A Stitch in Haste

An op-ed contributor* at the Washington Post tries to go from "oncologist" to "economist" —

The U.S. health-care system has two distinct parts — financing and delivery. The financing system is how we pay for health-care services. It is composed of employer-based insurance, the individual insurance market, Medicare, Medicaid, SCHIP, the veterans health system and other programs. Today, the private part — employer-based coverage and individual insurance — accounts for just under 55 percent of all payments for health care, while government contributes about 45 percent.

The delivery system consists of about 850,000 doctors, 5,000 acute-care hospitals, 39,000 pharmacies and 8,100 home health agencies, as well as hospices, surgical centers, radiological centers, laboratories and other outlets that provide the actual health-care services Americans need.

Strange, nobody thinks of the local supermarket in terms of "two distinct parts — financing and delivery." Nor does anyone partition a restaurant, or an auto body shop, or an investment bank, or a barbershop, into "financing and delivery." Just health care. Why might that be?

And the answer is not "because of insurance." Automotive insurance is not thought of in terms of "two distinct parts — financing and delivery." Neither is homeowner insurance, life insurance, travel insurance or any other kind of insurance.

The answer is because we have a government-imposed disconnect, an obsolete relic of World War II command-and-control economic authoritarianism, in which employers receive an irrational tax advantage for providing health insurance directly rather than simply paying employees more and having them buy their own insurance. The "financing and delivery" dichotomy is in no way endemic to health care — it is entirely a creature of government. As are, by corollary, all the problems and shortcomings that have flowed from it over the past sixty years.

And still the apologists for socialized medicine refuse to even consider that maybe, just maybe, the solution is to revisit that archaic structure: to revisit those "two distinct parts — financing and delivery" rather than simply take them as a given.

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Oops, did I say "socialized medicine"? Shame on me!

Properly speaking, socialism is when the state owns or controls the means of production. Thus "socialized medicine" is when the doctors are state employees; when the hospitals, drugstores, home health agencies and other facilities are owned and controlled by the government.

Assume as a thought experiment that tomorrow the federal government imposed a bubble gum tax, added on to existing payroll taxes. In exchange for these compulsory taxes, everyone would receive "free" bubble gum (because all enlightened, compassionate folk agree that there is a "right to universal bubble gum"). The bubble gum could come either directly from government-run bubble gum dispensaries, or via a bubble gum voucher or reimbursement program.

Would this be "socialized bubble gum"? I think so. I think you have to be a moron not to think so. Either way, does it really make a difference regarding the underlying impropriety of the program whether it's called "universal bubble gum coverage" or "socialized bubble gum" or "authoritarian bubble gum" or "command-and-control bubble gum" or "HillaryBubble 2.0" or "RomneyGum" or "zoop"?

Of course not, any more than it matters whether you call a cancerous growth a "tumor" or a "lump" or a "malignancy." Whatever you call it, it's simply not a good thing. And the appropriate treatment for it is certainly not be "more of it."

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*The piece seems to have been pulled from the WaPo site. Go figure.