American Health Care: Essential Principles and Common Fallacies
By Richard E. Ralston
(Revised and updated by Ryan Puzycki, July 2019)
Virtually all discussion of health care policy today avoids explicit reference to underlying principles. In the United States, any reference to uniquely American valuesincluding the inviolability of the individualis particularly avoided. Indeed, while the discussion consistently and studiously neglects to mention any fundamental ideology, it invariably takes for granted the standards of collectivism and the morality on which it relies, altruism. Outwardly, the mantra is "practicality."
Yet even within the terms of pragmatism, socialized medicine is not practicalit does not work. When pragmatic policy proposals are offered, it is always as a litany of concretes, often based on erroneous information, and never with the full context of the ideological causes such proposals routinely ignore. And it must be established that the reason socialized medicine does not work is because it is immoral.
The first task in proper health care policy formulation must therefore be to turn the discussion to its necessary roots. A foundation must be built by establishing the proper political and moral principles: the distinctly American values of freedom, individualism, and the right to life, liberty, property, and the pursuit of happiness.
Individualism must be at the heart of health care policy. Life, liberty and the pursuit (or practice) of happiness is the proper basis for policy. That must include property rights, and no right to property is more important than one's ownership of his or her own body. Failure to maintain this foundation opens the door to the most common attacks on freedom in health care.
One economist who is a tireless advocate of medical socialism has written that the only obstacle to universal health care is "ideology and personal choice." Eliminate those and we can have universal health care. Although the writer obviously is talking only about ideologies other than his own (which is easy to identify), elimination of such ideologies as freedom and individualism, and such concepts as personal choice, are a sure foundation for collectivism.
It used to be that the advocates of such policies were not so explicit, but the passage of the so-called Affordable Care Act (aka Obamacare) has shifted the debate decidedly leftward. President Obama once felt compelled to falsely promise that those who liked their health insurance could keep it, that they would preserve their right to choose. Ten years later, "Medicare for All," universal health care, or some other-named plan to eliminate private insurance is a central policy platform of more than one candidate running for the Democratic nomination for president. Leftists no longer feel the need to pay even lip-service to such outdated, individualistic notions of personal choice.
It is important to recognize that advocates of medical socialism are not primarily trying to apply the principles of collectivism in order to promote better health care. They are using the issue of health care in order to promote collectivism.
The objective of such paternalism extends far beyond the nationalization of health care. We and our children must all become dependent on government as the only source of our health care. Most children already must depend on government for their education (i.e., their indoctrination). Ideally these advocates of government would also like children to rely on government for food and housing. The motive may or may not be an ideological commitment to socialism; it is certainly an avid commitment to a political spoils system. The enemies of such a system are autonomous individuals pursuing their own happiness and deciding how to live their own lives. Like the corruption of the client system that helped destroy the Roman Republic, citizens are inculcated into a system that destroys personal freedom and choice through dependence on government for the needs of daily life. That is the ultimate goal: the abdication of freedom by citizens in exchange for a government that will take care of them. "It takes a village."
Without a foundation on the principles of individualism, the door is open to such false concepts as the "right to health care." Those who proclaim the "right" to health care usually mean its opposite, i.e., that no one has the right to any health care at all unless they get it from the government. When private health care is criminalized and everyone is forced into a government system with nowhere else to go, we are at the mercy of the political powers that administer such a system, whether it actually delivers health care or not. (This perversion of the concept of rights into goods and services, which you must be forced to provide to others, is described by Ayn Rand in her article "Man's Rights" in The Virtue of Selfishness.)
Is the objective really to criminalize private health care? To some extent that already has been achieved. The federal regulations governing Medicare were 130,000 pages long, until the Medicare Prescription Drug Bill added another 1,300 pages. The Affordable Care Act itself was 2,700 pages longand it added an estimated 20,000 pages of regulations to the Federal Register.
No one can understand them. No one can read them. No one can even lift them. It is not possible to comply with some of these regulations without being in violation of other provisions. Yet physicians and hospitals can be held criminally liable for violating many of these provisions. What can be the purpose of such confusion? It is the ability to subject physicians and the rest of us to the arbitrary and capricious application of these regulations by any random bureaucrat. These regulations have grotesquely distorted and set the standard for the way private insurance companies pay for medical expenses.
Does this currently affect us on a daily basis? Most definitely. If you are 65 years of age or older, after a lifetime of paying Medicare taxes you are stuck with it. But if you want or need a procedure that Medicare does not allow, and if your physician accepts Medicare patients, he is forbidden by law to provide it even if you choose to pay for it yourself.
Federal spending on health care has increased exponentially over the last 50 years, driven largely by Medicare and Medicaid expenses, including the Medicare Part D prescription drug program expansion signed into law by President Bush in 2003, as well as the implementation of health insurance subsidies under Obamacare. Federal spending on these programs has grown by 230 percent since 2000 through 2017 and now accounts for about 50 percent of total medical spending. Federal tax policy has provided strong incentives for third-party payment of medical expenses, divorcing most of the costs from those who receive services. That is another primary factor in increasing costs.
