the salt makers

Assisting the needy in health care is a "moral imperative" — not a constitutional right. The two are as different as a squirt gun and an Uzi.

If something is not permitted under our Constitution, the federal government simply cannot do it. Period.

The Founding Fathers vigorously debated the role of the federal government and defined it in Article I, Section 8 — spelling out the specific duties and obligations of the federal government.

Most notably, these included providing a military for national security, coining money, establishing rules for immigration and citizenship, establishing rules for bankruptcy, setting up a postal system, establishing trademark and copyright rules, and setting up a legal system to resolve disputes.

Charity is not there.

Early Start

Congress began ignoring its lack of authority for charity before the ink dried on the Constitution. When Congress appropriated $15,000 to assist French refugees in 1792, James Madison — a Founding Father and principal author of the Constitution — wrote:

"I cannot undertake to lay my finger on that article of the Constitution, which granted a right to Congress of expending, on objects of benevolence, the money of their constituents."

What about the Constitution's general welfare clause?

Madison said: "With respect to the words general welfare, I have always regarded them as qualified by the detail of powers (enumerated in the Constitution) connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators."

And consider government welfare's effect on people's willingness to give. During the Great Depression — before the social programs that today we accept as givens (Social Security, Medicare, Medicaid) — charitable giving increased dramatically.

After FDR began signing social programs into law, charitable giving continued, but not at the same rate. People felt that they had given at the office and/or that government was handling it.

Government "charity" is simply less efficient than private charity. Every dollar extracted from taxpayers, sent to Washington and then routed to the beneficiary loses about 70 cents in transfer costs — salaries, rent and other expenses.

The Salvation Army, by contrast, spends 2 cents in operating costs, with the remainder going to fundraising and the beneficiary. It achieves this, among other ways, by relying on volunteers to do much of the work.

After Hurricane Katrina, private companies including Home Depot and Wal-Mart provided basic needs, such as water and shelter, faster than did government. What were their motives? Generosity? Positive public relations — a form of selfishness? Does it matter?

What about the issue of moral hazard? Does government welfare distort behavior and cause people to act irresponsibly?

In 1964, President Lyndon Johnson launched a War on Poverty. Anti-poverty workers went door-to-door to inform women of their "right" to money and services — provided the recipients were unmarried and had no men living in their houses.

Out-of-wedlock births skyrocketed. In 1960, before the War on Poverty, out-of-wedlock births accounted for 2% of white births and 22% of black births. By 1994 — just three decades after Johnson began his "war" — the rates had soared to 25% and 70%, respectively.

Numerous studies conclude that children of broken homes with absentee or nonexistent fathers are likelier to commit crimes, drop out of school, do drugs and produce out-of-wedlock children.

In 1985, the Los Angeles Times asked the poor and nonpoor the following question: Do you think those on welfare have children to get on welfare? More poor people (64%) said yes to that proposition than did nonpoor (44%).

If not taxation, how then? In 1871, the city of Chicago burned to the ground. Contributions, with virtually no money from government, rebuilt the city.

After 9/11, so many Americans gave money that the Red Cross used some contributions for non-9/11 purposes.

Christianity Today wrote in January 2002: "Suddenly awash in a sea of money, relief agencies such as the Salvation Army need help. So much money — $1.5 billion so far — has come in that charities are having a hard time spending it."

Americans donated an even greater sum to those affected by Hurricanes Katrina and Rita.

A Giving Country

Three in four families donate to charity, averaging more than 3% of their income, with two-thirds going to secular charities. In total, Americans give more than $300 billion a year — more than the gross domestic product of Finland or Ireland. More than half of families also donate their time.

Absent (unconstitutional) government programs, individuals and charitable organizations can, will and — in many cases — already do provide services to the needy. A limited government — one that taxes only to fulfill its permissible duties — would allow even more disposable time and money.

People-to-people charity is more efficient, less costly, more humane and compassionate, and more likely to inspire change and self-sufficiency in the beneficiary. People can and would readily satisfy society's "moral imperative."

