The two big demands in President George W. Bush's
Jan. 28 State of the Union address were for the
government to go to war with Iraq and for new domestic
spending programs, among which he included the vast
expansion of Medicare now barreling through Washington.
That winter of our discontent has led directly to a long
hot summer in which our tax dollars are being torched.
At least he gave fair warning.
In retrospect, it is clear what he was really saying
to the Democrats: You give me my war and I'll give you
your socialism. The original idea between separating
executive and legislative power was to have one check
the power of the other. Government is stupid but not
that stupid: Cooperating in a mass looting of the public
turns out to be a win-win proposition for everyone but
those paying the bills.
That's not to say that war and socialism are not
designed to address real problems. Just as prior
military interventions seemed to create the conditions
and a rationale for the war on Iraq, the expansion of
Medicare seems to be driven by systematic problems in
the system that were crying out for a solution. That's
the nature of government, always fixing problems of its
own creation that create ever more problems for
government to fix. It's like the plumber who breaks more
pipes than he repairs - except that you can't fire him.
It was Ludwig von Mises' point that interventions in
the market economy create instability that generates
dislocations that seem to call for more intervention -
and so on until the logical result is socialism. I
emphasize logical result; the practical reality is not
written in stone. With political courage and ideological
conviction, it is possible to change course.
A trillion-dollar transfer
This huge expansion of Medicare is a clear case
of a wrongheaded intervention designed to repair other
bad policies and destined to create more bad outcomes.
It will guarantee vast drug payments to seniors
(welfare) in exchange for a flat monthly premium. The
higher your bills, the more government pays. The poorer
you are, the less you pay. The plan is complicated and
not final, but the result is a foregone conclusion: the
coercive transfers of another trillion dollars (over
time) from working younger and middle-age Americans to
older Americans already too dependent on government.
The bill's passage is made inevitable by the soaring
costs of prescription drugs (in part, due to patent laws
and inflated demand due to existing medical socialism),
the guaranteed income that comes to medical service
providers and drug companies from a government subsidy,
and the growing expectation on the part of old people
and their middle-aged children that "society" ought to
pick up the bill for the costs of aging.
Consider the absurdity of the proposed solution to
the problem of high costs: Pass a law and make them
affordable! No one would consider this a solution in
normal life. Let's say you are at the grocery checkout
line and the cashier shocks you with a $150 bill. Let's
say you respond by saying: The government must pass a
grocery-benefit bill to lower the amount I have to pay.
The cashier would laugh uncomfortably and hope that you
would soon be on your way. Try it with the car dealer,
the real estate agent, or the airlines: They will all
think you are nuts.
Yet when it comes to government, reasonable people
are under the impression that the costs of prescription
drugs can somehow be whisked away by the right kind of
legislation. Sure, some people benefit, but others are
paying the tab in one form or another. Let's not pretend
this is really "insurance"; it's welfare, the coerced
transfer of wealth from one group to another, as immoral
as it is inefficient. And further subsidizing and
therefore increasing the demand for drugs is hardly
designed to cut their costs. Just the opposite.
How costly will it be? Look at the demographics. In
1900, only 40 percent of the population lived beyond the
age of 65; now 80 percent do, while 40 percent live past
the age of 85. In the postwar period, the biggest change
involves the vast numbers that see their 90th and 100th
birthdays - extremely rare a century ago.
The gerontology industry
Those who credit government programs with this
progress are partially correct: Government has
subsidized the prolongation of life at the expense of
other social needs, simply by taxing the heck out of
young and middle-age people to fund a medical
establishment dedicated to pushing the life span limits
through ever more impressive life-sustaining gizmos and
drugs. This has given rise to a huge and largely
socialized gerontology industry that does nothing but
serve the needs of people who live a decade longer than
they might have before LBJ created Medicare and
Medicaid. But instead of giving us long lives, the
government has given us long and expensive deaths during
which the public sector and its connected interests
benefit at the expense of the rest of us.
The fiscal problem results from the reversal of the
numbers of young and middle-age taxpayers vs. old people
living on the dole. As the costs of a non-working long
life rise, the pool of the population working to pay the
bills continues to shrink. The costs themselves continue
to rise because the old-age health economy is
increasingly immune from the competitive forces of
market discipline.
Pushing the bill on others
Many experts have persuasively argued that the
programs face unthinkable long-term liabilities and will
go belly up in a few decades. No one disputes the claim.
But why should today's old people, who lobby for ever
more benefits, care what happens to old people 30 years
hence? They should. But leaving the check for the next
patron, especially given the perception that they should
get something out of the system, seems to be the
democratic thing to do.
Today's young people, meanwhile, aren't entirely
unhappy to be let off the hook for shelling out for
their elderly parents' medical care. The doctors and
drug companies are glad to take the cash, the
bureaucrats are not displeased by the security the
system gives them, and, as for the political class, few
members of this group think about much more than the
next act of legal extortion and bribery.
The idea of turning the health-care sector over to
the market is not even part of the debate. For the most
part, we trust the market to deliver food, energy,
housing, clothing, electronics, entertainment, etc., but
somehow, when it comes to health, we are pleased to let
government take full control and loot the population in
the process.
The Bush administration perfunctorily toyed with the
idea of making prescription drug coverage contingent on
participation in a subsidized private health insurance
program, but that idea was quickly shot down. Even the
Wall Street Journal, which is one of the few opinion
organs to condemn the Medicare expansion, endorsed two
government programs as an alternative: a "drug discount
card" and a "means-tested subsidy." It is a small step
from these to the proposal now being shoved through the
Washington meat grinder.
If we take a look at all the sectors in which
government socialism is expanding most dramatically -
whether education, health or security - we find that
they are ones where the government has been heavily
involved for the longest and failed the most miserably.
These failures breed more failures to be "fixed" by more
programs that inevitably fail. On the other hand,
sectors that are relatively free of political
involvement (high-tech, for example) are largely left to
the dictates of the marketplace. There are few evident
failures that seem to call forth political solutions.
More Subsidies, more regulations
The intervention in health care began with the
licensing of doctors and the restriction of competition
to keep their incomes high, continued with the
suppression of non-establishment medical schools to
further restrict supply, and ramped up with third-party
payments systems during wartime in lieu of wage
increases then forbidden by law, and further bolstered
with faux-insurance programs to circumvent Soviet-style
taxation.
It continued with tightened patent restrictions on
drugs, new subsidies for low-income and older citizens,
and became ever greater with more and more government
funding, rules, restrictions, mandates, taxes and
subsidies - all of which seem to grow more under
Republican rule (when these ideas are deemed
"responsible governance") than Democratic rule (when
these ideas are fought as socialistic). This is a system
that has been patched so often that it can't possibly
sustain itself over the long run.
What is the solution? No one wants to contemplate it:
We must reverse the intergenerational looting. The young
should stop paying in. The old should start paying
market prices. The sad stories of older people who do
not have the means to care for themselves or buy drugs
should stimulate the efforts of private charities
(though their care would then cost much less). Drug
companies should compete in a free market without
federally granted monopolies.
All of us need to stop treating the national pool of
wealth the way the Iraqi mobs treated Saddam's palaces
after the war. And the next time a president promises a
thrilling war and free goodies for everyone, we might
exercise a bit more critical intelligence.