The United States National Health Insurance Act (USNHI) – H.R. 676

On January 27, 2008, U.S. Representative John Conyers Jr. (D-MI) introduced a new version of a previously unsuccessful bill before Congress that would turn America’s health care system into a socialized, not-for-profit, singer-payer system.  Previous iterations of the bill had few co-sponsors (25 in 2003), and the current version (H.R. 676), has gained a modicum of traction thanks to Michael Moore‘s film documentary, Sicko, which contends that the United States is the only developed country that does not currently have “universal health care.”

As an advocate for market-based health care (which we currently do not have), obviously I have problems with 676.  A few days ago I attended a lecture and discussion about the bill, presented by advocates in favor of it, to an audience of comprised mostly of naive first and second-year medical students…with one of two true skeptics interspersed within.  Below I present a few of the problems with 676 and with single-payer health care in general.

First, the highlights of the proposed law.  676 purports to cover the following: primary care and prevention, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, the full scope of dental services (other than cosmetic dentistry), substance abuse treatment services, chiropractic services, basic vision care and vision correction (other than laser vision correction for cosmetic purposes), and hearing services including coverage of hearing aids.  Basically everything.  And you can go to any doctor or provider you want.  And there’s no deductibles, copayments, coinsurance, or other cost-sharing to be imposed with respect to covered benefits.  Sounds nice doesn’t it?

The cost.  I haven’t read the feasibility studies, but the text of the bill says all of this wonderful stuff, for every American citizen, will be paid for with income tax increases on the top 5% of earners, a progressive excise tax on payroll and self-employment income, existing government health care revenues, and a tax on stocks and bonds.  Additionally, the bill foresees a 15-year integration process, which will be paid for by issuing Treasury Securities.  Congress reserves the right to decide how much to tax the American public, it’s a basic tenet of our system of government…and with the guidelines above, we’re looking at a legislated equivalent of a blank check.  Why?  Because providing comprehensive, quality, accessible care to every citizen will command a budget possibly larger than any other ever conceived by man.  The U.S. Treasury will issue hundreds of billions upon hundreds of billions in debt to fund the 15 year transition period.  Just to “integrate” the new system, we are looking at compounding our debt (which is owned mostly be foreign investors), by nightmare proportions.  We will no longer own our own country.  Our grand-children and great-grandchildren will spend their lives paying interest to Dubai, India, China, Russia, and Japan.  The dollar will continue to weaken…perhaps it will reach parity with the Mexican peso.  Additionally, depending upon the size of the taxes necessary just to drive the operational side of this beast, there will be significantly less incentive for businesses to continue to exist on U.S. soil.  An excise tax on self-employment income is the government’s way of telling entrepreneurs and business owners to get f***ed.  

Medicare is poised to make up a record amount of our GDP in a few years…it’s already unsustainable and will soon be bankrupt in its current form.  It should be noted that the current form of Medicare covers only elderly people, and only pays for a fraction of the services listed above.  The USNHI proposes no revolutionary way to reduce the costs associated with administering an undertaking, which expands Medicare’s coverage on a exponential scale.  This is an atomic bomb. 

Private insurance becomes illegal if 676 is passed.  We use the term “universal health care” in quotations to describe countries like Israel and the United Kingdom, because these countries HAVE private insurance options.  People who can afford to, pay for supplemental private insurance, because even with smaller, more homogenous populations, these countries are not able to provide a fraction of what 676 promises.  And that’s with high personal income taxes, and very little defense spending (with the exception of Israel, most countries with quasi-socialized medical care depend on us for this).  In Canada, people routinely pay bribes to skip the line. 

This brings me to my next point.  Banning something the market is screaming for is like leaving picnic food at a park and putting up a “no ants” sign.  It’s a comical act of futility.  And it costs billions of dollars.  We have a country with a revolving door border policy.  Our government has spent hundreds of billions on drug enforcement…how well is that working?  How many people in this country own firearms purchased without proper licensing on a black market?  If you don’t allow for a private tier of health care payership, you force a black market to form.  Then you have to create government agencies to enforce and prosecute illegal “pushers” of private health care.  This cost isn’t factored into 676. Perhaps we could charge a “modest” excise tax…

Doctors will have no opportunity to attain true wealth.  Under 676, providers may elect to be paid government-dictated salaries, or reimbursed at government-dictated rates for services rendered.  Current private Health Maintenance Organizations (HMOs), who are the target of 676 supporters, reimburse doctors at a MULTIPLE of Medicare reimbursement rates.  This is because doctors cannot afford to stay in business strictly on Medicare payments.  With skyrocketing malpractice premiums forcing many doctors into retirement, we could be looking at a future with no domestic doctors.  676 does not (and legally cannot) address medical malpractice – medical licensing and tort reform are handled on a state level.  Doctors have little incentive to exist in this environment, particularly those doctors facing hundreds of thousands in student loans…which is most of them.  676 does not address medical school tuition.  With no primary care physicians, the queues will grow quickly.  In Canada it takes 10.1 weeks to get a CT scan.  How long will it take in a country our size?