A study by the British Patients Association tells the true story about socialized medicine in Britain. It's one of willful and woeful neglect of millions, missed diagnoses, and elderly patients left in pain.

While reading this disturbing analysis of the pitiful state of medical care in Britain in the Daily Telegraph, the Vincent Price horror classic "The Abominable Dr. Phibes" came to mind. Price portrayed a man who used bizarre methods to dispatch his victims.

The abominable British National Health Service, based on this report, is only slightly better.

The Patients Association's primary focus was the Mid-Staffordshire NHS Health Trust, where it was found that up to 1,200 people died through failings in urgent care the past six years. Their analysis was prompted by an avalanche of complaints of shameful care at the hands of the NHS.

Claire Rayner, president of the group and a former nurse, said: "For far too long now, the Patients Association has been receiving calls on our help line from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses."

There was the case of 82-year-old piano teacher Pamela Goddard. She was suffering from cancer and was left to suffer in her excrement as her condition deteriorated due to bed sores.

Before Florence Weston died at age 85, she remained without food or water as her scheduled hip replacement operation was repeatedly canceled.

Katherine Murphy, director of the Patients Association, said: "If this was extrapolated to the whole of the NHS from 2002 to 2008 it would equate to over 1 million patients. Very often these are the most vulnerable elderly and terminally ill patients. It is a sad indictment of the care they receive."

Daniel Bates at England's Daily Mail newspaper reported on one of our favorite examples of the glories of socialized medicine. He wrote about Mark Wattson, who after weeks of excruciating pain was happy to get his appendix removed — or so he thought. Doctors told him the operation was a success and sent him home.

Bates wrote: "Only a month later the 35-year-old collapsed in agony and had to be taken back to Great Western Hospital in Swindon by ambulance. To his shock, surgeons from the same team told him that not only was his appendix still inside him, but it had ruptured — a potentially fatal complication." Oops.

Under the NHS system, according to an analysis by the Rare Cancers Forum printed in the Daily Telegraph, about 1,000 victims of rare forms of cancer were denied drug treatment the past three years. Reason? NHS bureaucrats had not licensed them for their particular form of cancer.

Stella Pendleton, executive director of the charity, said: "The NHS is forcing desperate patients into the cruel situation where the chances of their being given the treatment they need depend on where they live. No patient should be denied a treatment recommended by a doctor simply because the cancer it treats is too rare for the medicine to be licensed."

The Daily Mail reports that thousands of British women are forced to give birth outside maternity wards due to a shortage of midwives and hospital beds. Some 4,000 women last year, up 15% from the year before, were forced to give birth in places ranging from elevators to toilets, putting the lives of mothers and babies at risk.

Meanwhile, it has been reported that up to one-third of health care trusts in Britain are importing doctors from as far away as Poland, Lithuania, Germany, Hungary, Italy and Switzerland because of a shortage of doctors willing to work in the evenings and on weekends.

An increasing number of British patients are being treated by exhausted foreign doctors with a poor command of English. Alarms went off after a German doctor brought in with just three hours of sleep had two patients die on his first shift in Britain.

Nigerian-born Dr. Daniel Ubani had just three hours' sleep after traveling from Germany to a shift in Cambridgeshire. He injected 70-year-old kidney patient David Gray with 10 times the recommended dose of morphine, and an 86-year-old woman died of a heart attack after Dr. Ubani failed to send her to a hospital.

Three days after Health Secretary Andrew Burnham falsely claimed on the BBC, "We have no waiting lists now in the NHS, and people have full choice of NHS hospitals," it was revealed that the government's own figures show that 236,316 people are waiting more than 18 weeks for a range of treatments, including oral surgery, rheumatology and basic geriatric medicine.

It's no surprise then to discover that while breast cancer in America has a 25% mortality rate, in Britain it's almost double at 46%. Prostate cancer is fatal to 19% of American men who get it. In Britain it kills 57% of those it strikes. We are not making this up.

