Prologue

As a medical doctor for, lo, these past 30 years, I have seen many change in the world of medical practice. Some, relating to diagnosis and treatment, have been remarkable. The flip-side is that, as a solo-practitioner trying to scratch out a living (don’t laugh; contrary to popular opinion, all doctors - especially primary care doctors such as I - are not wealthy), things have decidedly deteriorated. In any case, I have been asked by several readers of this chronicle to write on my impressions and opinions of the proposed institution of a national health care system in the U.S. So, for better or worse - offensive or merely infuriating - what follows are my thoughts on the proposal that has lately been so divisive: to whit, the government "running" health care.

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The greatest flaw of all political creatures is the hubris that runs through their veins as mother’s milk. Once benighted to manage the public coffers, wisdom (if they had any to begin with) seems to flee from their midst as bats from caves at twilight. For they, alight with the false glow that they are, somehow, magically transformed into modern-day Merlins, believe they can change not just hundreds of years of American history, thousands of years of human history and, yes, even the very nature of man. All it takes, in the grip of their Beltway delusions, is to throw enough money at what they conceive as injustice or inequality (feigned compassion gets votes) and they will try, as the alchemists of the middle ages, to turn lead into gold or, at the very least, man into angels. (Forgetting James Madison’s famous "If men were angels, no government would be needed".)

The most recently minted "right of man" is free health care for all. Just as enormous amounts of money have been squandered to conjure up other illegitimate "basic human rights", politicians set their quills to work to "better mankind". We have tried - and failed, miserably - to rid the nation of those other pesky flaws of human nature (poverty, crime, drug abuse, ignorance, sloth, and greed), but the denizens of the Potomac have it in their minds that, with just one more bloated, pork-filled government agency, the minions that foolishly elected them to office will be happier and healthier. And, maybe - just maybe - these same fools will be less likely to notice that their government has run it fiscal deficits to unthinkable levels and have debts that will never, ever be balanced.

This in clear view of the experience, almost worldwide, without exception, that national healthcare does not work any better than any form or fashion of socialism has ever worked. In just one example, a British journalist writes:

"The problem with the nationalized industries, for example, was simply that they were expected to provide more public services – in particular, jobs for union members – than their steadily shrinking productivity could justify. The NHS faced the same dilemma from the very beginning: the British public then, like a substantial part of the American public today, wanted to consume more health than it was willing to pay for. The NHS was launched in 1948 by proposals which estimated it would cost 145 million pounds per year. By the end of the first eight months, the NHS’s annual cost was 295 million pounds. By mid-1950, experts were anticipating that the bill for 1950-1 would be 426 million pounds." Incidently, the same article states that government spending for health care for the 2007-2008 year was 92 billion pounds or (are you ready?) thirty per cent of the entire budget for Great Britain.

Well.

Leaving aside, for the moment, whether or not we actually need a national health system, does anyone actually dare to state the obvious: WE CANNOT AFFORD A NATIONAL HEALTH SYSTEM! The national debt currently stands at somewhere north of $7 trillion and there is a recession in progress. The government is giving back tax revenue and, to my eyes, has no clear plan to resolve their free-spending habits in my lifetime or the lifetime of my children (or the generations to follow). We are, in a word, broke.

Aside from the fact that we simply cannot afford a program of the magnitude being proposed, there is a more fundamental question that we should all be asking ourselves before the Washington propaganda machine swings into full gear - as it undoubtedly will. As our eyes moisten, predictably, from the heart-wrenching ads depicting children dying (supposedly) from lack of access to health care and mothers crying over their children, lost to poverty and the "closed system" of the nation’s private hospitals, we need to stop, occasionally, and actually think for ourselves, if that remains possible in this age. The most important questions we should be asking ourselves, after all, is simply this: Is this government’s problem?

