Medicare for None
"Medicare for All," were it subjected to truth in labeling criteria, would more accurately be named "Medicare for None." This is a point made early in Sally Pipes's succinct but detailed analysis of the socialized medicine programs offered by Bernie Sanders and other Democratic POTUS candidates. Her book, False Premise, False Promise: The Disastrous Reality of Medicare for All, provides a chilling portrait of the much touted socialized health systems in Canada and the U.K. — programs plagued by doctor and hospital shortages; long waiting times; rationed treatment; substandard care; and, on occasion, appalling bureaucratic callousness.
Pipes begins her analysis with a perceptive distinction between traditionally accepted rights and the assertion that health care is a right. The former rights, she notes, oblige people only not to interfere with, for example, a person's free speech or religious practice. Non-interference is required as long as the exercise of those rights doesn't restrict the rights of others, as it would if one yelled "fire" in a crowded theater. These traditional rights are labeled "negative" because they "require others [including the government] to step aside and allow people to act independently."
On the other hand, in the case of health care, this "positive right" not only "gives us something," but also "requires someone else to give it to us." As Pipes illustrates in spades, defining "the criteria for positive rights ... is tricky" — a process that supposedly values equal medical care for all above, for example, the freedom of parents to pursue treatment for a sick child outside a nation's socialized framework, thereby making mincemeat of the most prized of all American rights, life and liberty. In short, residents of Canada and the U.K. forfeit a tremendous amount of freedom concerning the availability and quality of health care in return for a system designed primarily to offer an equal measure of care to everyone — an arrangement Pipes concludes "is a catastrophe for the people forced to live under it." Thus, a "right" to health care is transformed into the obligation to accept and contribute to a system that often provides mediocre and sometimes appalling care.
When analyzing specific "Medicare for All" proposals, Pipes notes that the program's popularity disappears when folks discover that it would totally do away with the private insurance held by 253 million Americans (mostly through employers) and would be far from free! Sanders's proposal adds at least $32 trillion to the federal budget over ten years and likely up to $60 trillion, since it "would prompt unlimited demand from patients." The latter figure represents a doubling of projected federal spending over the decade. Add to that cost the inevitable hospital closures and doctor shortages tied to stringent government reimbursement rates as well as the dislocations caused by outlawing private insurance, and you have the makings of a perfect societal storm — caused not by the quality of medical care (with which a large majority of Americans are satisfied), but rather by the cost of insurance. Far from reducing insurance costs, Obamacare saw a doubling of premiums in the individual market between 2013 and 2017. Meanwhile, employer-based family premiums continued to rise to over $20,000 a year in 2018.
The bulk of Pipes's book describes the reality of socialized medicine in the U.K. and Canada, both statistically and via a number of gut-wrenching anecdotes. Statistically, Pipes shows that the presumed monetary savings of socialized programs are largely illusory, since significant costs are hidden in taxes and take no account of lost wages and productivity due to demonstrably inferior health outcomes. Moreover, the typical assertion that the U.S. trails the U.K. and Canada in overall health rankings is also debunked by showing that those rankings don't focus on specific health outcomes (e.g., cancer survival rates), but rather give inordinate weight to socialist programs and even fail to account for the different standards countries have for calculating "infant" mortality. Additionally, those socialist-biased health comparisons don't take into consideration non–health related factors (such as traffic accidents and crime) that significantly affect life expectancy averages. When one compares like to like, U.S. life expectancy and infant mortality rates are comparable to or better than other advanced nations, and, significantly, specific health outcomes for treatment are consistently better than their socialized counterparts.
Pipes's book would be persuasive but not emotionally compelling without its numerous vignettes that put a human face on an often less than human bureaucratic monstrosity. Among others, there is the tragic story of a single mother of two without a car in southeast Wales who called ahead to inform an emergency clinic that she would be a bit late bringing in her severely asthmatic five-year-old child since she had to make arrangements for an infant's care and catch a bus. Her 18-minute tardiness resulted in the doctor's refusal to honor the appointment. Instead, it was rescheduled for the next day. That night, the child had another asthmatic attack and died in the hospital. Anyone reading Pipes's book knows that this tragedy is the direct result of doctor shortages that make a typical visit to a general practitioner in the U.K. last a grand total of nine minutes.
Then there is the case of young Charlie Gard, born August 4, 2016, with a rare genetic disorder that's typically fatal. His parents wished to try an experimental treatment in the U.S. that wasn't available in the U.K. and raised over a million pounds to give it a try. The doctors caring for Charlie Gard, however, petitioned the government to remove him from life support, and it is the court, not doctors and parents, that has the last say in such matters. Despite pleas from the Vatican and even assurance from President Trump that the U.S. would be "delighted" to help Charlie, "Charlie died in a hospice on July 18, 2017, after the court denied his mother's request to bring her son home for his final hours." Another couple was arrested for kidnapping when they took their child to Spain in 2014 for a cancer treatment not approved in the U.K. This story, fortunately, had a happy ending in Prague following a legal battle over proton therapy, a treatment available in the U.S. since 2001.
Ironically, socialist medicine doesn't mean the same care for wealthy and well connected individuals, as Canadian singer Michael Bublé moved to California, where his son was treated for liver cancer in 2016 at Children's Hospital Los Angeles. Even more egregiously, in 2010, Newfoundland's premier traveled to Mount Sinai Hospital in Florida for minimally invasive heart surgery that he could have received in his own country.
Pipes ends with a series of proposals for making American health care more affordable, ideas that focus on Health Savings Accounts, tort reform, individually tailored insurance policies, and a government program to take care of the approximately two million folks who would not qualify for private insurance — a small subset for which it makes no sense to socialize the entire health care system. Overall, Pipes's book is predicated on the hope that Americans won't give up their access to quality medical care if they know that the "free" care they are promised will cost almost as much as the 17% the U.S. now devotes to health care and will result in vastly increased waiting times, fewer treatment alternatives, massive dislocations, and restricted or no access to expensive drugs — all without the default option employed by thousands of Canadians: treatment in the United States.