the salt makers

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.