Health Care

I don't claim to be an expert on the subject. Far from it; I know very little. But the debate has come up recently and I'm afraid people are missing the point.

People talk about Universal Medical Coverage a lot. Michael Moore is going to release (well, has released, but let's maintain the fiction, shall we) a movie on the subject. I haven't seen it, nor do I plan to because I find Michael Moore annoying. But it sure has stirred up some debate.

We have, on the one side, people who say that the market should be allowed to rule. If we just get the Federal Government (of the USA, sorry foreign folks) out of it, the market, and wonderful capitalism red in tooth and claw, will work itself out. Medical insurance will become cheaper, and all will live in a wonderful Utopia of virtually free health care.

Then the other side, who believe that the government should take the whole thing over and give everyone medical insurance. Socialized medicine, Medicaid on a grand scale, workers comp for all... and so on. And then all will live in a wonderful Utopia of virtually free health care.

The problem, as I see it, is actually twofold. One, both of those ideas are simplistic and stupid. The pie in the sky may be apple, but I don't expect us to taste it any time soon. The market does a great job of screwing the poor, sad to say, and those are the people who need health insurance most. And the government, in its infinite wisdom, would no doubt make an even bigger mess of things than they are already. I'm not saying the system works, or doesn't need changing. I'm just saying that the extreme options are bunk.

But the second problem is a problem of discussion. Because, you see, what these people are talking about is health insurance. Insurance is great if there isn't universal free health care. And no doubt the market would act on insurance prices, just as the government might be able to insure people who couldn't get it anywhere else.

However, actual universal free health care is not insurance. It is free medical care. The price you pay is not based on anything other than how much health care the country uses. The government pays for it all and then gets that money back from the taxpayers, who all pay said tax regardless of whether or not they have used any of said free health care in the past. That's what socialized medicine really means.

I'm not saying that I'm in favor of that system any more than the current one. The United States government doesn't handle Socialism well, which is why we aren't one. But it is a completely different debate from the debate over the cost of medical insurance.

By way of illustration by analogy (a tricky business at that), suppose you have a government that charges you money any time you need to submit a government form. That money pays for someone to examine the form and then file it. If you needed to fill out a lot of forms, you might be tempted to hire your own bureaucrat who would examine and file all of your forms for a flat rate, rather than per form.

That private bureaucrat is insurance. If you don't require his services often, he doesn't charge much. The more forms you make him examine and file in the government building, the more he's likely to charge you next time his contract comes up for negotiation. In a free market, there's a good chance that you might find another bureaucrat who was willing to charge you less because of healthy competition. It is doubtful that you would ever find one who would do it for free. And if bureaucrats hear, at the annual bureaucrat union meeting (Local 723), that you submit a lot of forms, word is likely to get around and you're likely to have to pay more, regardless of the wonders of the free market.

Now suppose the government steps in and says they will mandate a bureaucrat's wages. The government passes laws saying that private bureaucrats can't charge too much. This is, in a way, insurance reform (a very over-simplified way). But you still have to find a good bureaucrat, even if you pay him the mandated amount. And bureaucrats might be inclined to simply decline to work for you if they thought you had too many forms to examine and file (in that same mythical government building)

Now suppose the government says that everyone must have a bureaucrat of their very own. Since some people have too many forms to fill out and no bureaucrats will work for them, the government hires bureaucrats for these unfortunate people. This is universal insurance. The government has stepped in and mandated not only the wages of bureaucrats but also that everyone must have one. But the bureaucrats who work for the people who fill out too many forms are likely to be overstretched and underpaid, and the system is likely to collapse.

Lastly, suppose that the government hires its own bureaucrats to work in the big government building, and instead of forcing people to pay to file forms, the government lets them do it for free. It pays its own bureaucrats from the taxes it collects from everyone. If you filled out lots of forms, you will still only pay taxes based on what you own. If you filled out none, then you're picking up the tab for nothing, but that's what taxes are for. The government no longer charges for forms; it makes that cost part of its operating budget. That's socialized medicine.

I used bureaucrats in the example for a reason, although it required a bit of logical legerdemain, because bureaucrats are actually a prime example of socialized bureaucracy in the United States. They aren't elected, they aren't payed by individuals, they are employees of the government. Under the purest form of socialized medicine, doctors would become employees of the government, and they wouldn't charge people anything for medicine.

That's not likely to happen, and looking at the track record of bureaucracy, I can't say I'm sorry. Like I said, I'm not pushing in favor of the extreme in any of these cases. But I do think people should understand the distinction between insurance and medical care, and a lot of people don't seem to have any idea there is one.

This got quite long with the analogy, didn't it. I didn't try to prove anything via analogy though. It's just a useful tool for looking at the situation another way, not a proof the the situation is as I've said. Look for yourselves.