“Medicare for All,”
were it subjected to truth in labeling criteria, would more accurately be named
“Medicare for None.” This is a point
made early in Sally Pipes’ succinct but detailed analysis of the socialized medicine programs
offered by Bernie Sanders and other Democrat POTUS candidates. Her book, False
Premise, False Promise: The Disastrous Reality of Medicare for All provides a chilling portrait of the
much-touted socialized health systems in Canada and the U.K. -- programs plagued
by doctor and hospital shortages, long waiting times, rationed treatment, substandard care, and, on occasions, appalling
bureaucratic callousness.
Pipes begins her analysis,
however, with a perceptive distinction between traditionally accepted rights
and the assertion that health care is a right. The former rights, she notes, only oblige
people not to interfere with, for example, a person’s free speech or religious practice. Non-interference is required as long as the
exercise of those rights doesn’t restrict the rights of others, as it would if
one yelled “fire” in a crowded theater.
These traditional rights are labeled “negative” because they “require
others [including the government] to step aside and allow people to act
independently.”
On the other hand, in
the case of health care this “positive right” not only “gives us something,” it
also “requires someone else to give it to us.”
And as Pipes illustrates in spades, defining “the criteria for positive
rights . . . is tricky” -- a process that supposedly values equal medical care
for all above, for example, the freedom of parents to pursue treatment for a
sick child outside a nation’s socialized framework, thereby making mincemeat of
the most prized of all American rights, life and liberty. In short, residents of Canada and the U.K.
forfeit a tremendous amount of freedom concerning the availability and quality
of health care in return for a system designed primarily to offer an equal
measure of care to everyone -- an arrangement Pipes concludes “is a catastrophe
for the people forced to live under it.”
Thus, a “right” to health care is transformed into the obligation to
accept and contribute to a system that often provides mediocre and sometimes
appalling care.
When analyzing
specific “Medicare for All” proposals, Pipes notes that the program’s popularity
disappears when folks discover it would totally do away with the private
insurance held by 253 million Americans (mostly through employers) and would be
far from free! Sanders’ proposal adds at
least 32 trillion to the federal budget over ten years and likely up to 60
trillion, since it “would prompt unlimited demand from patients.” The latter figure represents a doubling of
projected federal spending over the decade.
Add to that cost the inevitable hospital closures and doctor shortages
tied to stringent government reimbursement rates as well as the dislocations
caused by outlawing private insurance and you have the makings of a perfect
societal storm. But it would be a storm
caused not by the quality of medical care (with which a large majority of
Americans are satisfied) but rather by the cost of insurance. Far from reducing insurance costs, Obamacare saw
a doubling of premiums in the individual market between 2013 and 2017. Meanwhile, employer-based family premiums
continued to rise to over $20,000 a year in 2018.
The bulk of Pipes’
book describes the reality of socialized medicine in the U.K. and Canada, both
statistically and via a number of gut-wrenching anecdotes. Statistically, Pipes shows that the presumed monetary
savings of socialized programs are largely illusory since significant costs are
hidden in taxes and take no account of lost wages and productivity due to demonstrably
inferior health outcomes. Moreover, the
typical assertion that the U.S. trails the U.K. and Canada in overall health
rankings is also debunked by showing that those rankings don’t focus on specific
health outcomes (e.g. cancer survival rates) but rather give inordinate weight
to socialist programs and even fail to account for the different standards countries
have for calculating “infant” mortality.
Additionally, those socialist-biased health comparisons don’t take into
consideration non-health related factors (such as traffic accidents and crime)
that significantly affect life expectancy averages. When one compares like to like, U.S. life expectancy
and infant mortality rates are comparable to or better than other advanced
nations and, significantly, specific health outcomes for treatment are
consistently better than their socialized counterparts.
Pipes’ book would be
persuasive but not emotionally compelling without its numerous vignettes that
put a human face on an often less than human bureaucratic monstrosity. Among others there is the tragic story of a
single mother of two without a car in southeast Wales who called ahead to
inform an emergency clinic that she would be a bit late bringing in her severely
asthmatic five-year-old child since she had to make arrangements for an infant’s
care and catch a bus. Her 18-minute
tardiness resulted in the doctor’s refusal to honor the appointment. Instead, it was rescheduled for the next day. That night the child had another asthmatic
attack and died in the hospital. Anyone
reading Pipes’ book knows this tragedy is the direct result of doctor shortages
that make a typical visit to a general practitioner in the U.K. last a grand
total of nine minutes.
Then there is the
case of young Charlie Gard, born August 4, 2016, with a rare genetic disorder
that’s typically fatal. His parents,
however, wished to try an experimental treatment in the U.S. that wasn’t
available in the U.K. and raised over a million pounds to give it a try. The doctors caring for Charlie Gard, however,
petitioned the government to remove him from life support, and it is the court,
not doctors and parents, that has the last say in such matters. Despite pleas from the Vatican and even
assurance from President Trump that the U.S. would be “delighted” to help
Charlie, “Charlie died in a hospice on July 18, 2017, after the court denied his
mother’s request to bring her son home for his final hours.” Another couple was arrested for kidnapping
when they took their child to Spain in 2014 for a cancer treatment not approved
in the U.K. This story, fortunately, had
a happy ending in Prague following a legal battle over proton therapy, a
treatment available in the U.S. since 2001.
Ironically, socialist
medicine doesn’t mean the same care for wealthy and well connected individuals,
as Canadian singer Micheal Bublé moved
to California where his son was treated for liver cancer in 2016 at Children’s
Hospital Los Angeles. Even more
egregiously, in 2010 Newfoundland’s premier traveled to Mount Sinai Hospital in
Florida for minimally invasive heart surgery that he could have received in his
own country.
Pipes ends with a
series of proposals for making American health care more affordable, ideas that
focus on Health Savings Accounts, tort reform, individually tailored insurance
policies, and a government program to take care of the approximately two
million folks who would not qualify for private insurance -- a small subset for
which it makes no sense to socialize the entire health care system. Overall, Pipes’ book is predicated on the
hope that Americans won’t give up their access to quality medical care if they
know that the “free” care they are promised will cost almost as much as the 17%
the U.S. now devotes to health care and will result in vastly increased waiting
times, fewer treatment alternatives, massive dislocations, and restricted or no
access to expensive drugs -- all without the default option employed by thousands
of Canadians, treatment in the United States.
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