These are not cherry-picked stories, but rather daily life under the NHS. In the U.S., trial lawyers would have a field day as demands mounted for such deaths to stop until the system was overhauled.

As we said a week ago, this is what inevitably happens under all forms of socialized medicine.

No wonder that Daniel Hannan, a member of the European Parliament from Britain, has called the NHS a "60-year mistake" and encouraged "Americans to ponder our example and tremble."

When asked about ObamaCare on Fox News, Hannan said: "I find it incredible that a free people living in a country dedicated and founded in the cause of independence and freedom can seriously be thinking about adopting such a system."

And President Obama says it is our system that's unsustainable. We have seen the future of health care, and it doesn't work.

In the 48 hours of June 15-16, President Obama lost the health care debate.

First, a letter from the Congressional Budget Office to Sen. Edward Kennedy reported that his health committee's bill would add $1 trillion in debt over the next decade. Then the CBO reported that the other Senate bill, being written by the Finance Committee, would add $1.6 trillion.

The central contradiction of ObamaCare was fatally exposed: From his first address to Congress, Obama insisted on the dire need for restructuring the health care system because out-of-control costs were bankrupting the Treasury and wrecking the U.S. economy — yet the Democrats' plans would make the problem worse.

Accordingly, Democrats have trotted out various tax proposals to close the gap. Obama's idea of limits on charitable and mortgage-interest deductions went nowhere. As did the House's income tax surcharge on millionaires.

And Obama dare not tax employer-provided health insurance because of his campaign pledge of no middle-class tax hikes.

Desperation time. What do you do? Sprinkle fairy dust on every health care plan, and present your deus ex machina: prevention.

Free mammograms and diabetes tests and checkups for all, promise Democratic leaders Nancy Pelosi and Steny Hoyer, writing in USA Today. Prevention, they assure us, will not just make us healthier; it also "will save money."

Obama followed suit in his New Hampshire town hall last Tuesday, touting prevention as amazingly dual-purpose: "It saves lives. It also saves money."

Proponents of medical overhaul repeat this like a mantra. Because it seems so intuitive, it has become conventional wisdom. But like most conventional wisdom, it is wrong. Overall, preventive care increases medical costs.

This inconvenient truth comes, once again, from the CBO.

In an Aug. 7 letter to Rep. Nathan Deal, CBO Director Doug Elmendorf writes: "Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."

How can that be? If you prevent somebody from getting a heart attack, aren't you necessarily saving money?

The fallacy here is confusing the individual with society. For the individual, catching something early generally reduces later spending for that condition. But, explains Elmendorf, we don't know in advance which patients are going to develop costly illnesses.

To avert one case, "it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway." This costs society money that would not have been spent otherwise.

Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money?

Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.

That's a hypothetical case. What's the real-life actuality in the U.S. today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, "if all the recommended prevention activities were applied with 100% success," the prevention would cost almost 10 times as much as the savings, increasing the country's total medical bill by 162%.

Elmendorf additionally cites a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80% of preventive measures added to medical costs.

This doesn't mean we shouldn't be preventing illness. Of course we should. But in medicine, as in life, there is no free lunch. The idea that prevention is somehow intrinsically economically different from treatment — that treatment increases costs and prevention lowers them — is simply nonsense.

Prevention is a wondrous good, but in the aggregate it costs society money. Nothing wrong with that. That's the whole premise of medicine. Treating a heart attack or setting a broken leg also costs society. But we do it because it alleviates human suffering. Preventing a heart attack with statins or breast cancer with mammograms is costly. But we do it because it reduces human suffering.

However, prevention is not, as so widely advertised, healing on the cheap. It is not the magic bullet for health care costs.

You will hear some variation of that claim a hundred times in the coming health care debate. Whenever you do, remember: It's nonsense — empirically demonstrable and CBO-certified.

More here.

