Why Public Funding of all Medical Care is Impossible and Won’t Work – No

The simple answer is there is no way any country could afford it. The reason being that health care has to be provided by professionals who get paid, who have expensive tools, and that no matter how much you supply of it there will always be an unlimited demand for health care. And who is going to pay the bills?

Whether or not you think government should be doing some things, there are some things it would be possible to do and some it wouldn’t no matter how much you’d want them to; you can’t repeal the fundamental laws of economics or change mathematics to make it suit you.

Let’s say for a moment the government was going to guarantee that every person could receive enough food to live on. Well, you could estimate a cost for that because the basic survival would be the cost of a certain amount of beans, rice and water every day, and people can only eat so much before they are full. Multiply the wholesale cost for a minimum survival ration of food by the number of people in a country plus cost to distribute it to various locations for delivery and you could have an exact figure on how much it would cost to guarantee that no person in that country would ever have to die of malnutrition; it’s a simple matter of arithmetic. If there is enough food available it requires a finite amount to feed everyone at least above the level of starvation so no one would die from it and you could, conceivably, budget for that.

But it would be physically impossible to budget for unlimited medical care because there is no standard for what “medical care” is. Do we mean basic coverage of emergency conditions and do we include specialized care? Yeah, you could estimate for routine treatment like yearly exams and preventative care, and so forth, but when individuals need treatment for a medical condition, what they need is a judgment call, maybe they need it and maybe it’s not necessary.

You’re working in your house and you staple your hand to the wall. You’re going to need a tetanus shot and maybe stitches; no big deal. You have chest pains and it can be anything from indigestion to the start of a heart attack. The treatment necessary to cover this may be anything from 30c worth of antacids to $30,000 worth of heart transplant, and the only way to know is the expensive time of a number of skilled professionals (or, rather, we hope they are skilled professionals!)

We still have to ask how much medical care is necessary. Do we cover very expensive procedures; can everyone who needs a kidney transplant or a heart-lung transplant get it? Do we include optional plastic surgery because someone is suicidally depressed at how they look?

Then you get into political issues. Do we cover contraception? A married couple who already has two kids and wants to have the wife use a diaphragm or the pill because they want to wait before having a third can probably get it as reasonable (except those who oppose all contraception). But the 15-year-old girl who wants a diaphragm or the pill is going to be looked askance, plus some would say she probably should be using condoms since she’s probably having sex promiscuously, presuming she should even be having sex. But if we don’t give her the contraceptives, she has sex anyway and maybe gets pregnant or needs an abortion. Oops! Now I’ve opened an even bigger can of worms!

Abortions? Which do we cover? Do we exclude the so-called “partial-birth” abortions and how do you tell which are acceptable and which aren’t? Abortions for teenagers? Do their parents get notified? What if the 15-year old got pregnant because her stepfather (or her father) is having sex with her? What if it wasn’t rape, what if the girl thinks it’s okay to have sex with daddy? Or her brother? Should she then have an incestuous child and should the pregnancy be covered?

Drugs to treat erectile dysfunction? How about the woman who had eight kids, do we cover the procedures to allow her to do that? Do we exclude people from coverage because they made bad choices? Do we give a new liver to someone because they have alcoholism and ruined their liver? Do we give knee transplants to someone who blew their knees from obesity due to overeating? Do we give AIDS drugs to someone who got it because of sharing contaminated needles? Or because they engaged in high-risk sexual practices? Do we offer needle programs to heroin addicts so they don’t catch AIDS?

If they can’t get public coverage can they buy medical care privately? If a multimillionaire has AIDS he can buy drugs whether he got it from a badly tested blood transfusion or because he was a homosexual and caught it through risky sex practices, the reason he has it is irrelevant, as long as he can pay he can get all the treatment he wants or needs. But will we consider it valid to give unlimited treatment to people who have to have taxpayers pay for their medical care caused by personal misconduct?

And that brings up another issue: we don’t have mandatory organ harvesting or “opt out”; organ donation is “opt in”; your organs are not saved when you die unless you indicate it, say on your drivers’ license. This means since there are more people who want organs than organs available, there will be a waiting list. If you can buy your way onto the list, it opens the door for corruption and influence peddling, if not, a multimillionaire has to wait same as a waiter, except the multimillionaire might have the money to pay someone, say $1,000,000 to donate a liver. The waiter can’t afford that, so he might die if one doesn’t become available and he’s going to be upset, so buying organs has been made illegal. Now neither the multimillionaire who could afford it can buy one nor can the waiter who can’t. But the multimillionaire can fly to some country where it isn’t illegal and have the procedure done there. The waiter can’t afford this.

So what you end up with is a two-tier system; ordinary people get whatever care is available, and those with lots of money can get any care they want, and maybe because they can pay more they can get even better care. Unless there is jealousy and we prohibit private arrangements in which case everyone gets the same level of coverage, unless you can afford to travel out of the country to somewhere else and have it done there.

As medical technology develops we can treat more and more problems we could not in the past, and many of these treatments are expensive. If a doctor performs a lot of expensive procedures he can make a lot of money. If that’s private patients paying it’s their money (or their insurance company), it’s their business. Will taxpayers like it that some hot-shot doctor is making upwards of $10,000,000 a year doing 500 heart-lung transplants a year (2 a day, 10 a week for 50 weeks a year) at taxpayer expense? While some of them get by on $20,000 a year?

So does this mean that to cut expenses we cap the amount of money doctors make, and they decide not to bother to accept public insurance because they can make more money in private practice? In order to provide medical care at public expense, there are only two ways you can do it; either you ration everybody and there are limits on what you get, or you put people on waiting lists and as funds become available, if you’re next on the list you can get it. Or, again, if you’re wealthy and it’s not available for sale, you fly off on a vacation to some place where you can buy it.

The recent federal program to provide a coupon for $40 off a converter so people who have analog-only television sets cannot receive digital television signals would still be able to watch broadcast television is instructive. A low-level converter costs about $50; with the coupon that drops the price to $10. If you don’t care about the forty bucks, you can just pay it and buy a converter at any store; if you can’t afford the difference, you need the coupon. Only problem is, the program ran out of money; if you can’t afford the $40 and need a converter, you have to wait until funds become available. People had to be put on a waiting list when the money to cover the converters ran out. As older coupons expired without being used, those funds were recycled to people next in line. There were also questions about people in prisons who do not get cable – and for some people, the idea that prisoners can even have television is bothersome to them – would be able to watch TV since they were not able to get coupons or wouldn’t be able to use them.

And on that point, are prisoners entitled to care, or do we just let them die? If you have government-funded health care, someone is going to have to make decisions about who gets what care. If the government is paying for it, they’re going to be the ones who decide. Unless you’re wealthy in which case you usually can buy whatever you want. Unless those who want care and can’t afford it prevent that, then everyone gets whatever care some government clerk decides they qualify for.

If we go that direction, what we will have to have is a huge federal bureaucracy to decide what care is acceptable for people, except rich people who can afford to buy their way out of the system. Or if that option is unavailable we’ll get whatever care the government decides, except, again, rich people who can afford to leave the country to get whatever they want.