Again, setting aside the awful truth that the government has never run any "national business" without losing enormous amounts of money (e.g. U.S. Postal Service, Medicare/Medicaid, Social Security, et cetera), the deeper philosophical query, at the core, is this part of the government’s mandate in a democracy? I, for one, am of the opinion it is not. Don’t get me wrong. I really have no problem with "safety net" programs that can alleviate temporary and reversible hardships - 8 to 10 weeks of unemployment benefits, for example. But I have a fundamental difficulty with government programs that remove the incentives for people to find their own solutions to long-term problems and, instead, encourage the citizenry to become "wards of the state".Socialism is a disease that has brought many proud nations to their knees and is to be opposed at every turn. America has not learned that lesson as yet but, I fear, it soon will.

Political philosophers have written on the government’s duties and, less often, on the limits on these duties throughout history. Some (Godwin, Rousseau, Voltaire, Marx, and their contemporary incarnations have carried forward the torch of socialism, less eloquently, to be sure) have sought the Utopia of a completely egalitarian society, with equality for all. Fortunately for us, the stubbornness of man’s inherent vanity, selfishness and irremediable self-interest has sabotaged all these pretty theories and proven them, repeatedly, patently fallacious and completely ephemeral.

In opposition, one writer, a rare voice in the "Age of Enlightenment" when Utopias seemed possible, knew better of the nature of man and the limits of government. In 1780, Edmund Burke wrote a remarkably un-"P.C." polemic on the duties of government in relationship to the lower classes and what good government "owed" its "less fortunate". Here is an excerpt:

"To provide for us in our necessities is not in the power of Government. It would be a vain presumption in statesmen to think they can do it. The people maintain them, and not they the people. It is in the power of Government to prevent much evil; it can do very little positive good in this, or perhaps in any thing else. It is not only so of the state and statesman, but of all the classes and descriptions of the Rich—they are the pensioners of the poor, and are maintained by their superfluity. They are under an absolute, hereditary, and indefeasible dependance on those who labour, and are miscalled the Poor.

But the throats of the rich ought not to be cut, nor their magazines plundered; because, in their persons they are trustees for those who labour, and their hoards are the banking-houses of these latter. Whether they mean it or not, they do, in effect, execute their trust—some with more, some with less fidelity and judgment. But on the whole, the duty is performed, and every thing returns, deducting some very trifling commission and discount, to the place from whence it arose. When the poor rise to destroy the rich, they act as wisely for their own purposes as when they burn mills, and throw corn into the river, to make bread cheap." [Click here for the full text]

This, gentle reader is what could be written in the days before "political correctness" squelched hard truths, sugar-coated bitter facts and made political rhetoric nothing more than polite sound bites. In brief, speeches designed to make us feel guilty for the fruits of our labor and our belongings as they might be more than some other unfortunate. But, I fear, I digress from the point.

As to a national health insurance system in America, I say this: Firstly. now is not the time as we have neither the money nor the prospects of obtaining it to justify an adventure such as this would entail. Secondly, if we did have the money, I would argue that the experience of other nations has proven that national health systems are money pits and, with the track record of the U.S. Government, we would reestablish a multi-trillion dollar deficit with this program, alone, within a decade. Thirdly, if we had the money, it could be spent more wisely by a privately-administered insurance industry which based premiums on income and, at the very least, covered every child (who was a citizen of the nation) through 12 years old.

Finally, I refute the premise of a national health care system on its face. It is not the place of a democratic government to provide for every invented "right of man". Rights must be balanced by duties and we have given too little emphasis to the other side of that equation for far too long. Without the duties incumbent of a responsible citizenry - to educate oneself to be a productive member of society, honor the obligation of parenting a child and, in general, limitation of the animal appetites of our populace, we can have (and do not deserve) any new "rights". In point of fact, we are already losing what were once the very rights guaranteed by the Constitution because of irresponsible government and an equally unfettered nation of clueless, immoral and thoroughly feckless people..

The "right" to a national health system? Not now. Perhaps, not ever.


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Update: Still not convinced? British Hational Health System has a novel way of handling cost overruns.