More on the Upcoming Medicine Debate

Diana over at Noodle Food recently blogged about the latest salvo in the fight to enslave the medical profession: a state-by-state effort. In addition to this, a recent issue of the New England Journal of Medicine reminded me that the effort to enslave the medical profession continues unabated, even perhaps with renewed vigor, now that many are distracted by issues of graver immediate concern (e.g., the war).

The state-by-state implementation reminds me of nothing more than the "incrementalism" that Democrats resigned themselves to after the defeat of Hillary Clinton's proposed system of socialized medicine in the early 1990s. In addition, although the news article does not depict an initiative intended to appeal to conservatives (say, as a "states' rights" measure), it does bring to mind an alarming possibility: Might this "incremental" approach be augmented by Democrats appealing to conservatives? Might the push for socialized medicine be aided not only by the distraction of its usual opponents, but also gain renewed vigor as advocates attempt to turn some of these erstwhile opponents into allies?

We need not pose this as a rhetorical question. I have already discussed one such attempt, that by Ezekiel Emanuel and Victor Fuchs, who propose a fascist voucher program for universal coverage. Of this proposal, they say:

Conservative health-care reform has little if anything to offer Democrats, even moderate ones. [This voucher plan], because it enhances consumer choice while offering clear benefits to Republican constituencies such as large insurers and business, has a good chance to draw enough Republican legislators to get over the top.

This, in addition to the fact that its financing mechanism, a value-added tax, supposedly would present a chance to abolish the income tax, is supposed to make the plan appeal to at least some fiscal conservatives! I'd always imagined that social conservatives would be more vulnerable to the universal coverage pitch. But don't worry. Appeals to them are, unfortunately, also being made, as you will see.

So what did I find recently while skimming through a recent issue (July 7, 2005) of my wife's subscription to the NEJM? Two letters to the editor in response to another issue's four editorials urging "universal coverage"! Neither letter objected to this idea, but both did find fault with the universal coverage proposals for allowing even a remnant of free enterprise to be left standing! The letter by Arnold S. Relman provides us with the following quote, which presents the gist of the argument presented by both letters, as well as the level of the debate.

The two sounding board articles, by Emmanuel and Fuchs [Yes. The very article I blogged about also appeared in the NEJM in March. --ed] and Morgan and Lee, state that more federal taxes would be required, but neither suggests a unified insurance plan [italics added] to replace the costly mix of government entitlements and multiple for-profit plans and neither considers the possibility of changing the organization of practice or the system for compensating physicians in order to reduce costs and improve the quality of care. (NEJM 353: 96)

And at what level is the debate occurring, if we take the NEJM as an indication? The debate seems to be over as to whether the government should take over medical care, and the discussion has devolved into nitpicking over how, exactly, this should be done.

This is not surprising given that all four articles in the March 2005 NEJM argued in favor of government programs to implement universal coverage. While this is hardly a surprise, one article in particular is notable in formulating the issue in a way designed to appeal to social conservatives. In "Do We Really Want Broad Access to Health Care," James J. Morgan and Thomas H. Lee begin their assault on the "antitax movement" as the "main enemy of those who truly seek to meet the needs of the 45 million uninsured Americans" by stating the following.

One might have thought that an election that hinged on "moral values" would generate serious discussion of one of our most fundamental "value" issues -- that is, whether we really believe that broader health insurance coverage should be a high priority. The candidates were asked to debate on the basis of such issues as abortion, stem-cell research, and same-sex marriage. But their rather marked disagreement on how to increase access to health care was never treated as a "values" issue, perhaps because voters we unwilling to have their own values tested on this topic. (NEJM 352: 1260)

The plan, described as "higher taxes and possibly rationing," is the same old snake oil. But it has been repackaged to appeal to the religious right. Watch for socialized medicine (or at least its fascist twin) to be presented this way in the next presidential election.

What can one do? Engage in intellectual activism or support those who do. Become familiar with both the new arguments in favor of government-run medicine and with the many arguments that have been made (here and here, for example) in favor of freeing the medical sector from government interference. Join the debate in whatever forum is available to you. Most importantly, contest the idea that "free" health care -- that is, physician enslavement -- is a moral ideal. Support organizations that will fight for free medicine, like the Ayn Rand Institute or Americans for Free Choice in Medicine.

So far, the enemies of freedom are dominating this debate. Fortunately, it is far from being too late to change that.

-- CAV

Crossposted to the Egosphere