Is  A Comprehensive Universal  U.S. Health Care  System Possible?

Resolving the complexities of the American medical scene in one comprehensive program has been an invitation to debacle for more than a half-century.

Editorial, “The Emerging Disaster of ObamaCare,” Washington Times, April 8, 2016

Is  a comprehensive, universal, government –run health system  possible?

Is it possible for government alone to insure,  record, oversee, standardize, dictate, and pay for the care of 330 million Americans engaged in over 2 billion annual health care engagements and transactions?

And, if the comprehensive strategy fails,  is it possible for  a centrally planned plan to  be replaced by a comprehensive market-based system relying on competition and free-choice?

Neither System Alone  Is Possible

Neither system is possible. We need both.    Even socialized countries are turning to markets for relief  from rationing and demands of citizens  for access to the latest in life-saving technologies.  And even the most market based care must  provide government programs for the poor.

In the US,  Medicare, Medicaid, ObamaCare, and the VA cover 150 million, employers insure 160 million, and 20 million linger in the uninsured shadows. 

Despite all the talk  income inequities,  there are never  enough “rich” to cover everybody.

The possibility of a comprehensive system, either exclusively government-driven  or privately-run is impossible.  There are simply too many complexities, variables and  choices.   “In two words,” observed Samuel Goldswin of another venue, “ Im- possible.”

Yet the yearning for the impossible as articulated by Senator Edward Kennedy at the 1980 Democratic  convention lives on, “The work goes on, the cause endures, the hope still lives, and the dream lives on.”  Senator Bernard Sanders has picked up the progressive mantle by calling for Medicare-for-All at the cost of $15 trillion over the next decade.   Dreaming the impossible dream to reach the unreachable star never dies.

Both government  and the private-sector  have their limitations when it comes to providing  comprehensive care – government  because it breeds an incomprehensible bureaucracy that cannot deliver on its promises without rationing,  private markets because they cannot provide  unprofitable “free” care,  leaving sick patients out of luck and out in the cold.

Here is Peter F. Drucker (1909-2006), commenting on the role of government  in his book The Age of Discontinuity,

“We no longer trust government to perform. We have become a global shopping center and an information and knowledge economy driven by the computer. Government is too big, cumbersome, and inefficient to provide for or protect its citizens.”

“Once the ‘wicked private interests’ have been eliminated, the right course of action will emerge, and decisions will be rational and automatic. Private business and profits are bad – ergo, government ownership must be good.”

“The British in adopting the ‘free health service’ believe that medical care would cost nothing. All the health service is and can be is, of course, ‘prepaid’ health care. Nurses, doctors, hospitals, drugs and soon have to be paid by somebody. But everybody expected this “somebody” to be somebody else. At the very least, everyone expected that under a free’ health service the taxes of the rich would pay for the health care of the poor. There are, of course, never enough rich people to carry the burden of any general service.”

“The greatest factor in the disenchantment with government is that government has not performed. Government has proved itself capable of doing only two things with great effectiveness. It can wage war. And it can inflate the currency.”

“The best we get from government in the welfare states is competent mediocrity. What is impressive is the administrative incompetence. Every country reports the same confusion, the same lack of performance, the same proliferation of agencies, of programs, of forms, and the same triumph of accounting rules over results.”

“Certain things are difficult for government. Being by nature a protective institution, it is not good at innovation. It can never really abandon anything. The moment government undertakes anything, it is entrenched and permanent. Every beneficiary of a government program immediately becomes a” constituent.”

“Government is a poor manager. It is, of necessity, concerned with procedure, for it is also, of necessity, large and cumbersome. It must administer public funds and must account for every penny. It has no choice but to become ‘bureaucratic.”Every government is, by definition, a ‘government of forms.’ This means high costs. For ‘control’  of the last 10 percent of phenomena always costs more than control of the first 90 percent.”

Only history will tell if government is up to the job. History is not optimistic.