What Medicare for All really means

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Promoted from the diaries by streiff. Promotion does not imply endorsement.
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Medicare for all…the left makes it sound so simple.  I mean, the program is already in place, we just have to expand enrollment to everyone, and POOF, problem solved, right?? What could be simpler?

Well, as it turns out, just about anything would be simpler, not to mention cheaper. So let’s examine this a bit, again, since we seem condemned to have this debate every 10-20 years.   What are a few things we need to think about with government healthcare?

1)Regulations

Have we ever seen a government program that didn’t come with a stack of regulations that would make War and Peace seem like a birthday card rhyme? I haven’t.  Government money comes with strings (ie rules to follow).  Now, does anyone think that those rules will improve the delivery of healthcare?  Spoiler alert-no, it won’t.  Example: electronic records.  The government mandates that doctors and hospitals all purchase and use fairly expensive computer systems for record keeping and billing.  What does it accomplish? Besides increasing costs on the physician/hospital side (with no increase in payment, although there are now financial penalties for NOT using them), it slows down work for physicians (unless he adds more staff to complete the chartwork), and makes all the notes read alike (ie Mr Jones’ note reads exactly like Mr. Smith’s .  They are no longer as informative as they used to be, but instead are simply grocery lists of symptoms.

What benefits do those systems provide? To the government, plenty.  It’s a rich database of information about the patients and their habits, that they can use however they want.  Remember, he who pays the piper picks the tune.  If they’re paying for your health care, they can tie just about anything to it.  Think they won’t try? Soda taxes have already been implemented as it is.  What do you think they’ll do when they’re paying for your diabetes medications?

What about security? After all these are computerized records, now on the internet.  If they can steal pentagon plans and government employee databases, how secure are your records? Personally, I’ve never seen a paper folder in a medical office get hacked into and downloaded from North Korea  or China, but you can bet the computerized ones have.  That doesn’t even deal with ransomware.  Nowadays, the internet goes down, everything stops.  Do you want your surgery postponed by a DDOS attack?

All this because someone in a cubicle in Washington thought it’d be a good idea to computerize everything.

What else? Someone thought it’d be a good idea to tie physician payment to patient satisfaction scores.  Sounds great right? Make sure the patients are happy and they must be getting good care, right? Know what will make a patient REALLY vocal and unhappy with their care? Tell a narcotic addict you’re not prescribing him the medication he wants and watch your score (and your paycheck) drop right in front of your eyes. Then, to give the patient even more leverage, tell the world you’re going to publish all the scores online publicly.  Ever seen a “Yelp!” bully try to manipulate a restaurant into free meals? Do you really want physicians to have to deal with that?

2)Rationing

If something is “free” how many do you want? Usually as many as you can get.  Healthcare is no different. If someone else is paying, you’re going to want every ache, pain and mole treated.  Every headache needs a CT scan, right? What if I’m having a stroke? How do I know without a CT or an MRI? Well, if you’re paying, you’ll probably try Tylenol first.  If it’s someone else’s money, you’ll happily line up for an MRI.  Well the government isn’t going to foot that bill, so they’ll institute “guidelines”  as to who can qualify for those tests.  This already happens with insurance, but it’ll be worse with government.  Remember all those stories about waiting lists at the VA? I’ve seen those up close, and I can tell you it’s worse than you think.  I can also tell you that the American public has NO patience for that kind of treatment.  Just today I found out that there is a new regulation about how I prescribe pain medications, and before that the government decided what antibiotics I should use before surgery. Now, if they are going to dictate things to that level of detail, what do I need all that education for?

Another problem with this is that Doctors and Hospitals are left with all the responsibility, but no real authority.  The insurer/government will deny payment, but the patient and family aren’t looking at the government when they’re being told “no,” they’re looking at the doctor.  Well guess who gets blamed? Already insurers state that actual treatment is between the patient and the doctor, but they just refuse to pay.  That won’t get any better when it’s the government making all the decisions.  And just so you know, the insurers won’t just wither and die either.  The government will contract with them to “administer” the plan, and they’ll still be skimming off the top, just like they do now.

3)Cost

Tell me one government program that cost less than or equal to projections.  No, take your time, I’ll wait….

Well???

