Pawtucket Times

Healthcare: A house divided cannot stand

- By THOMAS L. KNAPP

The latest healthcare initiative from the Trump administra­tion and the Republican Party's leaders in Congress seems set to sink just like the last version. Mitch McConnell can't seem to round up the votes to push it through the Senate, if anything the House is more likely to tear apart than pass the Senate version, and the White House isn't getting anywhere with its attempt to mobilize the nation's governors behind attempts to modify the Affordable Care Act, aka “ObamaCare.”

Good. Even the most ambitious proposal up for serious considerat­ion – repealing ObamaCare and reverting to pre-2010 rules – is just nibbling around the edges of the problems of maximizing care availabili­ty and minimizing costs, as was ObamaCare itself. Sooner or later (and the sooner the better) one of two radical solutions will be adopted.

Note: “Radical” does not mean “extreme.” Per Oxford Dictionari­es, it means “relating to or affecting the fundamenta­l nature of something; farreachin­g or thorough.”

Let me define the problem by mangling a famous Abraham Lincoln speech: A house divided against itself cannot stand. I believe this healthcare system cannot endure, permanentl­y, half government-run and half kind sort a private. I do not expect healthcare to disappear – but I do expect it will cease to be divided. It will become all one thing or all the other.

The two real alternativ­es before us are:

Adopting a “single-payer” system in which the state takes complete top-tobottom charge of healthcare; or

Radically reducing – even eliminatin­g – the state's role in healthcare.

As a libertaria­n, I support the latter course. Every government involvemen­t in healthcare, starting with guild socialism and occupation­al licensure in the late 19th century (at the urging of the American Medical Associatio­n, to prop up profits for doctors) and proceeding through socialized healthcare for veterans (the VA), socialized healthcare for the elderly (Medicare), socialized healthcare for the poor (Medicaid) and partially socialized healthcare for everyone (from the Health Maintenanc­e Organizati­on Act to ObamaCare) has impeded care and raised costs at the expense of patients. A constituti­onal amendment requiring separation of medicine and state would be the best possible outcome.

But that seems unlikely to happen, doesn't it? The big business players in healthcare (pharmaceut­ical companies, hospitals, “insurance” companies, et al.) would rather use government to protect their monopolies and pass burgeoning administra­tive costs on to the rest of us than compete in a free market. And the customers (patients) themselves have good reason to distrust what's been falsely advertised to them as a “private sector” system.

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