Heavy regulatory regimes of insurance and medical licensing by 50 state governments have greatly inflated the cost of both insurance and health care itself. State regulations prohibit the purchase of insurance from other statesthereby eliminating the possibility of a competitive national market for insurance and further increasing the cost of insurance. Insurance commissioners and other regulators in every state have united in opposition to legislation allowing their citizens to buy insurance from other states. Presumably they each must believe that consumers are endangered by the regulatory environment in the other 49 states. Affordable health insurance is thus often impossible for consumers to find because it is forbidden by law.
The strongest advocates of medical socialism want Americans to believe that what we have today is a free-market health care system based on principles of laissez-faire capitalism, and that we need to replace it. Senators Bernie Sanders and Elizabeth Warren meanwhile blame corporate "greed" for high drug prices and rising insurance premiums, and argue that we need to eliminate them. What we actually have, of course, is an essentially fascist system of highly complex and government-financed health care manipulated by interest groups with political pull.
America's health insurance and medical care system is an overregulated, bureaucratic monster that is the creation of government. It is in need of major reform, and the status quo should not be defended. But reform of the system must not take the form of more of the government poison that has been killing it.
If you listen to Bernie Sanders on the campaign trail or the new crop of "progressive" congresswomen in the House (one would be forgiven for tuning out either), you’ll hear about the inferiority of American society and culture to almost all others. Name a country, and Sanders or Congresswomen Alexandria Ocasio-Cortez and Ilhan Omar make the case that its culture, education, politics, economy and health care are superior to America's to the degree that they embrace collectivism.
That is the foundation for the frequently heard statement that all other industrialized countries have a government-financed health care system. (That is, incidentally, not true.) Americans should, in this view, be embarrassed by their lack of collectivism and outmoded commitment to free markets. Collectivist systems ruled by enlightened intellectuals are obviously superior in every respect. If only Americans would discard such parochial curiosities as the Declaration of Independence, the U.S. Constitution, the Bill of Rights, and the very concepts of individualism and life, liberty, and the pursuit of happiness, we could freely embrace the benefits of government micro-management of our health care. Of course, a government that pays for all of our health care ultimately acts as if it owns our bodies, but anti-American elitists tell us that we should not be concerned with such ideological considerations.
Obviously, we must vigorously defend American values as a necessary precondition of health care policy. We must recognize that disdain and contempt for American values is often the motivation for collectivist policies. This is the current manifestation of a very old trend in America. In the 19th Century many intellectuals began to look to Europe for validation of their abandonment of the reason-based worldview of the Enlightenment and justification for replacing free institutions with various forms of state tyrannyback then, these intellectuals called themselves "Progressives." Americans must recognize these intellectual roots, best expressed in the surprisingly accurate popular term "Health Care Nazis." While today’s "Progressives" may no longer quote the same philosophers that inspired Hitler and have abandoned their penchant for eugenics and white supremacy, they maintain their forbears’ militant commitment to upturning American values. Still, old habits die hard, for their rebranded euphemism for universal healthcare, "Medicare for All," has become a litmus test of ideological purity on the left. The only appropriate American response to such health care folly is individualism and a free market.
Many people cannot afford comprehensive health insuranceespecially with current government regulations and despite what the Orwellian Affordable Care Act promised. Many people need medical care they cannot afford. These unfortunate facts are used as the basis for the argument that others must be forced to supply them with both insurance and health care. The context of proper political principles and American values, namely individualism, is ignored and replaced with the implied moral context of altruism, the morality of "other-ism" that underlies the political philosophy of collectivism. (Altruism, in this context, does not mean goodwill or kindness to others, but rather a system of morality that holds service to othersi.e., sacrifice of oneself to others or of others to oneselfas the highest moral good). Even if the existence of individual rights is acknowledged, it is trumped by altruism and collectivism.
Because health care is so important, we are told, issues of freedom and individual rights must be set aside. The need of patients requires that government sweep away the rights of all individuals in order to seize and distribute medical care to others. Of course, the truth of the matter is that it is precisely because health care is so important that the individual rights of patients and physicians must be vigorously defended.
It is appropriate for defenders of individual rights to point out that the government action that would in fact help make affordable health care more widely available is not more government controls and regulations, but the elimination of most current controls and medical programs. (Government-funded medical care for active-duty military personnel and injured veterans is of course appropriate, but in the case of veterans could be best managed by reimbursement to them for private care.) But that should never obscure a defense of individual rights as the only moral foundation for health care. The moral issue is also often clouded with the notion that even if socialism is immoral and inefficient in most cases, it is somehow appropriate in otherssuch as for children or the elderly. That assumes that the most precious value or gift that can be given to children is socialism or paternalistic fascism. If one wonders why the Republican Party has struggled to repeal Obamacare even when it had majorities in both houses of Congress and a Republican president, it is because they have failed to embrace individual rights in their defense of a free market in health care.
