Health­care: A house di­vided can­not stand

Pawtucket Times - - OPINION - 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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