Try to imagine a regime where, for whatever reason, the government decided to tax 99% of the population to subsidize wedding receptions for the other 1% of the population. A contrived scenario, I admit, but bear with me (perhaps it could be a future "reparations program" for gays who were unconstitutionally denied marriages by states with bigot amendments -- faux "reparations" are a hot policy topic in certain circles these days).
In any case, does anyone doubt that those 1% could have some mighty fine wedding receptions?
Now imagine that some malcontents, saddened and maddened by the fact that not everyone has wonderful wedding receptions, were to demand action. As much as one-sixth of the population, we are told, have no wedding receptions at all. Yet look at the wonderful job that the government's "1% program" does at providing wedding receptions. Why not just expand that?
So, after much huff-and-puff over whether there is a "right to a wedding reception" and whether the government should take over the entire wedding reception industry, the program is expanded to the point where it is not 99% of the population paying for 1%, but rather 1% paying for 99% (or, if you prefer, 100% paying for 100%, but only through a government single-provider bureaucracy). Could the quality of government wedding receptions be maintained as the program expands? Wedding receptions (which, again, can now only be obtained via the government program) would of course deteriorate over time. Eventually the program would go bankrupt.
This is certainly not a difficult scenario to understand in the context of wedding receptions.
So why is it such a difficult scenario to understand in the context of
health care?
Over the last decade or two, the [Veterans Health Administration] system has become a worldwide leader in both the adoption and the invention of health-information technology, and it has leveraged its innovations into quantifiable gains in quality of care.
...
Indeed, the VHA's lead in care quality isn't disputed. A New England Journal of Medicine study from 2003 compared the VHA with fee-for-service Medicare on 11 measures of quality. The VHA came out "significantly better" on every single one.
Note that this article is almost two months old and did not inspire this post. Rather, it was
this infantile Tapped post a few days ago, in which we are told that leading healthcare socialist Ezra Klein "delivered a first-class ass-whupping to Larry Kudlow" -- by doing little more than citing, ad nauseum and dishonestly, the Veterans Health Administration. To Klein, the VA appears to be the beginning and end of the discussion regarding socialized medicine -- just look at what an amazingly great (single-payer) job the VHA does -- so why not just make the rest of American health care exactly the same?
Which is, of course, utter nonsense. It is nothing more than the wedding reception fallacy.
Naturally, it's easy for the VHA to provide exemplary health care -- it's the "99% supporting 1%" situation. The entire federal tax base is underwriting the health care of a minuscule subset of the population (who, incidentally, tend to be far healthier than average going into the military -- even if they're
not so healthy coming out of, say, Iraq or Afghanistan).
But merely "replicating" the VHA would be switching to the "1% supporting 99%" scenario -- and it simply won't work. This is not a difficult concept: 99% successfully supporting 1% does not imply that 1% can successfully support 99%. In fact, you need only
two sentences to show why.
If a (properly administered and deployed) military is a legitimate public good (and it is), then surely providing at least some health care for veterans is also a public good, no different than providing them uniforms or bullets. That isn't the point. The VHA is a perfectly proper function of government. No dispute there.
The point is instead that, when central planner wannabes confuse legitimate public goods with their own warm-fuzzy-feeling agendas, then suddenly everybody starts paying for everything for everybody while nobody pays anything for anything. And then the system collapses under its own moral hazard, and these very same central planners claim not to know why.
There is nothing "cold and heartless" about expecting people to pay for their own wedding receptions. Or, to the extent possible, for their own health care -- supplemented when necessary by basic charity and a basic dole. No single payer or provider required, except to sate the egos of philosopher-king hopefuls like Ezra Klein.
Those who insist otherwise should think long and hard before praising each other's ass-whupping skills. There are no greater ass-whuppers than the laws of economics, the moral defectiveness of politicians, and the omnipresent incompetence of bureaucrats.