Imagine that your two best friends are British and Canadian tobacco addicts. The Brit battles lung cancer. The Canadian endures emphysema and wheezes as he walks around with clanging oxygen canisters. You probably would not think: “Maybe I should pick up smoking.”

The fact that America is even considering government medicine is equally wacky. The state guides health care for our two closest allies: Great Britain and Canada. Like us, these are prosperous, industrial, Anglophone democracies. Nevertheless, compared to America, they suffer higher death rates for diseases, their patients experience severe pain, and they ration medical services.

Look what you’re missing in the U.K.:

Breast cancer kills 25 percent of its American victims. In Great Britain, the Vatican of single-payer medicine, breast cancer extinguishes 46 percent of its targets.

Prostate cancer is fatal to 19 percent of its American patients. The National Center for Policy Analysis reports that it kills 57 percent of Britons it strikes.

Organization for Economic Cooperation and Development data show that the U.K.’s 2005 heart-attack fatality rate was 19.5 percent higher than America’s. This may correspond to angioplasties, which were only 21.3 percent as common there as here.

The U.K.’s National Institute of Health and Clinical Excellence (NICE) just announced plans to cut its 60,000 annual steroid injections for severe back-pain sufferers to just 3,000. This should save the government 33 million pounds (about $55 million). “The consequences of the NICE decision will be devastating for thousands of patients,” Dr. Jonathan Richardson of Bradford Hospitals Trust told London’s Daily Telegraph. “It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate.”

“Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets,” Daniel Martin wrote last year in London’s Daily Mail. “Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour [party] pledge. The hold-ups mean ambulances are not available to answer fresh 911 calls. Doctors warned last night that the practice of ‘patient-stacking’ was putting patients’ health at risk.”

Things don’t look much better up north, under Canadian socialized medicine.

Canada has one-third fewer doctors per capita than the OECD average. “The doctor shortage is a direct result of government rationing, since provinces intervened to restrict class sizes in major Canadian medical schools in the 1990s,” Dr. David Gratzer, a Canadian physician and Manhattan Institute scholar, told the U.S. House Ways & Means Committee on June 24. Some towns address the doctor dearth with lotteries in which citizens compete for rare medical appointments.

“In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment,” Pacific Research Institute president Sally Pipes, a Canadian native, wrote in the July 2 Investor’s Business Daily. “That’s 86 percent longer than the wait in 1993, when the [Fraser] Institute first started quantifying the problem.”

Such sloth includes a median 9.7-week wait for an MRI exam, 31.7 weeks to see a neurosurgeon, and 36.7 weeks — nearly nine months — to visit an orthopedic surgeon.

Thus, Canadian supreme court justice Marie Deschamps wrote in her 2005 majority opinion in Chaoulli v. Quebec, “This case shows that delays in the public health care system are widespread, and that, in some cases, patients die as a result of waiting lists for public health care.”

Obamacare proponents might argue that their health reforms are neither British nor Canadian, but just modest adjustments to America’s system. This is false. The public option — for which Democrats lust — would fuel an elephantine $1.5 trillion overhaul of this life-and-death industry. Having Uncle Sam in the room while negotiating drug prices and hospital reimbursement rates will be like sitting beside Warren Buffett at an art auction. Guess who goes home with the goodies?

A public option is just the opening bid for eventual nationalization of American medicine. As House Banking Committee chairman Barney Frank (D., Mass.) told SinglepayerAction.Org on July 27: “The best way we’re going to get single payer, the only way, is to have a public option to demonstrate its strength and its power.”

Barack Obama seconds that emotion.

“I don’t think we’re going to be able to eliminate employer coverage immediately,” Obama told a March 24, 2007 Service Employees International Union health-care forum. “There’s going to be potentially some transition process. I can envision [single payer] a decade out or 15 years out or 20 years out.” As he told the AFL-CIO in 2003: “I happen to be a proponent of single-payer, universal health-care coverage. . . . That’s what I’d like to see.”