Across the entire political spectrum, altruism is the common element that clears the way for both the right and the left to devastate freedom and individualism. Socialists, welfare-state paternalists, Christian conservatives, public employee unions, and politicians seeking to make their constituents dependent on them for all of their needs unite under the banner of altruism. There is no principle of political philosophy, no economic law, no proven efficiency of free markets or proven incompetence of government, no American value, that is not trumped by altruism. Any government action purporting to be a sacrifice for the good of others is generally sanctionedeven when in fact the proposal will help kill those it is supposed to help while making life miserable for everyone else. That is why supporters of reason, freedom, and individualism should always take on altruism directly.
Specific Policy Development
Health care based on the foundations of individualismuniquely expressed through American valuesrequires free markets to work effectively. Individualism requires a principled defense of free-market health care.
Because the transition from the current regulated mess governments have created will be long and difficult, it is also necessary to take notice of not just the unprincipled and immoral foundations of the present corrupt system, but of the huge amount of misinformation in circulation about current needs and realities.
In this context, while policy options must always refer back to correct principles, in any given instance it is the direction of policy that often should be considered. Is the direction more government controls, regulations, bureaucracy and spending, or less? If less, a proposed reform might be appropriate if it is not proposed in conjunction with regression to more government.
For example, while government interference in the pricing mechanism of free markets should always be resisted, the obscure powers of Pharmacy Benefit Managers (PBMs) warrant closer inspection and must lead to improved pricing transparency. Particular attention needs to be given to a review of the provisions of the Federal Anti-Kickback Statute which give "safe harbor" protection for kickbacks to PBMs. While we can debate the wisdom of the entire statute, we can push for reform in the direction of greater freedom and choice by identifying that PBMs should not be given special government protection at the expense of those receiving the medications when they collect and pocket kickbacks. However, the underlying principle is that government should protect the individual rights of everyone and not just the special interests of the few. We can take advantage of such limited opportunities for progress on the road back to freedom in medicine only if our goals remain firmly rooted in the right principles.
In this context it can be useful to review the most common misinformation and fallacious reasoning about the current policy situation and suggest rhetorically effective replies. Recourse to correct principles is the best response, as there is no limit to the false information and irrationality that can be manufactured. Nevertheless, some things should not be allowed to go by without comment and need to be specifically refuted. A mantra of commonly accepted misrepresentations has developed that is endlessly chanted to the exclusion of any rational discussion of the real issues. They must therefore be challenged.
1. "The quality of health care in America is ranked lower than 36 other countries."
When you hear this, always ask, "Ranked by whom and how?" In 2000 United Nations bureaucrats at the World Health Organization sent a survey to "officials and experts" selected by the U.N. Why should we be surprised to learn that government "officials and experts" in France thought that their government-run health care system was the best in the world? The scoring of these surveys also made them meaningless. For example, 25 percent of the scoring was weighted based on the assessment of how "fair" the financing was in each country. For "fair," read socialistthe list was largely a ranking of how socialist each country's system is.
2. "Medicare and Medicaid are far more efficient and less wasteful than private insurance, spending only three percent on administrative overhead."
When you hear this, always ask, "Why is the administrative cost always given as a percentage?" One reason is that, due to the age of covered patients, the average Medicare and Medicaid reimbursements are higher than those of private insuranceand administrative costs are therefore a lower percentage of the larger amount paid. Another reason is that the huge cost of contending with 130,000 pages of Medicare regulations is pushed onto the providers. The cost of the more than 100,000 employees of the Internal Revenue Service who collect Medicare taxes are also omitted from Medicare's "administrative overhead." But the biggest reason is that the government programs make no effort to minimize expense or fraud. When reviewed a few years ago, fraud counted for about $50 billion in Medicaid expenses every yearas high as $18 billion in New York alone. Total spending has been going through the roof for more than 40 years, but the government's administrative cost of burning money is quite low. That does not prove that the government is efficient or prudent. Private insurance companies, on the other hand, need to keep fraud and expenses down or go out of business.
3. "We can control the costs of Medicare by more vigorously prosecuting Medicare fraud."
Eliminating fraud is always a good idea, but Medicare fraud is made possible because [it] is a giant, sprawling, complicated bureaucracy with millions of transactions and thousands of incomprehensible regulations. We should not expect that we can reduce fraud by creating even bigger bureaucracies, implementing more regulations, and advocating more government intrusion. We cannot reduce fraud by increasing its causes. We need a return to a simpler system with patients and doctors making more decisions without the heavy hands of government and the insurance companies who are now its creatures. We need more individual freedom and choice.
4. "State expansion of Medicaid has been a huge success."
Typical of left-wing mathematics, the definition of government success never includes any consideration of the costs. The assumption is that the costs of any expansion of government control don’t matterafter all, it’s just government money. Whatever it costs us, it is a "success." Ask how long government can afford such successand who will pay for it when the government no longer can. We need to start evaluating the success of government on some other basis than simply there is "more" of it.
5. "Government or universities develop most new medications and then just hand them over to pharmaceutical companies to manufacture and make all the profits."
When you hear this, mention that the National Institutes of Health (a government agency) reports that the pharmaceutical companieswho spend about $60 billion each year on researchdevelop more than 90 percent of new drugs.
6. "Advertising of drugs is bad because it increases the price of medications."
