The oft-stated conservative fear of Obamacare is that it will lead to painful rationing through various government mandated standards of care, “death panels,” rationing, and the like–our state-of-the-art healthcare system would decline in quality. But this does not seem the pattern of American entitlements. Section 8 hasn’t led to lower quality housing for the poor, nor have Social Security, Medicare, or Medicaid shrunk over the course of their existence. Indeed, by disbursing costs and concentrating benefits in certain groups–in the case of healthcare, that group being the elderly, the sick, and the medical providers themselves–it seems far more likely that costs and spending will expand precipitously, accelerating the insolvency of the American government.
Robert Samuelson today makes an apt comparison with Massachusetts, which enacted a similar plan statewide, and can’t seem to control costs:
Aside from squeezing take-home pay (employers provide almost 70 percent of insurance), higher costs have automatically shifted government priorities toward health care and away from everything else — schools, police, roads, prisons, lower taxes. In 1990, health spending represented about 16 percent of the state budget, says the Massachusetts Taxpayers Foundation. By 2000, health’s share was 22 percent. In 2010, it’s 35 percent. About 90 percent of the health spending is Medicaid.
State leaders have proven powerless to control these costs.
Republicans need to grow up on the “death panel” talk. The problem with healthcare, at least in part, is overspending due to perverse incentives brought about by third party insurance. People do need to ration care, but the correct position is that it should be through the pain of price and the freedom of markets, just as we ration spending everywhere else, including necessities like car repairs or clothing or food. For anyone who is destitute, such rationing needs to be through the logic of non-profits and the supervision of the “poor house.”
Nothing is free, and this is certainly true with health care. Conservatives and Republicans should not be defending the recently minted notion that the elderly can bankrupt the young and the country as a whole on the basis of some perverse and false pro-life principle that says all cost-benefit analysis is immoral. It’s not. But it’s better accomplished by the decentralized decisionmaking of multiple actors in the market than it is by a government bureaucracy. Indeed, the long dormant notion of central planning is making a comeback, and on this issue free market principles are thoroughly and verifiably superior. On healthcare, it seems most likely, we will feast for a while, and then have a famine.