And why a public option just for medicine? Wouldn’t government clothing stores be best suited to furnish the garments Americans need to survive each winter? And why not a public option for restaurants? Shouldn’t Americans have universal access to fine dining?

All kidding aside, government medicine has proved an excruciating disaster in the U.K. and Canada. Our allies’ experiences with this dreadful idea should horrify rather than inspire everyday Americans, not to mention seemingly blind Democratic politicians.

More here.

So, first we had Massachusetts, then Hawaii discontinuing their universal children's health insurance after only seven months, now we have Tennessee? There is a stunning parallel between Hawaii and Tennesse: the exact same thing we are concerned about with ObamaCare...people dropping their private insurance for the cheaper, subsidized government option. On a national scale, it would simply mean the death knell of private insurance, which effectively means the death knell of biomedical technological innovations and pharmaceutical advancements. Obviously, this is good for no one.

Tennessee was home to a failed attempt at universal single payer care, and has lessons to teach a President who has promised that in pursuing his goal of universal health care, he will learn from the policy failures of the past. In 1994 Tennessee implemented managed care in its Medicaid program, creating a system known as TennCare. The objective was to use the anticipated savings from Medicaid to fund and expand coverage for children and the uninsured. The result was a program that nearly bankrupted the state, reduced the quality of care, and collapsed under its own weight.

The genesis of TennCare has many parallels to the situation in which we find ourselves today. It was a public option plan designed to save money and expand coverage. In the early 1990s, Tennessee was facing rising costs in its Medicaid program. TennCare was designed to replace Medicaid with managed care and use the promised savings to expand coverage. By 1998, TennCare swelled to cover 1.2 million people. Private business dropped coverage for employees and forced them onto state rolls. By 2002 enrollment had swelled to 1.4 million people and forced Tennessee's Governor to raise taxes and ultimately propose an entirely new state income tax to cover the unforeseen costs. Governor Bredesen was ultimately forced to dramatically restructure a program he has since called "a disaster". By 2006 Bredesen had disenrolled nearly 200,000 people and slashed benefits.

TennCare lessons challenge the Administration's thinking on the benefits of a "public option" solution to assuring American's have the care they deserve. As a Tennessee doctor who provided care under TennCare and a state legislator who had to find ways for the state to pay for it, we learned these lessons the hard way. They shaped the way we both approach health care policy. With Democrats promising to pass a similar system in the House by August, those lessons are worth sharing with the country now.

"Free" Care Is Expensive: No matter how forthright the Administration's cost estimates are; no model accounts for the rational decisions that push people to over-utilize the "free care" a public option offers. TennCare's gold plated coverage included every doctor's appointment and prescription. As such, patients with a cold opted to charge the state hundreds of dollars for doctor visits and medicine instead of paying $5 out of pocket for over-the-counter cold medicine. Over-use caused TennCare's anticipated savings to evaporate and its cost to explode. While TennCare consistently covered between 1.2 and 1.4 million people; costs increased from $2.5 billion in 1995 to $8 billion by the time of TennCare's restructuring. It consumed a third of the state budget including nearly all state revenue growth. When the illusion of "free" care is fostered, it is always over-utilized.

Employers Prefer "Free" Care to Private Care: If the government offers universal health care, why wouldn't businesses move employees to the plan as a sound business decision? In Tennessee, this behavior dramatically expanded the public burden as people who had once been on private insurance migrated to the "free" option of public care, adding to the State's unanticipated cost. Studies indicate that only 55% of those added to TennCare came from the uninsured population, while the rest came from a decline in private coverage.

There Is a Difference Between Access To Care and Availability Of Care: Government-run health care advocates must overpromise on benefits to gain support for their plan, only to renege on those promises when the bill comes due. It's a classic bait-and-switch. To pay the TennCare bill, benefits were slashed and reimbursement rates for doctors and hospitals were reduced. Ultimately, 170,000 people were cut from the program. Since they weren't being paid; fewer physicians could afford to accept TennCare patients. So while a TennCare card guaranteed you access to care, it did not guarantee the availability of care.

