worthy of coverage?

Because this plan is supposed to be "universal" and the only way to make this happen is for the government to confiscate some people's money to pay for other people's medical care, whether that means visits to the doctor for mild headaches or a lung transplant made necessary by a lifetime of three packs a day. Up to a point, that is: The amount people are willing to be taxed.

The acronym FHB is designed not to evoke much thought for a reason: Under this plan, it would be the sordid purpose of this agency to decide whose lives to save with however much confiscated money it had. Under this system, you will have lost the choice to keep however much money you will pay in VATs and how to spend whatever the government has earmarked for your medical care.

There is no free lunch. Medical care, like any other good, exists in limited quantities. As a result of this scarcity, we have a choice. We can allow government functionaries to ration it for us, resulting in lower quality, higher (if hidden) costs, and a loss of control over our own medical decisions. Or we can attempt the real reform of excising the cancer of government control once and for all from the medical industry, giving ourselves individually the best medical care our own money can buy on the open market.

-- CAV