Stay healthy: government-improved healthcare will mean ailing sickness care.(HEALTHCARE)(Cover story)

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If they had been designing a health system from scratch, the change agents assuming power in January would have done things differently. Barack Obama and Ted Kennedy would have given us a Single Payer for medical care, as in Canada and Britain (and Cuba and North Korea) and (according to national healthcare promoters) "the rest of the industrialized world." Senate Finance Committee Chairman Max Baucus (D-Mont.), on the other hand, doesn't feel he needs to go so far back in time, but he'd make similar changes nonetheless. In his Call to Action: Health Reform 2009, he speaks of failed efforts to enact "national health insurance" or "socialized medicine," starting around the turn of the last century, in 1900. It's finally time to just get it done, they say.

The motive behind their efforts, they also say, has to do with about 46 million uninsured Americans. But the politicians' plans are not just about insurance, which is only a method of payment for medical services. The real agenda is to use "coverage for all" as a lever to make fundamental changes in the way patients are treated--and in the economy and society as a whole. This is evident to anyone who listens carefully. Obama, Kennedy, and Baucus are talking about universal health reform, or what Baucus calls "serious and comprehensive reform of the health system in crisis."

This is also evident if one analyzes the "insurance" model they have in mind to follow--Massachusetts' healthcare plan, which boasts of achieving universal coverage, or almost, by forcing most people to buy insurance or face a tax penalty, or, if eligible, to enroll in a government-subsidized plan. "Progressives" like the plan for several reasons. In particular, young and healthy patients would be forced to pay more to subsidize older, sicker patients. (It plays off the Obama "wealth redistribution" idea.) Instead of pricing premiums according to risk, insurers would have to accept all corners, and charge them all the same. This changes the nature of the product from insurance, which is about the accurate pricing of risk, and turns it into a collectivized prepayment system. Welfare, in other words. Premiums become a type of privatized taxation--a neat way of sidestepping protests about tax increases.

What We're Promised

Obama has promised to allow people to keep the insurance plans they have if they like them. Their plans, however, might no longer exist because they might not measure up (likely won't measure up). The plans won't pass muster if they allow a person to benefit from good health and a prudent lifestyle, and not "contribute" enough to the collective pool. But if your plan can no longer be offered, don't worry; a proposed insurance exchange, like the Massachusetts Connector, would match people up with a "high-quality, affordable, comprehensive, nondiscriminatory Health Plan." Insurers may go along with the scheme in exchange for a guaranteed market: 46 million new customers overnight! And individuals would have to buy a product they might otherwise reject as being unnecessary or too expensive. Obama promised to delay forcing the plan on Americans until insurance becomes "affordable"--by the government's definition, not necessarily the customer's--but he may well accept the demands for mandates.

Obama and friends also promise that they will ensure that providers deliver quality care--better care than we have now. The reformers claim that at the present time the United States spends much more than other countries but still has worse health outcomes. They claim to know this because rankings made by the World Health Organization place U.S. medical care below most other developed countries--far below most socialist countries. In the WHO ranking, France has the best medical care, Italy came in 2nd, the United Kingdom was in the 18th spot, Saudi Arabia 26th, and Canada 30th. The United States came in 37th, just above Cuba (in 39th place). The politicians don't state (or don't know) that the WHO rankings are designed to place a much higher value on "equitable" access and less value on satisfying consumers' desires. In fact, if everyone in a country received poorer medical care than people in the United States, but care was "universal," it could rank higher than the United States. (See "Bad Economics & Medicine" in our January 5, 2009 issue for a more detailed explanation of the WHO rankings.)