Government Control Puts More People In The Exam Room Than Just You And Your Doctor: Because government health care can only provide what it can afford, a determination of cost-effective care becomes more important than doctor-recommended care. Doctors become intermediaries between the government and patients, only able to offer suggestions on treatment. Tennessee physicians often spent more time arguing with government bureaucrats over care than they did providing it to their patients. Other actors soon inserted themselves into the process, including trial lawyers and advocacy groups who stepped in to sue the state. Efforts to rationalize the program, pay doctors, and heal the sick became frustrated by repeated consent decrees and lawsuits that turned the system into a bureaucratic morass that itself could not be healed.

The President's new health care czar was a critical link in the TennCare story. Serving as Human Services Commissioner in Tennessee and then as a key health staffer in the Clinton Administration, Nancy DeParle should be well aware of Tennessee's health care saga. We hope that she lists the kind of universal care that TennCare embodied in the "don't try again" column.

We want to provide access to affordable basic health care for all Americans, and we're actively seeking a solution to do this. But creating a plan like TennCare is not the right answer. We understand the magnitude of the task ahead and we are dedicated to this debate and seeing reform come to our health care system.

Blackburn and Roe are Republicans representing Tennessee in the House of Representatives.

The candidate who told his supporters "to argue with them and get in their face" now finds the shoe on the other foot. So they're taking names and encouraging you to turn in your neighbors.

So this is hope and change — telling American citizens who in a democracy disagree with you that they are mind-numbed robots participating in mob action and expressing "manufactured" outrage.

Considering that upward of 80% of those hooligans like their doctors, like their insurance and like their care, anger over your government-run health care was not that hard to assemble.

It was not that long ago that Barack Obama told a crowd of 1,500 supporters in Elko, Nev., to challenge those who disagree with them and him: "I want you to go out and talk to your friends and talk to your neighbors. I want you to talk to them whether they are independents or Republicans. I want you to argue with them."

President Obama spoke then as the community organizer he was — a true disciple of Saul Alinsky who worked with and for Acorn in the days when they were storming banks and government meetings to force them to ditch creditworthiness as a criteria and forcing them to issue loans to those who couldn't afford them.

The president is familiar with the Alinsky way, the Chicago way, of organizing a group to act. Obama spent years prodding underprivileged Chicagoans to channel their political anger by orchestrating activist mob scenes designed to coerce businesses and public officials. A 2007 profile in the left-leaning New Republic was titled "The Agitator." He's still at it.

The community organizer is trying to organize America in his image, but the American people are more than scared bankers and groveling politicians. They are the descendants of the original tea partiers who threw the teas in Boston Harbor. That Tea Party protested taxation without representation. Their descendants are protesting the taxation they are getting with it.

Obama cut his political teeth as a community organizer with Acorn, the group that buses people all wearing the same red shirts and all carrying the same union-printed signs to the homes of AIG executives and their families and anyone else they want to intimidate. Brown shirts would be more appropriate.

The modern-day tea partiers and those opposing government-run health care carry kids on their shoulders and wave signs they've hand-painted on their living room floors to protest the mortgaging of their future and the bankrupting of their country. According to the Democrats, these people are dangerous and need to be watched.

Democrats once warned about privacy and the shredding of the Constitution when President George W. Bush sought to monitor the communications between foreign terrorists and their American contacts.

They have no objection to the administration openly asking citizens to report rumors, casual conversations and the contents of e-mails to the government. The White House Web site brazenly asks: "If you get an e-mail or see something on the web about health insurance reform that seems fishy — send it to flag@whitehouse.gov."

They say they merely want to correct the record, but we see an enemies list being compiled by a government seeking to nationalize and control everything from car dealers to emergency rooms. What are the name-gatherers going to do? Dispatch the red shirts of Acorn?