When you hear this, ask, "Why does any business advertise any product? Because they just want to add to their costs and increase the price?" Manufacturers of computers and other technological products who spend a lot on research need to find their market. A pharmaceutical company, spending an average of $800 million to develop a major new drug, has a few years of patent protection to bring the drug to the attention of physicians and patients who need it. This allows them to spread research costs over a much larger customer base and reduce unit costwhich lowers the price.
7. "Pharmacy Benefit Managers (PBMs) are just the latest proof that government is required to keep drug prices down."
The increased scrutiny of the obscure powers of Pharmacy Benefit Managers (PBMs) warrants closer inspection and must lead to improved transparency about how that market works. Transparency in pricing is certainly neededespecially if our insurance requires us to pay more than retail prices. However, we have moved far away from a free market, and we don't really know what the drug companies, the insurance companies, the pharmacies, and now the prescription benefit managers are getting from the process. So, we need to confirm if discounts negotiated by PBMs with government sanction are just pocketed by them or actually reduce prices paid by consumers. Particular attention needs to be given to a review of the provisions of the Federal Anti-Kickback Statute which give "safe harbor" protection for kickbacks to PBMs. We can debate the wisdom of the entire statute, but PBMs should not be given special protection when they collect and pocket kickbacks. Those receiving the medications should not have to pay for that. We need answers, without the heavy hand of government
8. "Private corporations are wasteful and bloated bureaucracies. Government-provided health care is lean and efficient."
When you hear this, you might want to laugh. Then ask, "So you think that the 20th Century proved that communism and fascism work?" Is the Department of Motor Vehicles or the purchasing practices of the Defense Department our best models of administrative efficiency?
9. "Private profit centers lower the quality of care administered by the Department of Veteran Affairs."
If the government owes good medical care to veterans because of their service, it should be the best and most timely care available, which is not always or inevitably available from the government. The delivery of medical care to veterans whose service has earned it should not be subject to an ideological test that any care the government provides is preferable because no one is making a profit. Huge bureaucracies over time tend to serve themselves rather than those they were designed to help. We must be diligent in protecting deserving veterans from that trap.
10. "Group Purchasing Organizations (GPOs) are yet another example of how profit-driven corporations make health care more expensive."
When you hear this, ask, "Should we be surprised to learn that a key reason that the prices of medications and medical supplies spiral out of control is because the government requires it?" Like most coercive monopolies, GPOs are government created and given a boost by specific acts of Congress exempting them from kickback restrictions (now politely called "share backs"). Hospitals and others pay too much, pass the cost on to you or your insurance, and then take a kickback. If it looks, sounds, and smells like a racket, it is a racketwith congressional blessing. It is very hard to fight off socialized medicine with government-defended fascist schemes. Getting rid of these rackets is one step toward allowing the price of drugs and medical supplies to fall to market-driven levels.
11. "People live longer in some countries because of their socialist health care systems."
When you hear this, ask if the people in those countries didn't live longer before they nationalized their health care systems. Ask how many people in those countries died on their highways, were killed in combat, shot by criminals, addicted to drugs, severely overweight, or in poor health when they arrived as illegal immigrants.
12. "The free market is callous and greedy, while government health care is compassionate and pays close and solicitous attention to the needs of every individual."
When you hear this, think of the notorious, vermin-infested annex in the old Walter Reed Army Hospital within sight of the VIP suites for members of Congress, the billions of dollars wasted on the abandoned high-speed rail project in California, King-Harbor Hospital in Los Angeles, the Veterans Affairs Administration, the government of New York State, members of Congress, every political spoils system since the Roman Republic.
13. "We can lower health care spending by eliminating all profits."
When you hear this, ask why we pay FedEx, UPS and DHL to deliver packages at a profit instead of using the U.S. Postal Service. Ask why we pay Microsoft and Apple for computer products at a profit instead of having all computers and software produced by the government. Ask why we don't have the government produce all of our food and build all of our housing if it can do it so much better without needing a profit. Ask where the money would come from, without profits, for drug research and development. Ask how expensive government drug research would be if it never had to get results. Ask what the cost of assuaging public employee unions and the politicians they fund will be when profits are eliminated.
14. "Government controls will lower the cost of insurance premiums to what we can afford."
When you hear this, ask why the government requires those who struggle to afford insurance to pay taxes on the money they use to pay for it. Ask why the government mandates that insurance cover treatments advocated by special-interest lobbies even when people do not want the coverage. Ask why state governments refuse to allow competitionand lower premiumsfrom insurers in other states. Government controls are now making insurance more expensive. Affordable insurance is hard to find because it is forbidden by law.
15. "Americans spend a higher percentage of their GDP on health care than any other country."
There are both good and bad reasons for the present level of spending on health care. Bad reasons include the waste and fraud in government-financed health care, regulations that drive up the cost of insurance, and the adoption of complex Medicare reimbursement procedures and regulations by private insurers. Good reasons include the fact that Americans spend more on health care because they can. America is a rich country, and what is more important than health care? How much is too much? Americans not only have the most advanced drugs and diagnostic and other medical equipment, but we also make them more available than any other country. If we had a free-market medical system, those who could afford to try and live forever in perfect health would spend money that would stimulate medical research that would benefit all of us.
