- - Wednesday, March 15, 2017


Lost in the partisan bluster and shouting about the future of Obamacare, and the Republican “repeal and replace” reform, is the stark reality that the nation has arrived, finally, at the point where it must decide what kind of health care it wants, and how to pay for it.

With Obamacare in ruins, Congress and the country have two ways to go. Option #1 is to turn to a free-market health-care system that maximizes consumer/patient choices, competition among providers, and the privately directed innovation that has made American health-care the best in the world.

Option #2 is to turn financing and management of the health-care system — one-seventh of the American economy — over to the government. This would be a government-run single payer system with the state using its monopoly power to impose lower prices and reduced services with the utopian goal of equal access to care for everybody.

Nearly every analyst agrees in private that Obamacare has sent the health care system into an accelerating death spiral. Costs are exploding — premiums are up 22 percent this year and they’re expected to be that, or higher, next year — as healthy people flee the insurance market and sick people sign up for coverage on the way to the hospital. The system mocks the idea that Obamacare could be operated as a sound system.

The left has seized on the latest Congressional Budget Office estimate that over the next decade, 24 million Americans will lose their health care under the prospective Republican plan. But under Obamacare at least twice that number, perhaps as many as 50 million Americans, will lose their health care if nothing is done.

The crucial question is whether something can be done before the system, such as it is, disappears in an enormous puff of red smoke. Most analysts of liberal bent concede in private — and sometimes in public — that Obamacare can’t be fixed with Band-Aids, spit, patches and baling wire. This is the legacy Barack Obama is so proud of. Robert Reich of the University of California at Berkeley, a prominent liberal economist, proposes the single-payer option. Medicare and Medicaid would put everyone into one enormous health “insurance” market, covering everyone from the cradle to the graveyard.

But if government health care can control costs, why aren’t Medicare or Medicaid, or the Veterans Administration health-care system, controlling costs now? These systems already control nearly half of the insurance market.

Medicare and Medicaid, however, are going broke as fast as Obamacare. Both have tens of trillions of dollars worth of unfunded liabilities, and assigning millions of additional patients to the decks of the Titanic makes no sense. The experience of Europe and Canada, with single-payer systems, is not an encouraging one. Many patients who require major surgery or the latest treatment, flee their government “free” care and hurry, if they can, to the United States.

Why the cost of health care has risen at twice the pace of inflation is the question no one can (or will) answer. Some of the increased cost is attributable to remarkable improvements and innovation in medical technology. As Americans grow more prosperous many are willing to spend more of their money on preserving good health.

The explosion of health-care costs began with the introduction of Medicare and Medicaid in the late 1960s. Before then health-care costs rose roughly parallel to the cost of everything else. These government programs, like Obamacare, were supposed to make health care affordable. If you’re saving $2,500 a year on your health insurance, as Barack Obama and the Democrats promised, raise your hand.

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