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The Problem with Government Healthcare August 31, 2009

Posted by federalist in Government Spending, Healthcare.
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The WSJ gave Betsy McCaughey half of their opinion page on Thursday to expose the views of Ezekiel Emanuel (“Obama’s Health Rationer-in-Chief“).  The disapproving essay concludes with a question, “Is this what Americans want?” and seems to presume that Emanual’s principles for allocating scarce medical resources are so horrifying that simply describing them is sufficient to reject them.

However this did not reduce my enthusiasm for Emanuel’s philosophy.  McCaughey’s citations show Emanual raising essential issues, making excellent ethical arguments, and providing solutions that make perfect sense for government spending on individual welfare.

The problem with this debate is that it is about two separate but sometimes correlated questions:

  1. How much healthcare should government provide?
  2. Should government healthcare usurp private markets for the same goods and services?

What is both reasonable and necessary for government healthcare would be unethical for free market medical services: Namely, a system for rationing finite resources that considers cost and benefits in a social, not individual, context.  Government can’t pretend that it has unlimited resources.  And in this debate I have not yet heard an explicit argument in favor of the default method for allocating scarce resources: queues.

Government needs some socialist basis for (A) taking money from some people (via taxes) and (B) giving it to others (via medical services).  Of course a major part of the debate pertains to (A), i.e., the degree and manner in which government is justified in coercing some people to contribute towards the health of others.  But given some level of government-sponsored healthcare Emanual offers an ethical framework — indeed, the only coherent one I have encountered — for part (B): disbursement of finite resources

The second question raised above is more difficult, but insofar as a rationing system is employed to problem 1A it need not interfere with private markets.  I.e., Govenrment should not encumber private commerce in medical goods and services even if it does itself engage in socialized medicine.

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1. federalist - September 7, 2009

Two great rejoinders in a flurry of letters to the WSJ on McCaughey’s article.
From Donald Pryce:

Ms. McCaughey deplores the fact that Ezekiel Emanuel has systematically explored alternatives and advocates choosing social over individual interests. What she ignores is that Medicare is part of an implicit choice, i.e., that irrespective of need the elderly should receive public support while the uninsured young should not, but should help to pay the premiums.

And from Richard Amerling:

In his Lancet article, Dr. Emanuel assumes perpetual scarcity: “. . . the scarcity of many specific interventions—including beds in intensive care units, organs, and vaccines . . . is widely acknowledged. For some interventions, demand exceeds supply.” In fact, shortages in these specific areas, and shortages in general, are the result of government policy.

The number of intensive-care beds cannot be expanded without first applying for a “certificate of need” from state health authorities. The organ shortage is entirely attributable to the 1984 federal law banning “valuable consideration” for donated organs. Vaccine shortages are a direct result of the de facto nationalization of the vaccine industry under the Clinton administration, and tort litigation based on junk science.

Price controls and caps on specialist training slots have created physician shortages that will only worsen under ObamaCare.

We need to get the government out of the health-care industry, which is the opposite of what Congress and the White House are pushing.


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