16. "Public opinion polls show that most Americans want more government health care."
A February 2019 survey by Morning Consult/Politico showed that 50% of voters would support Medicare for Alluntil they learned that it would eliminate private health insurance, when support drops in half. A lot of people may at first respond favorably when asked if they think someone elseanyone elseshould pay for their health insurance. Government, their employer, anyone else will do. They might not reply in the same way if asked if they should be responsible for providing everyone else with health care. They might not reply in the same way if they understood the consequences of government health care, such as rationing and long waits for surgery, treatments, or referral to specialistsor the government causes of problems with the status quo. They might not reply in the same way if asked if they really trust politicians and the loving arms of the federal bureaucracy for all of their health care. They might not respond in the same way if asked if they want government control of all aspects of health with nowhere else left to go.
17. "Short-Term Health Insurance plans are bad for consumers and should be forbidden."
Giving more affordable health insurance options to greater numbers of Americans is certainly alarming to much of the medical and political establishmentbut it is certainly welcomed by the consumers who want and need these plans. Politicians who condemn short-term plans because they are temporary do so not out of concern for the long-term needs and wants of consumers, but because they fear that greater choices for consumers will become permanent. The only choice acceptable to these politicians is the option forced on them by the government.
18. "Huge jury awards in medical malpractice suits do not increase health care or insurance costs."
When you hear this, ask where the money comes from to pay the hundreds of millions of dollars in contingency fees that go to some trial lawyers every year. Ask whether these lawyers really care only about the "little guy." Ask why so many physicians and surgeons now have to pay liability insurance premiums of far more than $100,000 a year. (No, the insurance companies do not keep it all or lose it in the stock market.) Ask how the government legal framework and court management for our tort system is set up to encourage lawyers to convince so many juries that all patients live forever in perfect health unless a physician or hospital makes a mistake. Ask how much is paid in political contributions every year by trial lawyers to buy protection for this legalized extortion. Ask how some law firms were able to hire one radiologist to review more than 600,000 x-rays and diagnose most of them with the same disease. Ask how many billions of dollars are wasted on unnecessary tests and procedures that physicians have to order to protect themselves from frivolous lawsuits.
19. "The best way to reduce the debt and federal spending is health care reform."
Ask how the largest entitlement program in history, administered through more than one hundred new boards, agencies and commissions, will reduce spending and government debt. Ask how Medicare and Medicaid have reduced spending and debt.
20. "Members of Congress resist government control of medicine because of political contributions of drug and insurance companies and their lobbyists."
Some may be motivated by such financial considerations. But other politicians eagerly threaten those corporations with legislation that would do great harm or put them out of business completely. In the face of such threats they have the right to protect themselves. Those who are offended by these contributions are strangely unconcerned by $1 billion in campaign contributions from trial lawyers since 1990, massive political contributions paid for by the dues of members of public employee unions or by politicians who extort contributions from the American Medical Association through annual threats to lower Medicare reimbursements to physicians. Fastidiousness about political contributions is unconvincing when it is so highly selective.
21. "Congress will pay for whatever is required by health care reform in a way that is budget-neutral."
Congress has never done socertainly not for Medicare, Medicaid or the Prescription Drug Program. Health care reform proposals pretend to do that, which is why they rely on creative accounting gimmickssuch as combining ten years of new taxes with only six years of new spending. As a rule, politicians who seek more power do not spend a lot of time worrying about how to pay for that power. That is a detail. The important principle for them is an ancient one: "bread and circuses." They will promise anything to those citizens who surrender their choices and rights in return for a promise to take care of them. Dependence on government and politicians is the goal, and end in itself.
22. "Government-owned insurance companies must be created to provide competition in the marketplace."
It is a clear principle of the philosophy of law that government, or the "Sovereign," cannot competeit can only compel. Competition does not exist because by law and regulation the government does not permit it. Advocates of such government insurance have clearly stated that they support it only because it is the best path to a single-payer system or complete government takeover of insurance. As former Congressman Barney Frank said, government insurance would soon "demonstrate the strength of its power" and wipe out all private insurance. A public option would be created by Congress for that purpose and would then be administered by the government with that goal. An optional trigger to create a public option would be administered by those looking for any excuse to pull it. That would be the inevitable result of a game in which the government is the dealer, the cashier, the banker, the rule maker, the policeman and the judge.
23. "Work requirements for Medicaid are a free-market solution that will control costs and promote personal responsibility."
Aside from the illogic of requiring the ill to work, ask what about the government doling out free healthcare promotes personal responsibility. Ask how continuing the existence of a vast government welfare scheme promotes the free market. Ask what it will cost to monitor and enforce these work requirements. Ask whether the creation of a new government bureaucracy to control the costs incurred by an old government bureaucracy is a better idea than getting rid of the first government bureaucracy. Ask what the unintended consequences might be of confusing government diktats for free-market solutions.
24. "Support of a vast expansion of government control of medicine by drug companies and insurance companies means reform must be good for business."
