Posted by
voice_of_reason on Wednesday, July 22, 2009 8:47:19 AM
Take a time-trip back to the 1950s ... where, politicians were trying to 'solve' the problem of Education. The objective was to declare Education a basic human right, and then come up with a system that was:
* fair - after all, why should a kid from a poor family get a lower-quality education than a kid from a rich family?
* free - since many other countries followed this model, surely it made sense for the most affluent nation on earth?
* good - nothing but the best .. after all, it's "for the children"
Politicians devised systems that were expected to provide access to all (universal), and provide high-quality education at an affordable cost.
To be fair, they did achieve the goals of free education and universal access. But 'free' does not translate into 'inexpensive'. All right, one might say, but what about quality? Unfortunately, the well-intentioned plans failed miserably in producing high-quality education.
Luckily for the politicians who 'achieved' Universal Public Education, it took several decades for the damage to become obvious. And now, the concept of Public Education is so ingrained in our national psyche, that one hears arguments such as "without Public Schools, our children would be uneducated."
Along the way, irreparable damage has been done to the market for Education, since most captive tax-payers couldn't afford the double-cost of sending their kids to Private Schools. With more than 90% of the market beyond reach, Private Schools cannot 'compete' against the coercive monopoly of Public Education. Except for the few Private Schools that are church-supported, the only Private Schools that survive are those that can tap into a relatively small pool of affluent families in their regions.
The 'public option' that is being proposed in today's Healthcare debate represents the same kind of slippery slope. One can expect the following chain of events:
* with great fanfare, the Public Option [given a nice, catchy name such as AmeriCare] is unveiled in 2010. It is expensive (to the taxpayers), but cheap for 'subscribers'.
* By 2012, AmeriCare enrolls about 100 million subscribers - many of whom leave their previous insurers 'voluntarily'. At this point, it is already 'too big to fail', but since it is mostly successful, no one actually thinks along those lines.
* Due to Govt clout AND the large enrollment AmeriCare is able to squeeze providers [hospitals, doctors, nurses, pharmaceutical mfrs,..] and provide decent healthcare to its subscribers. At this point, AmeriCare is deemed a huge success .. ensuring the short-term electoral success of its proponents, who remind voters how "dastardly conservatives warned that the Public Option would result in low-quality, rationing .. but, look .. we did it, and you still have the same high quality and great access".
* Providers [hospitals, doctors, nurses, pharmaceutical mfrs,..] are forced to raise prices for the remaining Private plans, who now have to raise prices, restrict access etc. More people leave their Private plans 'voluntarily', since they are hearing wonderful stories from their fellow-citizens who previously enrolled in AmeriCare.
* By 2016, nearly 90% of the country is on some form of Govt sponsored health insurance [Medicare, Medicare, SCHIP, AmeriCare..]. There are still a few Private plans, but they are for the affluent .. sort of like the Private Schools. AmeriCare is still considered a great success, just as Public School systems actually worked quite well for several decades.
Hop into time-travel mode and fast forward to, oh, about 2025:
* shortage of doctors: in the early years of AmeriCare, there wasn't a significant shortage of doctors. After all, where would the vast number of trained doctors go .. Canada? But there are fewer doctors to replace retirees .. since it isn't a lucrative field any more.
* shortage of hospitals and equipment: squeezing the providers would naturally curtail their profit margins, reducing investment in this sector. Initially, the effect of this would be mitigated by 'cost shifting', but, as noted earlier, there wouldn't be many Private plans in existence.
* shortage of pharmaceuticals: initially, pharmaceutical companies would 'make it up in volume', since AmeriCare would guarantee a growing market for existing drugs. But, lower margins would eventually require cost cutting by pharmaceutical mfrs.
* lack of innovation: what incentive would a pharmaceutical company have to spend $1-2B on the next innovative drug, if they are not allowed to recoup a Return on Investment that is commensurate with the risks? Proponents of Govt sponsored research would say that the Govt would sponsor University-based 'not-for-profit' research, which would mitigate some of the damage - for some time. But, absent the profit motive, innovation would stall. That is because, Govt cannot sponsor R&D in all areas that enable such innovation. For example, companies that make R&D equipment would also face similar pressures, and would not have the incentive to innovate.
* AmeriCare is now a $5T (and growing) annual drain on the US Govt. Costs continue to go up, while quality drops and rationing becomes a fact of life. Having engulfed and devoured most of the alternatives, it is inconceivable to consider eliminating AmeriCare. America will continue to throw money at AmeriCare, with each passing generation thinking that it is basically a good idea, and will work perfectly if 'tweaked' properly.
* The American people have a vague recollection that things used to be better, but an increasing majority holds the opinion "it isn't perfect, but if we didn't have AmeriCare, people would have no health care at all."
* President Obama, now a revered 60-something liberal icon, is given the status that was previously reserved for the likes of FDR & LBJ. Liberal historians refer to him as "the President who healed America".
And, here is what the politicians will be saying in 2025:
* Healthcare has always been a fundamental right in America
* AmeriCare is too big to fail, and needs to be subsidized to an increasing extent every year.