The Medicare Disaster:

I've just had an enlightening conversation with dear Sovay, who is up in arms over the Medicare disaster. "What Medicare disaster?" you may be forgiven for asking if you, like me, have been paying no attention to the subject these last few months. But it's a big story, as you can see reading here and here, and also here, that last link being to Josh Marshall's blog. Marshall, as everyone knows, is given to monomaniacal focus -- which can be a useful trait in crisis situations, though it keeps me from reading him often -- and just now it's Medicare he's focused on.

I don't write to criticize except on one point, which is the corruption involved in (a) misleading everyone as to what this program would cost (i.e., the usual corruption involved in socialist welfare plans), and (b) allowing lobbyists so much influence in how the law was written. Both complaints are with the Congress as much as with the administration; they set out to pass this benefit for political gain among seniors, and apparently did whatever was necessary to achieve that goal. If that meant downplaying costs, as it always does when the government goes into health care, so be it; if that meant giving their corporate lobbyists access so as not to see a withering of financial support from them, so be it.

This is in fact corruption, of a predictable and sad, but pervasive type.

Sovay holds that I am "setting the bar too low" in not being outraged over the other aspects of this case, the most troubling of which is that people are going to die because of the government's rank mismanagement. As I've explained to her, people dying due to mismanagement is what I expect when the government is placed in charge of important matters. This is never more true than when it attempts to take over health care duties.

It's not that I don't care; it's that the political class and the seniors are absolutely insistent on the government doing this. As a result, these disasters are inevitable. Government is not competent to handle anything this important. There are some important things that have to be handled by government, because no one else can do it at all -- maintaining a functional blue-water navy, for example. That doesn't mean the government does it well, just that they're the only ones who can do it at all. Ask any squid what he thinks of Naval bureaucracy sometime. (If you really want to hear some griping, ask what he thinks of their health care.)

I have always been hostile to the idea of a prescription drug benefit, as I am always hostile to all government health care schemes. Mark Steyn has written a few pieces on this subject, including this one:

Making idle chitchat as his fingers felt his way around my fleshly delights, [Steyn's doctor] explained that "waiting" is built into the concept of a government health service: "If you need surgery," he said, "it's in my interest to get you in and operated on as soon as possible, because that's money for me. The faster it happens, the better my cash flow. But when the government runs the system, every time you get operated on it costs the government money. So it's in their interest to restrict or delay your access. When you look at the overall budgets--salaries, buildings--it's not hard to understand that the level of service you provide to the patient is one of your few discretionary costs. So the incentive is to reduce that."


A few years back, [Steyn's wife] felt herself beginning to miscarry. Nobody was at home so she called a cab and went to the emergency room at the Royal Victoria. Knowing what "emergency" means in the Quebec system, she grabbed a novel on the way out--an excellent choice, Mr. Standfast by John Buchan, our late Governor General. It's 304 pages, and my wife had the time to read every single one of them before any medical professional saw her. While she was reading, she was bleeding, all over the emergency room floor, the pool of large dark red around her growing bigger and bigger, until eventually a passing cleaner ran her mop over the small lake and delivered a small rebuke to my wife for having the impertinence not to cease bleeding.... Since my wife's experience, the average wait time in Montreal emergency rooms has apparently gone up to 48 hours. So don't pack an overnight bag, take two, and the complete works of John Buchan.
Steyn's wife didn't die, but in Montreal hospitals the death rate is four times the US average from an easily prevented infection that normally results from a lack of cleanliness. The government runs the janitorial services, too.

So now the government has taken it upon itself to provide for lifesaving drugs of millions more people than ever before. The short term consequence? Lots of those people will get very sick, and some of them will die, because the bureaucracy isn't up to the task.

Sovay asserts that any other administration -- Clinton, Bush I, Reagan -- would have handled this better. I honestly don't believe that. It's nothing in favor of Bush II, who certainly isn't the President that Reagan was. It's just that this is exactly what I expect from government, which is why I think we should keep it out of as many places as possible.

The other thing I think about it is that we should tend to push the required government "down" as much as we can, as local governments tend to be relatively more responsive. Sovay tells me that twelve or fourteen states are now providing lifesaving drugs on an emergency basis, since the Feds have totally failed to do so. Great, I say -- if they're succeeding where the Federal government has failed, let's have them do it instead. Block grant the money to them, and fire all these bureaucrats at the Federal level -- including the Bush appointees at the top, if you like. Fine with me. Then, if there is a problem, there's a chance the folks at the state level might really get it fixed.

I don't mind if Bush takes a political hit for this. He deserves one. But let's be clear on why he deserves it. It isn't because the program should have been managed better. It's because he should have known that this is how it would be managed.

This is what government does. It has no business being involved in health care, except -- perhaps -- in terms of block-granting money to the states to protect the poorest and the weakest who truly can't make market-based arrangements. Even those are far from perfect -- I get annoyed with my insurance company every time I think about them -- but they're far better than any government endeavor at the basic work of keeping patients alive, clean, and keeping the wait times short.

For those American citizens who really can't avail themselves of that better way of obtaining health care, I don't mind that we should look out for them. But let's do it at the state level, and restrict the Feds to providing the cash to poorer states if necessary.

Of course, we're not really going to do that. What we're going to do is muddle along with the bureaucracy in panic mode, with people growing sick and dying because they either trusted or were forced to trust the Feds to keep their promises and manage to run things in a good order.

Don't weary me with "experts" who say it could have been done better; if those experts think so, they can take the job at a government wage. They're obviously qualified. They'd rather work at their think tanks instead? Then they can shut up. They aren't interested in doing what it takes to fix the problem. They want to slam others for 'not caring enough,' but they care more about their cheery paycheck than about getting their hands dirty and making things right.

This is a disgrace. Congress, the President, and the whole health-care bureaucracy are equally damned by it. They ought to be ashamed of what they've wrought.

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