When drug companies or insurance companies abandon a moral and economic defense of their businesses in favor of buying influence or making a deal within the spoils system, they have started down a road to their own destruction. As has the American Medical Association, which long ago gave up any defense of the rights of physicians to practice medicine as they think best, in favor of transforming themselves into a public employee union going checks-in-hand to Congress every year to prop up the size of Medicare reimbursements. When businessmen and professionals flee from their principles to play the political game, they will discover that politicians can play it far more effectively. The bribes will progressively buy less and less, and politicians will forget their new friendsor, as is the case with many advocates of Medicare for All, they won’t even pretend to care whether these industries continue to exist. Having traded protection of their rights for short-term, short-sighted patronage, the insurers and drug companies will eventually find themselves without principles, without friends, and without protection of any sort.
25. "The government should require all senior citizens to receive end-of-life counseling."
End-of-life counseling is important, although receiving it many years in advance of death will not always provide sufficient guidance when it is most needed. But the government has no business forcing seniors to submit to such counseling. Americans are correctly concerned that a government that pays for such counseling and the cost of care will seek to set the terms of the counseling, or to place emphasis on the financial advantages of dying sooner rather that later. Government must never make or force end-of-life decisions.
26. "Old age is not a disease."
That idea is the reason that the Food and Drug Administration has no interest in research on drugs and supplements that would extend healthy life spans. Death from old age is not officially a disease. The FDA does not care if and when you die, as long as you are not sick when it happens. Admittedly the rigidity of the FDA's methods does not lend itself to such research. If a supplement demonstrates promise for extending life spans, the FDA would probably require a thirty-year clinical trial to approve it. If approved they would then require another thirty years of "comparative effectiveness" studies to make sure it works better than everything else. By then we would be dead, but the FDA will have kept us safe. If that seems ridiculous, remember all of the terminally ill patients who have died in recent decades while being denied access to existing drugs approved years later by the FDA.
27. "Government insurance mandates will decrease the cost of insurance premiums."
Forcing everyone to buy insurance (or anything) will drive up the price. Forcing coverage for treatments or conditions for which everyone does not want coverage will drive up the price. Forcing young people to buy insurance will cost them a lot more if it used to cover insurance for older Americans. Requiring men to pay as much as women will increase premiums for men, even though they die younger. (It is not fair that men stop paying for women's insurance just because they are dead.)
28. "Too many medications are wasteful and unnecessary. The government must decide which are the most effective and forbid the use of any others."
When you hear this, first ask how much it will cost the government to do this and how long it will take. Do you want to pay that additional cost? How many years are you willing to wait for a drug you need while the government decides this? Do you want to decide, for example, if Excedrin or Advil relieves your headache most effectively? Or do you want the U.S. government to tell you? Do you want your doctor to decide if a drug will save your life, or do you want to wait for the government to decide? Should a drug be forbidden for a woman because it does not work as well for men? Or forbidden for a member of one race because it does not work as well for all races? Or do you want your doctor to treat you as a unique individual with your own needs? One of the most promising areas of medical research is personalized medicine, developing treatments based on each patient's genetic information. Will a huge government "comparative effectiveness" bureaucracy eliminate that research? Should the use of drugs that work best for you become a crime?
29. "Insurance companies can afford huge malpractice settlements, and doctors can afford large liability insurance premiums."
Ask who we really think ends up paying those premiums. Ask how much the fear of second-guessing and litigation has increased the use of unnecessary and expensive testing and treatments, and how much other "defensive medicine" has driven up the cost of health care and health insurance for everyone.
30. "Governments provide their citizens with free health care."
Point out that government cannot create anything, but rather it can only take things. Health care, like everything else, is ultimately made possible by business activity. What a government means when it says it is giving you something for "free" is that it is forcing you to pay for something whether you use it or not, or taking something from you to give to someone else.
31. "Countries with nationalized health care systems provide their citizens with all the health care that they need."
When you hear this, ask why Canadians travel to the United States every year and spend $1 billion on American health care. Ask why Americans have more access to MRI and CT scan equipment and more of the new breakthrough drugs. Ask why Americans have better survival rates for cancer and heart attacks. Ask why more than one third of physicians employed by the National Health Service in Britain buy private insurance, and why six million of their potential patients in Britain also buy private insurance, when government health care is free. Ask why so many British citizens waiting for free surgery and cancer treatment fly to India to pay for it, and ask why no one, other than Michael Moore, is jumping on a boat to get free health care in Cuba.
32. "Physicians must provide any services that the government requires because they are indebted to society for their medical education."
The first answer to this is that "society" did not spend many years of intense, dedicated effort to complete a medical education. Individual physicians did that, most of them accumulating a lot of personal debt in the process. But the most important answer is that, while many of us experienced public education (of inconsistent quality), we do not owe anyone anything. You might be grateful to some but not all of your teachers. You might be grateful to your parents for their taxes that paid for your education. But that does not mean that you must accept an undefined, unlimited and eternal moral obligation to everyone that ever has been or will be alive because you received a public education. Of course, this argument indicates that, for some people, imposing such an obligation might be the purpose of public education: if the government provides a part of your education, it owns you for life.