"I can only imagine the level of justifiable outrage had your predecessor asked Americans to forward e-mails critical of his policies to the White House," Sen. John Cornyn, R-Texas, said in a letter to President Obama. "As Congress debates health care reform and other critical policy matters, citizen engagement must not be chilled by the government monitoring the exercise of their speech rights." So where is the ACLU, anyway?

The American people have always valued their freedom and their liberty. They see it disappearing under a battalion of unelected and unaccountable czars. They're as mad as hell and aren't about to take it anymore. Power to the people.

More here.

As the issue of health care reform builds to a legislative climax, it is important that we not merely parrot the same kinds of proposals we have seen for the past 50 years. A Point of View writer on this page recently lamented that "after a half-century of attempted reform" we have not reached the promised land of equality in health care. Let me rephrase this: After 50 years of increasing government interventions, through a maze of agencies that now control half of all medical dollars in America, the financial mess is getting worse.

But rather than simply presume that more programs and more coercions are the answer, should we not at least consider that the source of the problem may be those very programs and that the solution lies elsewhere?

Historically, the huge rise in health care costs began in the 1960s with the Great Society programs, especially Medicare. Fiscally, that program is approaching insolvency. To create an even greater labyrinth of bureaucracy now -- in new programs that, after juggling the figures, advocates are proud to say will cost less than a thousand billion dollars over 10 years -- is to add to the very cause that led to the rising costs and to invite a monumental financial crisis in the next decade. Economically, this is hard to dispute.

But such economic arguments have not stopped the train to further government intervention, and we should ask why.

The answer is that the advocates of government medicine are upholding health care as a moral right. Desiring to mandate this "right" by legislative fiat, they have been unwilling to face the cause and effect relationship between increasing government actions and rising prices. That is because the moral goal of equality, measured against the claims to a right to health care, has trumped the mere economic arguments.

As a result, calls for more and wider programs -- to enforce the "right" -- have continued, even as prices rise. This has led to even greater price distortions, which have fueled calls for more interventions, leading to higher prices and demands for more programs.

This vicious cycle is blinding people to the fact that the fundamental cause of the problem is the government interventions, which have caused the distortions.

Again, even a cursory look at the evidence shows the cost problem beginning in the late 1960s, when the government began its massive increase in programs designed to make us all equal by legislative decree. And if one thinks that England today is a model for what a country should do, one may not know the reality of six-bed wards in National Health Service hospitals, of patients waiting over a year for heart operations or of refrigerated trucks in hospital parking lots to store bodies from the flu season (all of which I saw when living there).

Just ask yourself what your car insurance would cost if everyone demanded it as a government-guaranteed "right." Imagine car repair shops having to go through a 10-year approval process -- as pharmaceutical companies must -- before offering a service that the government will then provide to millions of people as a "right." Then ask what the response would be if some people broke with the consensus and said that car repairs were a service to be paid for. They would be shouted down as immoral -- while people demanded that their insurance pay for oil changes and ripped seats.

Congress would pass more programs. Prices would quadruple, and car insurance would become a crushing expense.

Those who want to see an end to spiraling medical costs should challenge the premises behind the government interventions.

The first premise is moral: that medical care is a right. It is not. There was no right to such care before doctors, hospitals, and pharmaceutical companies produced it. Health care is a service, which we all need, and none of us are better served by placing our lives and our doctors under coercive bureaucratic control.

The second premise is economic: that the government can produce a positive result by redistributing thousands of billions of dollars from its most productive citizens. This is the road to stagnation and national bankruptcy, not universal prosperity.

If Congress really wanted to address health care problems, it could begin with three things: (1) tort reform, to end the ruinous lawsuits that force medical specialists into insurance costs of hundreds of thousands of dollars per year; (2) Medicare reform, to face squarely the fact of the program's insolvency; and (3) regulatory reform, to roll back the onerous rules that force doctors, hospitals and pharmaceutical companies (who are pilloried for producing the care that many people then demand as a "right") into satisfying bureaucratic dictates rather than solving patients' problems.

More here.