No Subsidy for You

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If you want to know who was the first to mess up the American health-care system, it was the unions. They introduced third-party payers, and that doomed the free-enterprise system.

Later on, the government compounded the problem by introducing two more layers of third-party payers — Medicaid and Medicare. From that point on, medical costs started their version of scaling Mount Everest.

A lot of people who like to talk about free enterprise really don’t understand it. Free enterprise means the entire transaction is free from any outside interference. In medicine, it means the patient negotiates with the doctor what he will pay, and vice versa. Depending on the circumstances, doctors often were faced with a choice of withholding their services or accepting what the patient could afford. In those cases, something is always better than nothing.

At the same time, in the free-enterprise era, there was a lot of charity. There were charity hospitals, and most doctors did charity work. If you got sick and couldn’t afford to pay for treatment and couldn’t get any charity, then, of course, you died. That, too, is part of free enterprise.

The industrial unions introduced health insurance. In the presence of a third-party payer, the doctor is going to charge what the third party will pay. There is no negotiation involved. That was all well and good until the cost of premiums started going up because insurance companies are not in the business of charity.

One of the factors that encourages some American industries to shut their plants here and open some overseas is these high health-insurance premiums. With the passage of Medicaid and Medicare, we got the worst of both worlds.

Now we have subsidized health care for the elderly and the indigent, but what about working men and women and the young? Oops. No subsidy for you. You, in fact, are the source of revenue to subsidize the elderly and the indigent.

Medicare, being a government bureaucracy, pays whether the patient is a 65-year-old workingman or a 90-year-old multimillionaire. Furthermore, because humans begin to wear out as they grow older, the bulk of government money is spent on geezers rather than on children whose lives are still ahead of them.

Well, you might think, the answer is a government program that covers everyone. The political problem with passing that kind of program is that in order for it to be affordable, you’re going to have to limit the incomes of doctors and other health-care providers. And what do doctors think about losing income? As the line of an old joke goes, "Oh, I fights ‘em, I fights ‘em."

Standing between you and any kind of government health-care program are the health-care providers and the pharmaceutical corporations. You are talking about one heck of a bruising, down-and-dirty, no-rules political war, and I don’t see any politicians on the horizon with the backbone to undertake such a war.

What calls the shots in Washington? Money. Who has the money — working men and women or pharmaceutical corporations and millionaire doctors? The American people are going to have to find themselves a tougher breed of politician before they will ever win that fight.

In the meantime, the only way to beat the system is to live well and die quick and sudden.

Charley Reese [send him mail] has been a journalist for 49 years.

© 2007 by King Features Syndicate, Inc.

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