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Nowhere in the Declaration of Independence does it say there is a right to health care.  The purpose of the US Constitution, as stated in the Preamble, is to "promote the general welfare," not to provide it.  The Bill of Rights lists a number of personal freedoms that the government cannot infringe upon, not material goods or services that the government must provide.  According to former Congressman Ron Paul, "you have a right to your life and you have a right to your liberty and you have a right to keep what you earn in a free country... You do not have the right to services or things."  Nevertheless, recent polls by the Pew Research Center show that 60% of Americans say the federal government is responsible for providing health care coverage to all citizens.

Capitalizing on this trend, Bernie Sanders has introduced legislation that would expand Medicare into a universal health insurance program with the backing of at least 15 Democratic senators—a record level of support for an idea that had been relegated to the fringes during the last Democratic presidency.  "Now is the time for Congress to stand with the American people and take on the special interests that dominate health care in the United States," he wrote in a New York Times op-ed.  "When you have co-paymentswhen you say that health care is not a right for everybody, whether you're poor or whether you're a billionairethe evidence suggests that it becomes a disincentive for people to get the health care they need," Sanders said.

In the Netflix series House of Cards, President Frank Underwood campaigned for the White House by telling Americans, “You are entitled to nothing.”  The fictional presidenta Democrat, no lesswas forthright with American voters about the unaffordable and unsustainable structure of America’s entitlement programs, and he was rewarded at the polls.  In real-life America, unfortunately, there is no such honesty from the political class.  Many in the Republican party are now resigned to contemplating a government takeover of the health-care industry in the wake of their failure to repeal and replace Obamacare.  Charles Krauthammer, for example, woefully predicts that President Trump will opt for single-payer health care.  And American Spectator editor F. H. Buckley optimistically calls for Trump to look to the failed Canadian model of universal coverage.

This week, J. D. Tuccille of Reason magazine explores the pitfalls of single-payer healthcare, which was actually what President Obamacare was aiming for when he legislated Obamacare.  After considering the facts, would you vote for nationalized healthcare?  If so, tell us why at  




                                          HEALTHCARE  IS  THE  CORNERSTONE  OF  THE  SOCIALIST  STATE   -Monica Crowley     




Are You Sure You Want Medicare for All?

Expanding existing government healthcare systems would spread the reach of their already messy problems.


by   J. D.  Tuccille*   [Filed 9/12/17]


Senator Bernie Sanders (I-Vt.) plans to unveil his long-awaited "Medicare for all" proposal for government-controlled, single-payer health care.  His colleague, Sen. Elizabeth Warren (D-Mass.), is all-in on the scheme.  "Medicare for All is one way that we can give every single person in the country access to high quality health care," she writes. "Everyone is covered.  Nobody goes broke paying a medical bill.  Families don't have to bear the costs of heartbreaking medical disasters on their own."

And for starting us along the path to all of that high-quality care, she adds, "We owe a huge debt to President Obama."

Well, there is something there. Debt, that is.  Huge, accumulating mounds of it, swamping everything in sight.  In 2001, the Congressional Budget Office warned that spending on retireesspecifically Social Security and Medicare"will consume…almost as much of the economic output in 2030 as does the entire federal government today."

"Notwithstanding recent favorable developments," the Medicare Trustees conceded in their report this year, "current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation."   The report foresees that "the trust fund becomes depleted in 2029."

In actual dollar amounts, says Michael D. Tanner of the Cato Institute, "Medicare faces unfunded liabilities approaching $48 trillion.  And, if we return to double digit health care inflation, we could see Medicare's liabilities swell to more than $88 trillion."

This is the regular Medicare system that we have now, targeted at the growing but limited population of retirees.  Medicare for All would take this existing system's promises, costs, and unfunded liabilities, and apply them to the whole country.

Medicare is in the hole, by the way, even though it pays medical providers rather less than private insurance.  "The government program typically pays only 80 percent of what private insurers do," CNN noted in 2014.

Red tape is also a huge burden for medical providers who accept Medicare. "A random survey of 1,000 practices found physicians and staff spend 15.1 hours engaged in quality measure reporting each week, at a cost of more than $40,000 per year for each doctor," according to FierceHealthCare.

Jumping through bureaucratic hurdles for the privilege of accepting substandard compensation isn't as attractive as it might seem.  That may be why a growing number of physicians refuse to see Medicare patients, others limit the number they'll accept, and more balk all the time.

Under a single-payer system, options for medical providers may be more limited than they are nowthere probably wouldn't be any better-paying private insurers to take by preference to the government system.  But there also wouldn't be any private insurers to effectively subsidize Medicare patients.  In the case of a single-payer transition, doctors who find the terms of Medicare for All unacceptable may switch entirely to private-pay (if that's still permitted), while some percentage will leave medicine entirely.  Considering the potential for switching over to single-payer in The Atlantic, Olga Khazan predicts "Hospitals would shut down, and waits for major procedures would extend from a few weeks to several months."

Such delays and restricted access assume that Medicare for All means an actual attempt to replicate the sort of care currently provided by the retirement system, including its costs, writ large(r).  If, instead, the U.S. were to expand existing government healthcare for the poor into Medicaid for Alla plan explicitly endorsed by Sen. Brian Schatz (D-Hawaii)the plan's offerings and costs would be rather different.  That is, the program would offer less, and be pretty bare bones.

Medicaid "limits the drugs and treatments its beneficiaries can get," Khazan notes. "Americans would find it stingy compared to their employers' ultra-luxe PPO plans."

Medicaid, by the way, pays less than Medicareabout 61 percent of what the retiree medical program pays providers. "Focus-group participants estimated that the current  Medicaid rates were covering roughly 5070 percent of their costs of providing care for Medicaid patients," according to a HealthAffairs survey.  Given that many providers lose money on every Medicaid patient seen, it's unsurprising that a lower percentage of physicians accepts such patients than takes Medicare patients.

Physicians have to chase the various state Medicaid plans for their pittance, even so. Illinois hasn't paid billions of dollars owed to providers for patients' medical billsand ignored a court order to do so, leading to yet another order that the state may or may not take seriously.  Connecticut isn't quite so far in the red, but also holds back payment to providers.  And my wife, a pediatrician, isn't alone among providers in having to constantly treat our state's Medicaid system like a deadbeat that needs constant nagging before it offers a few dimes on the dollar for what it owes.

And, yes, Medicaid is rule-bound too, governed by most of the same red tape that ensnares Medicare.

Again, switching to Medicaid for All would limit providers' choices.  They could take the plan, switch to private pay (if allowed) or leave medicine.  But if each patient seen represents an actual loss, few providers would have the ability, let alone incentive, to knuckle-under and accept the new order.  Many would be out of businessor politicians would be scrambling to find yet more money to make sure that the country maintained some sort of health care industry.

A big part of the problem, as Cato's Tanner pointed out earlier this year is that "Americans want widely contradictory things from health-care reform.  They want the highest-quality care for everyone, with no wait, from the doctor of their choice.  And they want it as cheap as possible, preferably for free."

Promising, as Sanders and Warren do, to give everybody high-quality health care without regard for ability to pay will always find an enthusiastic audience.  But delivering on that promise is likely to give us not the illusion of Medicare for All, but rather its awful, unsustainable reality.


esday, September 6, 2017 © King Features

*J.D. Tuccille is a contributing editor at Reason magazine. This commentary was filed Tuesday, September 12, 2017 @Reason Foundation.

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