For everyone who believes more government force is the best way to solve problems, the Democratic presidential debates must feel like an all-expense-paid vacation at a fantasy camp.
Take health care. They’re trying to.
Lost in all the thundering that health care is “a human right” is the obvious fact that health care is a service provided by people who spend a lot of years acquiring the knowledge essential to providing it. They work in facilities that are expensive to construct and maintain, and they carry costly liability insurance to cover the claims if anything goes wrong.
Free speech is a right. Free health care is a fantasy.
At a baseball fantasy camp, people who lack the talent to play professional baseball can wear the uniform of their favorite team and hang out in the locker room with their favorite players. It’s really cool, and it’s really expensive.
But not as expensive as presidential candidate fantasy camp, which if you’ve watched the Democratic debates has already cost you four long evenings that you’ll never have back.
Then there’s the cost of the policy proposals. Some of the presidential candidates are pushing a policy they’ve named “Medicare for All.” But of course, they don’t all mean the same thing when they use the same term.
Former Vice President Joe Biden favors adding a “public option” to the Affordable Care Act that his campaign estimates will cost $750 billion over 10 years. Biden would pay for this by raising the top income tax bracket to 39% and raising capital gains taxes for families with incomes over $1 million.
Biden thinks health care is a right to somebody else’s money.
Sen. Bernie Sanders thinks Biden’s plan preserves “corporate greed” and advocates a “Medicare for All” plan that will make competing private health insurance illegal. He says there will be dental, hearing and vision coverage, as well as coverage for long-term care, with no insurance premiums, no deductibles and no co-payments.
Last year, a study by the Mercatus Center at George Mason University said the Sanders plan would cost something like $32 trillion over ten years. Other studies have found that it would cost far less, possibly even saving the government money.
Can you guess how?
The difference between the $32 trillion estimate and the money-saving estimate is how much the government pays medical providers.
If doctors and hospitals are paid the Medicare reimbursement rate for all patients and procedures, the plan costs a lot less.
Can you guess how that will work out?
Want to go to medical school? Come on, it’ll be fun. You study biology and chemistry and every aspect of medicine, and you stay up all night cramming for exams, and you work insane hours during a years-long period of training, and when you finally become a physician you’ll get to work for payments so low that you will literally lose money every time you see a patient.
No? It doesn’t sound like fun?
Well, there goes my investment in Medical Fantasy Camp. I really thought that was going to be a winner.
One question the debate moderators forgot to ask the candidates: Raise your hand if under your plan, doctors would earn less than the guy who refills the vending machine in the break room.
Sanders’ latest Medicare-for-All bill is co-sponsored in the Senate by four of his Democratic presidential rivals: Sens. Cory Booker, Elizabeth Warren, Kamala Harris and Kirsten Gillibrand.
There are ever-evolving differences in their views on the specifics. These have been the subject of much discussion by people who like to spend their time arguing over fantasy camp topics like whether the ’27 Yankees were better than the ’75 Reds. For example, Sanders would phase in his single-payer system in four years, Harris would allow ten.
There are also ever-evolving differences between the Harris plan and the latest Harris plan, including whether private insurance would be outlawed or just vilified.
Most of the Democratic candidates are in favor of vilifying private enterprise of all kinds, especially insurance companies and pharmaceutical makers.
Suppose they succeed in eliminating private insurance and putting price controls on prescription drugs, or, alternatively, suing major drug companies into bankruptcy over their marketing practices for painkillers.
Then everyone will have the same health coverage, provided by the government. Doctors who stay in the field will have to work for whatever the government chooses to pay, and they’ll probably have to fill out even more paperwork to justify every decision and demonstrate every outcome. There will be more patients and fewer doctors, meaning longer waits, and if enough hospitals close, a lot of people may need a plane ticket to get to the nearest medical provider.
The Affordable Care Act attempted to require all Americans to buy health insurance and to subsidize everyone who couldn’t afford to pay for it, while requiring insurance companies to cover everyone and to include certain mandatory minimum benefits in every policy, without crazy rate increases.
Even the Democratic presidential candidates don’t defend it any longer, if they ever did.
Under the Tax Cuts and Jobs Act of 2017, signed into law by President Trump, the penalty for not buying insurance is now set at zero, which has caused the courts to question whether the law is still constitutional. The Supreme Court upheld the ACA only because the penalty was a tax, and Congress has the power to levy taxes. Nothing in the Constitution gives Congress the power to require Americans to buy health insurance or any other product or service. With the “tax” set at zero, the ACA could be tossed out by the Supreme Court.
We’re all going to have to figure this out together. Naturally, after I sell my investment in Medical Fantasy Camp, the demand for it skyrockets.
Susan Shelley is an editorial writer and columnist for the Southern California News Group. Susan@SusanShelley.com. Twitter: @Susan_Shelley.
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