33. "Health care is very important, so the government should control all medical practices and health providers, to give everyone all the health care they lay claim to."
When you hear this, say, "Not in America. Our own health must never be handed over to government because it is so important."
34. "The government must take over health care to control increasing costs."
Ask when the government has been able to control the cost of anything, let alone something as technological, complex, personal and dynamic as health care. Ask why the cost of health care managed by the government has been increasing so rapidly. Ask, "What is the cost of cost control? How much do current cost-control efforts add to the amount of paperwork and expense of billing? How much would ever more controls add to the cost of health care?"
35. "The Food and Drug Administration must be given more powers and funding to control the development of drugs."
When you hear this, ask, "How many terminally ill patients have died while waiting for drugs later approved by the FDA? What does the FDA approval process add to the cost of new drugs? Why does the FDA spend years trying to determine how drugs might work in every possible instance, while losing track of safety issues? Why do clinical trials using terminally ill patients require that half of the dying patients be given a placebo instead of the new drug? How has the enormous power of the FDA become a magnet drawing those with a political agenda to manipulate and manufacture clinical research to serve their objectives?"
36. "The Food and Drug Administration must create a new agency to evaluate new drugs for comparative effectiveness with other drugs, after they have spent years being evaluated and tested before being approved for safety and effectiveness."
Ask how much longer that will add to the time needed for new drugs. Ask what that will add to the cost of each new drug. Ask how new clinical trials will be able to compare the effectiveness of drugs that meet the unique needs of each gender and of different ethnic and age groups. Will your gender or ethnic group be denied medications that work better for them but not for all groups? Ask how all drugs can be compared in this way when some individuals respond differently to many drugs, and what will happen when a drug that is the only thing that helps some people is prohibited because something else works for others. (Ask whether the government should decide that, if ibuprofen works better than aspirin for most people, aspirin should be prohibited even if it works better for you.) Ask what will happen to the development of new "personalized medicine" that targets only a few individuals if the government requires that everything work the same way for everybody.
37. "The government should spend billions more on medical research to cure more diseases."
When you hear this, point out the most distinguishing factor of government medical research: it never has to actually get results. Private research is always more efficient and gets results because it has to in order to pay for itself. Also point out that government research funds are often allocated to "politically correct" diseases based on the political pull of the constituents for those diseases, rather than to areas that are more auspicious for research. Invested funds are always more productive than dollars taken from taxpayers.
38. "The government can rapidly cut the cost of health care by mandating electronic medical records."
Ask how that will reduce the cost of treatment, medical equipment, drugs, physician services or any other health costs. Ask if the increase of electronic records that has been happening for many years has had any substantial impact on rising costs. Ask how, if all medical records are included into a single, government database, with access available to hundreds of thousands of workers in medicine and related fields, there will be any medical privacy possible. Ask why creating electronic records require that all of your medical records must be turned over to the government without your permission. Ask why the new "national coordinator" will be able to review your records to evaluate and require changes in the treatment recommended by your physician. Ask why this national coordinator will be able to turn your records over to any organization for "research," without your permission, or sell your records to outside businesses for marketing purposes, without your permission, or why the Secretary of Health and Human Services will be able to turn your records over to anyone for any purpose, without your permission. Ask anyone if they think their physician will be able to recommend a treatment for them if inspection of medical records resulted in a rebuke by the national coordinator for providing the same treatment to other patients.
39. "Health care is broken."
First ask yourself if you think your own health care is broken. If it is, ask who broke it. If the answer is the regulatory and legislative activity of politicians, ask how they can be trusted to fix it. Ask if the reform they advocate will be in their own political interest or in the interest of the best health care.
40. "Government programs such as Medicare and Medicaid cut medical costs by controlling and reducing reimbursements paid to physicians and hospitals and other providers."
Ask what happens when providers are forced to provide services at a rate that does not cover their costs. We have decades of experience with that. They must shift those costs to other patients and private insurers, which increases the cost of health care and insurance for everyone.
41. "Mandatory insurance is the best course of health care policy because it supports individual responsibility."
When you hear this, ask if it should also be mandatory to buy a nice house and take out a big mortgage to solve housing problems. Ask if making the lack of insurance into a crime has anything to do with individual responsibility. Ask how destroying individual rights supports responsibility. Ask if the purchase of something is made mandatory, will that make it cheaper, or more expensive. Ask if politicians who use the force of law to require you to buy health insurance will be able to resist micro-managing exactly what such insurance must cover. Ask how special interests will use the mandate to make contributions to politicians and lobby to add more coverage requirements for their benefit. Ask why politicians, like former Senator John Edwards, also want to require, through such mandates, that everyone get specific examinations. Ask how such requirements will be enforced and what it will do to the privacy of medical records. How does being forced by the government to do things increase individual responsibility? Why not encourage freedom?
42. "The government should require the computerization of all medical records, which should then be made available to the government to ensure their privacy."
Ask why the same people that are terrified of the NSA listening in on their phone conversations have no problem with giving the government every personal detail of your medical history.
43. "We need to trust the government to provide us with the best medical care."
