Protesters supporting “Medicare for All” hold a rally outside PhRMA headquarters in Washington, DC. on April 29, 2019. (Win McNamee/Getty Images)
Medicare for All is one of the major topics being discussed this election cycle, particularly by Democratic presidential hopefuls.
It’s also one of the least understood topics in the public debate, despite that it’s incredibly important. Almost every one of us will need health care services at some point in our lives, and particularly as we age. Yet it’s rare for anyone to actually discuss the meaning of Medicare for All, or single-payer insurance, which are pretty much the same thing. The terms are thrown around specifically to confuse.
No matter the terms used, the bottom line remains the same: We’re discussing socialized medicine. It’s socialized, or a product of socialism, because it would be completely government-run. As someone who has actually lived under socialism and seen the ugly reality of this type of system, I have a few observations.
Even the current use of these terms is purposefully deceptive and designed to dissimulate the real meanings, which should make any thinking person worried. Take, for example, the name Medicare for All. Medicare is a program designed to cover seniors as they reach 65 years old, particularly if they don’t have health insurance. If you already have health insurance from an employer even after retirement, which has been the case for the majority of people, then Medicare acts as supplemental insurance. It’s essentially a supplement or safety net for citizens 65 or older, depending on the circumstances.
Medicare for All, on the other hand, completely replaces all insurance.
The term single-payer is similarly used to mislead. The reference to single-payer means there is only one payer of insurance claims because there is only one insurance company that exists—and that is the government. It’s a curiously odd way to phrase 100 percent government-run health care.
More important is the way that a government-run system must function, compared to that of private insurance.
When insurance is provided by the workplace, the number of providers that can exist and pay medical expenses is essentially unlimited, with hundreds of thousands of associations, companies, and businesses involved. A government-run system has to be paid through taxes, and there are always limits on how high taxes can be raised, particularly since high tax rates already exist to cover all the other costs of government. As a result, under the government-run system, there are instead limits on the budget for medical expenses.
There’s another factor that’s seldom discussed: the horrible inefficiency of the government in general.
We rate charities by their efficiency, and that’s an important factor in deciding whether to make a donation. The best charities are about 90 percent efficient, meaning for every dollar you give to them, they only spend 10 cents on overhead such as office space and paying salaries. Generally, a charity with, say, a 50 percent rating means it is spending 50 cents out of every dollar on overhead expenses and is deeply inefficient. Usually, the largest overhead expense is paying salaries, so it means these types of organizations that drop below 50 percent efficiency are more of a platform to pay themselves than they are a charity.
What we don’t see are the efficiency ratings of government with regard to paying out funds meant to help people. Government can’t possibly be efficient when you think of all the levels of bureaucracy our tax dollars pass through: Congress, which makes the budget; the IRS, which collects the money; the Treasury Department, which makes the actual payments; the General Services Administration, which makes all the many contracts needed to accomplish everything else; and the list goes on.
Worldwide, socialized medicine has always ended up going down the same track. At first, it seems to work, then quickly it comes under budget constraints.
There is always a small number of people who receive huge amounts of medical services, often seeking medical help for even the most minor requirements. There’s no reason not to do so, because treatment is free. We have had emergency rooms around the United States close because they can’t turn anyone down for treatment, even if the patient can’t pay.
Budget limits always force the system into a deficit, and once that stage sets in, the government has no choice but to begin to find ways to limit services and cut costs. Limiting services is done logically, and the first procedures to be affected are the big, expensive, and difficult procedures, which are, of course, almost always lifesaving by their nature.
Transplants are a perfect example of both an expensive and difficult procedure, and they don’t always work. Quickly, the number of such operations becomes limited, and those in need often die before they move to the top of the list. Critics call the overseers of this process “death panels,” because they decide who will receive the lifesaving procedures and who won’t. That decision process carries over into every aspect of medical treatment.
By necessity, the process ends in triage. The working-age individual is the highest priority on the list, because, once “repaired,” they can go back to work and pay taxes into the system. The next priority is the young, because they will grow into taxpayers. The last and lowest priority are the old. Their utility to the system is zero, and they only represent a drain on medical and retirement resources. They’re supposed to die to make way.
As costs go up, the government invariably “fixes prices” so that doctors are forced to have a private practice on the side to make money. All the best medical care takes place in those private clinics, which aren’t covered by any insurance. That means only the rich get good medical care, because they’re the only ones who can afford it.
The largest of companies will open private clinics for their employees and hire a certain number of doctors to work there, at a decent salary, because the medical system is so bad. This doesn’t create a government-run insurance problem, because the medical care is given out only at the company’s clinic and is a direct benefit to employees. The government allows these because it reduces the strain on the system.
Brad Johnson is a retired CIA senior operations officer and a former chief of station. He is president of Americans for Intelligence Reform.
Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times.