I didn’t think so. If you put that many people to work on the government’s dime, they’ll come up with ways to justify their existence.  Most of that will result in reams of paper, but no healthcare delivery.  That kind of thing doesn’t come cheap.  Most people can’t even wrap their brains around how much $3.2 Trillion/year is (the projected cost of Medicare for All). Just to give you an idea, if you were to spend $10 every second it would take you 10,000 YEARS to spend 3.2 Trillion.  That’s all the way back to the stone age, folks.  If it’s easier to grasp, you can spend $100/second and get back to the time of Beowulf (a bit over 1000 years ago). And don’t forget, that’s just the estimate.  Government estimates are usually off by at least a factor of two.

Even now (before it’s fully socialized), hospitals hire armies of clipboard toting people whose only purpose is to keep up with the ever changing –and often nonsensical –rules.  Rules that are contradictory and obscure in nature such that they are impossible to follow.  These rules, though carry the force of law, and you are guilty until proven innocent if they accuse you of breaking them.  Think about having the IRS in charge of your healthcare- that’s what medicare is like to deal with.  There is a quote from Atlas shrugged that comes to mind:

“Did you really think we want those laws observed?” said Dr. Ferris. “We want them to be broken. You’d better get it straight that it’s not a bunch of boy scouts you’re up against… We’re after power and we mean it… There’s no way to rule innocent men. The only power any government has is the power to crack down on criminals. Well, when there aren’t enough criminals one makes them. One declares so many things to be a crime that it becomes impossible for men to live without breaking laws. Who wants a nation of law-abiding citizens? What’s there in that for anyone? But just pass the kind of laws that can neither be observed nor enforced or objectively interpreted – and you create a nation of law-breakers – and then you cash in on guilt. Now that’s the system, Mr. Reardon, that’s the game, and once you understand it, you’ll be much easier to deal with.”

That might be a passage from a novel, but it accurately depicts the people to whom we’re being asked to turn over our healthcare. And the reason we’re told we should do so is:

4)The so called “Right to Healthcare”

No one should die from lack of insurance, nor suffer from lack of money, the argument goes.  Well, despite the claims to the contrary, that sort of thing doesn’t happen often here.  I have personally NEVER seen anyone denied care for anything life-threatening because they weren’t “covered.”  If someone has a ruptured spleen, we don’t wait til the visa card clears before we fix it, and we don’t call Blue Cross for a precertification. Sure, they get a bill later, but it’s not like I can put the spleen back in if they don’t pay. Try not paying the plumber for emptying your septic tank.  He’ll put that sewage right back where he found it. Don’t pay the painter after he paints your house? He won’t unpaint it, but he’ll slap a lien on your house and get paid when you sell it.  We don’t have those options, we basically just don’t get paid but we’ve done the work.

“But people NEED their healtchcare, it’s not fair to withhold it.”  OK, but you’ll die sooner if you don’t have food.  Do you have a right to groceries from Kroger or Publix? Why not free meals at the five star restaurant downtown? Do you have a right to a house? You need shelter after all. Here’s the thing about rights: No one has to do anything for you in order to exercise a true right.  No one has to build and staff a church for you to exercise your right to worship as you please.  No one has to listen to you nor provide a forum for you to exercise your right to free speech, and no one has to buy a gun for you in order for you to have the right to keep and bear arms.  Those things are YOUR responsibility to provide or pay for.  Sure, the government has to pay for an attorney for you, but only if the government itself is trying to deprive you of life, liberty or property.  They don’t have to pay for an attorney for you to sue your neighbor for violating the HOA agreement about grass cutting height. Healthcare cannot be a right, simply because someone has to DO something to you or for you in order for it to be delivered.  If you have a right to someone else’s labor then they do not “own” themselves or the fruits of their labor. In essence, they are forced to work without any consideration for being paid, which is something that has been illegal here since 1865.

There is another quote from Atlas Shrugged that applies here:

“I quit when medicine was placed under State control some years ago. Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun.

I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything except the desires of the doctors.

Men only considered the “welfare” of the patients with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness, his is not to choose, they said, only “to serve.”

That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards — never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover in their operating rooms and hospital wards that is it not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe if he is the sort who doesn’t.”

The government has royally screwed up healthcare since they got in the business fifty years ago, and they haven’t figured out that the laws of economics can be ignored for only so long.  Price fixing leads to shortages every single time they’re tried, and that’s what medicare is at its core, a price fixing scheme, without any control over the cost of delivering care.  Try as they might, they can’t get around this one immutable fact that applies to most things, healthcare included: You can have it Fast, you can have it Good, and you can have it Cheap…pick any two.

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