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QOTD: Constitution Not Socialist July 11, 2007

Posted by federalist in Government, Healthcare.
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Mark Fuller in today’s WSJ letters:

[O]ur government is to “provide” for the common defense and “promote” the general welfare. I cannot find in any of the early documents that government is to “provide” for our welfare. Our Founders gave us a blueprint for a republic, not a blueprint for socialism.

Also noteworthy from today’s letters: Uwe Reinhardt asks whether American conservatives are consistent in their opposition to socialized medicine.

Why do I never hear any Republican political candidate, or the editorial page of the Journal for that matter, openly advocate the abolition and privatization of the VA health system? Why are even the staunchest American conservatives, and the veterans themselves, so protective of the VA health system, if socialized medicine is so bad?

Since veterans indeed seem very protective of the VA system it seems fair to assume it “works,” i.e., it provides quality service in a reasonably timely fashion.  The classic formulation, “Speed, Quality, Cost — pick two” leave me to wonder if the VA system is cost-effective, or if it’s just that nobody is willing to scrutinize the costs because it’s politically untenable to short-change veterans.  Or maybe it is cost-effective and it only “works” because the bureaucrats and doctors are dedicated to the mission of serving veterans so it enjoys some sort of altruist rents that aren’t available in a generic instutition.

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1. federalist - July 23, 2007

WSJ prints follow-up letters to Uwe Reinhardt today:

In his July 11 Letter to the Editor, Uwe Reinhardt states that “he has never heard a Republican candidate or the editorial page of the Journal openly advocate the abolition and privatization of the VA health system.” As Prof. Reinhardt knows quite well, the VA health system is not a form of health care insurance. In order for insurance to exist, there must be a spread of risk over the healthy, as well as those in poor health.

By definition, almost everyone entering the VA system is in need of health care because of an impairment that the veteran is well aware of. This is known in the insurance vernacular as adverse selection, which will cause any true insurance system to fail.

The VA health-care system is a social net that a compassionate society willingly funds to care for veterans, who deserve health care that they probably couldn’t receive elsewhere. Many of their needs are service related. This is why he will never hear any rational opponent of socialized medicine call for the abolition or privatization of the VA health care system.

William Stephenson
Princeton N.J.

Prof. Reinhardt wonders what makes Americans accept the VA health system while being ambivalent about other forms of socialized medicine. Brushing aside the political cobwebs, there’s a simple answer: The VA system is part of the pay package for the dedicated men and women who risk life and limb to protect our country. We understand they’ve earned this continuing compensation. An adequate pay package and socialized medicine are two different subjects.

Thomas E. Mullen
San Diego

In response to Prof. Reinhardt’s “life long quest” to understand the continued existence of the VA system, I once had the opportunity to put that question to one of our state’s esteemed senators. Having done some of my training as a physician in the VA system, I recognized it as a totally dysfunctional, bureaucratic, civil service wasteland; the care delivered was poor at extreme costs to the taxpayer. I asked the senator why we could not give a “Veteran Health Credit Card” to every veteran so that they could get first-dollar health care, anywhere, anytime they wished, and completely shut down the antiquated VA system.

I felt that their health care prospects would improve dramatically and it would still save the taxpayer millions. He most candidly answered it would be political suicide to any congressman that proposed such heresy, since the VA bureaucracy is so powerful and entrenched, and that they would be there long after he was gone.

Bill Cramer
Arlington, Texas

I would like to help Prof. Reinhardt understand the complex cerebral processes of Americans who are skeptical of government-run medical care yet support a well-funded government program for veterans. We are so grateful to our young men and women who risk their lives for our safety and liberty that cost and efficiency are secondary in our minds in ensuring that these fine people have access to exceptionally good medical care.

However, because we do not feel the same obligation to the general public, we are unwilling to support a broad-based VA-style medical system. Instead, we support policies that encourage individual choice and provide for market incentives to restrict the demand for medical services. We have a long way to go in devising policies to reach these objectives, but the alternatives — socialized medicine, Medicare, Medicaid, the Massachusetts experiment, etc. — are driving us away from these goals.

Steven R. Weisbrod
Washington


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