October 3, 1999

Health Plan Invokes Law of Unintended Consequences

All the talk about Federal budget “surplus” has got Democratic candidates giddy over prospects for the holy grail of politics – universal health care. Or, at least, for children and the poor.

Republicans, they of fiscal responsibility, are quiet. The experiences of Sweden, England and Canada are instructive of national bankruptcy, but who can deny children and the poor?

Maybe Scrooge, Grinch and the Merchant of Venice – but not People Who Care!

Bill and Hillary’s tilt at the health-care windmill was too much, too soon and too expensive even for the awesome borrowing power of Uncle Sugar.

Now comes another Bill – Bradley, of aw-shuks demeanor – who would invite 45 million non-insured folks into the health insurance plan for Federal government employees with very little premium payments.

If this threatens to wreck the Federal employee plan – as seems likely -- Bradley instead would provide tax credits to subsidize premiums for private insurance plans. He estimates the cost to non-poor working Americans would be a “only” $65 million annually.

Bradley is reported “not to know’ what the actual cost would be. One of his aides says the amount cited “probably is a little bit low.” He ignores the $374 billion of surplus over the next ten years that President Clinton is depending upon to “shore up” – not save – Medicare.

Nor does Bradley’s plan provide for prescription drugs for Medicare recipients which Clinton wants for his legacy.

Nor does it pay for the increased costs that would occur if Health Maintenance Organizations (HMOs) are forced to pay for emergency care and procedures outside their bare-bone programs. No pun intended. HMOs are lobbying hard to preserve their prior approval for medical procedures and their freedom from legal liability.

No wonder prestigious doctor associations are calling for profession unions, and consumer advocates are pressuring for the right to sue HMOs for malpractice.

Americans instinctively rejected the Clintons’ universal health care plan in 1994 which put the cost mainly on employers. We want affordable health care but not costs passed to us in the form of higher prices for goods by employers – or of costs passed to us in the form of taxes by government.

All sides of the health care problem want the government to help -- but to stay out of doctor-patient relationships.

We remember the attempt a couple of years ago to force physicians to restrict their practices. They were ordered to treat Medicare-Medicaid patients only -- with government- dictated “cost containment” -- or to serve only private patients, without price controls.

This was so preposterous, Congress took the matter under consideration. There it rests until/unless old-line liberals regain control.

Last August, the Health Care Financing Administration (HCFA) issued a Patients’ Bill of Rights. It orders physicians and hospitals to provide a long list of vague “rights” -- expanding on the Hippocratic Oath which has guided physicians effectively for two thousand years.

As usual, when the sorcerer’s apprentice gets hold of his master’s magic wand, government wisenheimers once again have blundered into the Law of Unintended Consequences.

Consider the following HCFA rule: “A physician must see and evaluate the need for restraint or seclusion (sedation) within one hour after initiation of this intervention.”

This sounds reasonable – except it may jeopardize other patients receiving a doctor’s attention simultaneously. A heart surgeon in the middle of an operation might be called to the bedside of a recovering patient trying to pull out life-support tubes – a common occurrence. A sedative or restraint obviously is needed.

However, a verbal order relayed to a registered nurse or intern now is not sufficient. The physician of record must drop everything and “evaluate” the agitated patient face to face.

Question: who gets sued when one or the other patients die - - the doctor or HCFA?

Answer: you can’t sue the government.

Facts of life are simple to understand. Taxes take 38 percent of private earnings. History indicates that nations collapse when 40 something percent of all worker earnings are confiscated for public purposes. There is a limit to taxation – regardless of perceived need.

The most additional help we can hope for from government is a large subsidy for health catastrophes and, perhaps, expansion of local health departments to serve indigent people.

Cradle-to-grave government care sounds noble, but is unattainable. We have gone down that road just about as far as possible. Americans will have to re-learn ten, little, two- letter words: “If it is to be, it is up to me.”

PARTING SHOTS

Dan Quayle has dropped out of the presidential race. Now, spelling teachers and illiterate journalists won’t have him to kick around anymore.

* * *

Al Gore has moved his campaign headquarters to Tennessee. This is not far enough away from Clinton to be of any help. Try Timbuktu.

By Lindsey Williams, columnist for Sun Coast Media Group newspapers