Vouchers for all medical care?

Health-care reform is in the air. Unanimous dissatisfaction with the current system on the part of patients, business, insurers and physicians has placed the U.S. health-care system on the front pages.

Most worrisome, much discussion centers on more government control and bigger bureaucracies to satisfy an attitude of entitlement — that health care should be highly advanced, fully accessible for all and paid for by “someone else” — regardless of who.

In the present system, patients are isolated from paying directly for their care by the third-party payer. Consumers do not even consider cost, because of the illusion someone else is paying. Meanwhile, bureaucrats own health care and control the decisions by controlling the money.

Empowering the American people to direct their own health care must center on giving patients control of the money: The “ownership society” would extend to health care. Direct spending from patient to doctor for the great bulk of medical care is an essential remedy for health-care costs. Prices come down when the patient is the customer.

Universal coverage is a reasonable goal, but not for the reasons many assume. For the uninsured, lack of access to top-notch medical care is not the issue. Nor is reduced overall cost to the system via insuring the uninsured. And we will not debate the idea a significant portion of uninsured persons simply choose not to pay for insurance rather than find themselves unable to do so because of straitened circumstances. Data show the major benefit of universal insurance is that preventive care and health outcomes probably would improve for those who now lack insurance. Those goals are unquestionably desirable.

The top-down, statist control of medical care based on government vouchers proposed by Ezekiel Emanuel and Victor R. Fuchs in the New England Journal of Medicine represents a very naive and hazardous approach to medical-care costs. They propose government vouchers for all health care, and a new government-controlled health-care bureaucracy.

While the voucher gives the appearance of individual responsibility, there is no substance to it. “Government vouchers for all health care” will transfer virtually all control to the politicians (directly or indirectly through government boards) for the entire health-care system. That system would let government bureaucrats determine which benefits are insurable, decide which diseases, ailments and injuries are worthy of government subsidies, and dictate how and what amount health-care providers are paid.

We need only look at how government actually handles these issues to see how untenable this is. When government specifies which benefits are insurable, the state mandates services that many people would never buy if free to choose. If government dictates which diseases are worth government subsidies, are we ready for a national debate over covering abortions? On one hand, why shouldn’t they be provided for poor women? On the other hand, should government require Catholics and others who oppose abortion to pay taxes to support it?

Are we also thinking of giving government complete authority over how health-care providers are paid? We all must realize how government-administered price-setting has already distorted health-care decisions and failed to control costs.

In addition to the alarming authority given politicians, there is little reason to believe these plans will lower expenditures. Government voucher systems covering all medical care will in no way attack the basic source of unwanted cost growth — the third-party payer system, which shelters patients from making cost-conscious decisions, produces massive administrative costs and induces artificial pricing.

Moreover, there are good reasons to believe it will lower quality (an inevitable result of more government interference in areas where it has little expertise and should stay at the periphery).

The basic assumption government is responsible for providing medical care is something that must finally be scrutinized and debated. Are not food, housing and clothing just as important in the long run as medical care? On the same principle, should they not also be provided to everyone?

Yes, medical information transparency is imperfect between patient and doctor. But on what basis does that lead to the conclusion government is the answer?

It would seem Americans would not desire a complete totalitarian state, a Big Brother protectorate. Yet that is the path we contemplate.

As a physician, a patient and an independent and thinking citizen, I would be naive to believe in a beneficent government capable of all good things. It is disturbing to give the government such unprecedented authority over our most important personal decisions and individual rights.

More government control over my health care and that of my family is simply unacceptable. In my profession, that would be termed the ultimate case of malpractice.

Scott W. Atlas, M.D., is a senior fellow at Stanford University’s Hoover Institution.