Those who want to replace American medical care usually begin by trying to convince us that American medicine is the worst in the developed world. They want Americans to believe that medical care is better anywhere and everywhere else. Ask if we would be better off if we turned our care over to the Department of Veterans Affairs. Ask if we have evidence that switching control of medicine into the loving arms of our politicians will be well managed. Ask how government will deliver better results when politicians currently have to outsource Medicare accounting to private insurance companies to pay the bills. Ask if government health care does not often turn into political health care, to serve the spoils system of politicians and provide service primarily to those special interests with political pull.
44. "Only government can reduce the cost of health care and keep costs down."
Do we really think that the same legislators who are over-budget and behind schedule on building high-speed trains to nowhere and beholden to their public employee unions and other spoils systems will be able to better manage our care? Ask why the government cannot do as good a job at providing affordable primary care as new walk-in clinics in retail stores. Ask why Wal-Mart and its competitors have done more to reduce the cost of generic drugs than any government program. Ask why every government health care system in the world reduces costs only by reducing the availability of health care, by increasing rationing and the time spent on waiting lists for referral to specialists, diagnosis, and treatment, and by denying access to some medications, testing, and treatment completely. Ask why, based on more than two hundred years of experience, we should think that the government can hold down the cost of anything.
45. "People need health care, so health care is a right that must be provided to them by others."
The response must be that everyone has a right to seek health care, to make their own decisions about it, and even to ask others for it if they can't get it. But no one has a right to anyone else's time, services, or life.
46. "Health care spending can be reduced by providing insurance to everyone, because costs now incurred by the uninsured will no longer be passed along to the rest of us."
Ask how those savings can be achieved without spending as much or probably more to pay for the insurance.
47. "Health care spending can be reduced by mandating that everyone buy insurance."
Ask why the insurance mandate under Obamacare did not lead to a reduction in healthcare spending, or why premiums continued to rise. Ask those individuals who were forced to buy health insurance they didn’t want if their health care costs were reduced. Ask why Medicare, which is mandatory for all Americans, has seen rapidly increased spending beyond all expectations, has $37 trillion in unfunded liabilities and is rapidly running out of money.
48. "All medical insurance must cover pre-existing conditions".
Our politicians have become experts on how to make insurance more expensive for everyone. It has been noted that "Life is a pre-existing condition." We should not therefore put the cost of insurance out of reach of many in order to provide it to a few. That makes everyone dependent on politicians to provide insurance and medical care, which is probably the objective. We must always allow for affordable insurance choices and not claim that long waiting lists resulting from government provided medical care are more than Potemkin hospitalsthe illusion of care.
49. "The elimination of the individual insurance mandate is causing Obamacare to fail and insurance subsidies to rise."
Obamacare was failing long before the individual mandate was eliminatedunless you count unlimited government spending and coercion as measures of success. Was Obamacare succeeding when President Obama had to order unconstitutional premium subsidies to keep prices down? Was Obamacare succeeding when the only way to make insurance "affordable" for older citizens was to force young people to buy insurance at unaffordable higher prices? Ask those 13 million people who were previously forced, fined, or taxed to buy insurance that they did not want if they agreed with Obamacare’s standards of success. Obamacare only further distorted health care markets and achieved its success through government coercion and the power of the printing press. The only real solutions to reining in insurance premiums is more freedom and choices, more competition, more use of tax-free health savings accounts, and easier access to generics and other drugs. Allowing consumers to buy health insurance on a national basis across state lines and reforming litigation to reduce legal costs in the healthcare system would also help. The end of the mandatereally, a taxto force individuals to enroll in Obamacare will not restore the lost private insurance that President Obama falsely promised we could keep, but it has ended a gross injusticeand that is a success.
50. "State Prescription Drug Affordability Boards are needed to reduce and control the prices of prescription drugs."
Creating a new government bureaucracy will not reduce the price of prescription drugsespecially not new drugs that cost more to develop than the prices that would be permitted by "affordability" boards. Ask what would happen if every state created such a board. What would the cost of working with the Food and Drug Administration plus fifty state boards do to the affordability and availability of new drugs? Ask whether creating bureaucratic nightmares are more likely to help people or increase the price of drugs. History is our guide: nearly one hundred years ago the Federal Reserve System, with a Federal Reserve Board and regional Federal Reserve banks, was established to insure a stable money supply and eliminate recessions, depressions, inflation, and unemployment. Ask how the Federal Reserve Board has done with that. Ask why we should expect better results from prescription drug "affordability" boards. Based on experience, what could possibly go wrong?
51. "Only the government can guarantee quality health care."
Ask if the U.S. Postal Service provides better and more affordable delivery than FedEx or UPS. Ask if public schools and teacher unions guarantee better or even more affordable education for children than private and parochial schools. Ask if government-run Veterans Affairs hospitals provide better care than private commercial and non-profit hospitals.
52. "The government can require American medicine to concentrate on wellness."
Ask if most government systems don't concentrate instead on rationing. Ask if a wellness approach will help those on waiting lists for months or years for medical diagnostic equipment, access to specialists or surgery.
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