Up till now, voters considering what might change in America's health care system under a new president have probably felt safe assuming Republican hopeful Mitt Romney would favor a national version of the plan he signed into law in Massachusetts.
In the Bay State, carrying health insurance is now mandatory, just as carrying car insurance is essentially mandatory for all American drivers. But those who find those insurance payments prohibitively expensive are promised tax subsidies or credits, essentially shifting much of the burden of medical costs onto taxpayers, turning health and medicine into expensive, collective responsibilities.
Former North Carolina Sen. John Edwards is also offering a plan that would require every American to buy health insurance, though federal tax subsidies would help reduce the cost of coverage.
On Monday, with what the campaign doubtless hopes would be a dramatic drum-roll, the consensus Democratic front-runner, former first lady and current New York Sen. Hillary Clinton, unveiled her own health care proposal.
During her husband's first term in office, Mrs. Clinton was put in charge of a committee that met in secret to devise a nationalized health care system. The result was the 1,300-page "Health Security Act," which would have created a system closer to the socialized arrangements now familiar in England and Canada, even going so far as to impose criminal penalties on doctors and patients who "got out of line" and attempted to negotiate treatment for cash outside the government rationing system.
The plan was a political disaster, "almost derailing Bill Clinton's presidency and helping put Republicans in control of Congress for years to come," in the summary of those 1993 events being circulated by The Associated Press this week.
Sen. Clinton now says she has learned from that experience, jettisoning the complexity and uncertainty of that last effort in favor of a plan that stresses simplicity, cost control and consumer choice.
And what is that plan? Mandate that every American carry health insurance, while offering federal tax subsidies to help reduce the cost of coverage. Yep. Make that three.
Leave aside for now the notion that a new $110 billion-per-year program (do we hear $300 billion?) represents "cost control." Unfortunately, Sen. Clinton either misunderstands or misstates the problems with her 1993 effort. Certainly it was overly complex -- as any attempt by the government to take over a major slice of our relatively free-market economy would have to be complex.
But is the pursuit of "simpler" state-run bureaucratic compulsion -- telling doctors and hospitals to spend less money, deciding which sick people go to the front of the line and which to the back -- really the answer?
The care of highly trained medical professionals will always be in limited supply, as will access to the most modern and effective medicines and medical equipment.
When demand for anything exceeds the supply, some form of rationing is inevitable. In a free market, rare things and services are "rationed" by price. Those who work hard and succeed can afford more and better. Providers are encouraged to develop and offer improved service and technology through the profit incentive. Those of lesser means are still able to purchase far better medical care than is available to anyone under a socialized system by working hard, putting away savings, developing a credit rating that allows them to pay off medical bills "on time," and by entering de facto voluntary medical "collectives" by purchasing some form of health insurance, if they wish.
Meantime, under a free-market system -- free of compulsion -- doctors and hospitals have always offered life-saving care to the indigent on a charity basis.
But under government-run systems of socialized medicine, it's ultimately the politicians and the politically favored who ration care as they see fit. Those moved to the back of the line may be older patients, those whose prognoses are not as good, or those who are seen as "undeserving" because their own bad behaviors caused their health problems.
The more Draconian features of the original 1994 HillaryCare proposal were no accidents. They are necessary components of any system of state medical compulsion.
As a side effect -- and as we are already seeing under the current "partially" socialized regime -- all kinds of new things come to be viewed as the "legitimate" concern of the bureaucracy now undertaking to pay our medical bills, from whether we smoke and drink, to whether we eat fatty foods, right down to whether we wear safety helmets and seat belts, and pay extra for all kinds of other "safety" stuff.
It's called the Nanny State.
There is another way, of course. States could encourage insurance companies to offer less expensive, "stripped-down" plans -- rather than ordering them to add all manner of costly, politically favored coverages.
States could be encouraged to admit to the practice of medicine anyone who meets fixed standards -- no raising the bar to prevent "too many" physicians or hospitals from being licensed and thus creating "excess competition."
Beyond that, politicians could encourage the lowering of prices that always follows free competition by urging doctors and medical centers to post their prices and hourly rates, and by further "allowing" them to charge less to those who wish to pay in cash, than they charge those who expect these practitioners to absorb the additional costs of billing (and waiting for partial payments from) Medicare or Medicaid.
Which presidential candidate is suggesting that?
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