Then there’s the problem of illegal immigrants.  676 only covers American citizens.  Are we prepared to deny all care to illegal immigrants?  I doubt so.  The cost of providing similar care to this demographic (making up a significant chunk of the population), has not been factored into the bill.  Taxes go up more.  A true welfare state. 

There’s a slippery slope here.  At some point you have to decide whether you’re country’s mission is Capitalism (the American Dream), or Communism (from each according to his ability to each according to his need).  I don’t think we’re ready to give up the ghost quite yet.  The great empires of the world had much longer tenures than 200 years.  Are we ready to become a welfare state, and give the crown to a new empire?  The next empire probably isn’t going to be as nice as us.  It probably isn’t going to drop food and vaccines on African villages…

Finally, the perfect irony.  The purveyors of USNHI tout it as the answer to large for-profit HMOs that put shareholder interests and CEO salaries before patient well-beings.  What?!  By putting the government in charge of it?!  The same government that takes handouts from special interests groups that represent all kinds of nasty interests perpendicular with those of individual American health care users?  Corruption was invented in Congress.  Congress created the original food pyramid to promote the interests of the U.S. Agricultural industry, not our health.  That’s why it recommended 5-11 servings of starch per day.  One could cogently argue that the government created type II diabetes to help the American farmer.  If you read history, governments, especially those with absolute power, don’t have the best track record in the human rights category.  There was this guy named Stalin, maybe Michael Moore should do a documentary…

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A Case Against Universal Health Care

In Mark Steyn‘s book “America Alone,” an argument is made that big government makes its citizenry dependent and eventually helpless, in a manner of speaking. Gerald Ford had a famous quote which speaks to this: “a government big enough to give you everything you want is big enough to take away everything you have.” Many will argue that this is the classic slippery slope argument…the notion of a government turning against its people like Skynet in Terminator 2 is pure doomsday rhetoric. Steyn turns the quote on its head: “a government big enough to give you everything you want isn’t big enough to get you to give any of it back.”

American Alone’s thesis is that fanatical Islam is taking over Europe…because Islam is youthful and passionate, and Western Europeans are aging, self-centered and soft…partially because they’ve built a lifestyle around socialized government programs. But mostly because they aren’t reproducing fast enough to keep up.

Both of the reasons supporting Steyn’s argument tie directly into the socialized health care systems of these European countries. Government programs like universal health care are expensive. Mixed with the bureaucracies of government, very expensive. Once a society is used to the cushy benefits of a little socially equitable communitarianism, no mode of government will ever get the votes to reduce the program’s benefits. People are simply not willing to give up those benefits, and in countries like Greece and France, in a few decades there will not be enough working people to pay the taxes to keep the programs in place. The aging populations will bankrupt these systems. Greece’s pension liabilities will make up a laughably unsustainable 25% of its GDP by 2040.

It’s amazing that these countries can afford to insure every one of their citizens now, even with high income taxes. The truth is many can’t. They’ve had to outsource their defense programs to the United States and other countries, to defray the costs. Although outsourcing isn’t the correct word because it implies some sort of contract for payment. We offer our help for free. America is the ATM machine to the world. One could make a cogent argument that American taxpayers are paying for Canadian health care. If America elected to reduce its defense budget to European levels and provide universal health care to its constituents, it would no longer be able to offer its aid to HIV-infected African children, or help out with the next tsunami. The next time SARS (Severe Acute Respiratory Syndrome) infects Toronto hospitals, as it did in 2003, our CDC (Centers for Disease Control) scientists and doctors won’t be working all hours of the night to fill the holes in Toronto’s under-sophisticated health systems.

The “aged dependency ratio,” which is the number of elderly people receiving state benefits relative to the number of working-aged adults supporting them, offers an ominousness to the future of many Western countries. In 2000, America, Australia and Canada all stood at .26 seniors/working people. In 30 years, America will be at .47 (possibly unsustainable in an of itself), and Australia and Canada will be at .56 and .63 respectively. For Canada, this means that each working person will be financially responsible for the pension payments, health care coverage, and other benefits of two-thirds of another person. If you think reduced weekly work hours and increased vacation times will get the job done, perhaps you should take a beginning level economics class.

Americans live in a free country, and have come to expect to be able to choose between dozens of breakfast cereals and hundreds of automobile models, universities, and cable tv channels. Can we honestly say that we’d be willing to give up our ability to exercise choice when it comes to life and death decisions…that which we spend largest sum of our income…our health care decisions? Would we be willing to forego any choice and outsource the whole bit to Uncle Sam? If so, I think it would be because we don’t understand the implications…

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