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The Government’s Role In A Free Society

Stanley Feld M.D.,FACP,MACE

U.S. Congressman Paul Ryan gave a speech in January 2010 at Hillsdale College's Allan P. Kirby, Jr. Center for Constitutional Studies and Citizenship defining the role of government in a free society with particular reference to healthcare.

Paul Ryan understands the constitution and uses a lot of common sense.

Mr. Ryan traces the history of the progressive movement of the Democratic Party in America.

“The social and political programs of the Democratic Party’s progressive movement came in on two great waves: the New Deal of the 1930s and the Great Society of the 1960s”.

“Today, President Obama often invokes progressivism and hopes to generate its third great wave of public policy.”

 This desire by President Obama leads him to believe he will be judged as one of the greatest Presidents in American history.

President Obama believes his ideology will save the healthcare system, the financial system, and the country.

There is no question the healthcare system needs to be reformed. It has become unaffordable and inaccessible to people who need healthcare insurance coverage.

The need for reform leads Dr. Don Berwick former Director of CMS to conclude that by definition effective healthcare system means the redistribution of wealth.

The debate in healthcare is not whether we need healthcare reform but what form that reform should take.

“Under the terms of our Constitution, every individual has a right to care for their health, just as they have a right to eat.”

“These rights are integral to our natural right to life. It is the government's chief purpose to secure our natural rights.”

 But the right to care for one's health does not imply that government must provide health care, any more than our right to eat, in order to live, requires government to own the farms and raise the crops.

The government's chief purpose is to secure our natural rights. It is a critical sentence defining the role of government by our constitution.

It is not the role of government to provide healthcare any more than it is our right that the government feed us. It is the individual’s responsibility to do both. 

It is the government’s obligation to protect our rights. The government’s obligation is to establish free market conditions so providers and vendors cannot take advantage of us and abuse our rights. We should not be entitled to food or healthcare.

Paul Ryan goes on to say,

“ With good reason, the Constitution left the administration of public health—like that of most public goods—decentralized.

 If there is any doubt that control of health care services should not have been placed in the federal government, we need only look at the history of Medicare and Medicaid—a history in which fraud has proliferated despite all efforts to stop it and failure to control costs has become a national nightmare.”

All the stakeholders are experiencing this nightmare after 47 years of the government making adjustments to the Medicare and Medicare rules.

No one predicted the adjustments made by both the government and the stakeholders would result in unsustainable costs for the government, private sectors and the people.    

This national nightmare is going to expand with the passage of Obamacare, the funding of the multiple agencies formed and the proposed 32 million more uninsured people to be added to Medicaid along with the increasing number of baby boomer going on Medicare.

Democrats, Republicans and Independents believe in fairness to all. Americans are very charitable people and are frequently mobilized to help the needy.

However, President Obama has tried to appeal to our sympathy for him by painting a contrast between himself and his opponents.  He is trying to persuade us that he is the good guy and the rest are bad guys.

“If you believe this economy grows best when everybody gets a fair shot and everybody does their fair share and everybody plays by the same set of rules, then I ask you to stand with me for a second term as president.” 

On closer examination his actions have gotten us deeper into our fiscal dilemma. He has not leveled the playing field; he has wasted money and increased our deficit.  The U.S. is at the point where it cannot borrow itself out of its jam.

If the U.S. continues to try to print (money) itself out of the jam the economy will implode.

President Obama’s ideology has created uncertainty and decreased the private sector willingness to create jobs and stimulate the economy. He has not created enough jobs with his massive stimulus packages.

A reader wrote,

We ran out of money a long time ago.  Every dollar we spend is 40% borrowed money and healthcare in our country is comprised of 50% taxpayer money.  What else do we need to see in terms of the math to believe we are on an unsustainable path?

Paul Ryan argues,

“President Obama urges us today—out of compassion—to support the progressive model; but placing control of health care in the hands of government bureaucrats is not compassionate."

Bureaucrats don't make decisions about health care according to personal need or preference; they ration resources according to a dollar-driven social calculus.

 Dr. Ezekiel Emanuel, one of the administration's point people on health care, advocates what he calls a “whole life system”—a system in which government makes treatment decisions for individuals using a statistical formula based on average life expectancy and “social usefulness.”

“ In keeping with this, the plans that recently emerged from Congress have a Medicare board of unelected specialists whose job it would be to determine the program's treatment protocols as a method of limiting costs.”  (USPTF and IPAB)

I believe there are very few Americans who would be satisfied with this kind of halthcare system once they understand what is happening.  

Ryan goes on to say:

"The good news is that we have a choice.

 There are three basic models for health care delivery that are available to us:

 (1) Today's business-government partnership or “crony capitalism” model, in which bureaucratized insurance companies monopolize the field in most states."

Medicare and Medicaid’s administrative services are outsourced to the healthcare insurance industry by the government. The healthcare insurance companies charge the government 40% of the Medicare and Medicaid healthcare dollars for overhead.

President Obama claims that the medical loss ratio will limit the overhead to 20% and 80% will go to direct medical care. Wrong!

 The overhead is disguised in direct medical care costs.

How do you think top healthcare insurance executives can receive many millions of dollars in compensation each year?

 "(2) The progressive model promoted by the Obama administration and congressional leaders, in which federal bureaucrats tell us which services they will allow."

We have seen over and over again unintended consequences, excessive waste created by cumbersome rules and regulations, and stakeholders adjustment to take advantage of the rules and regulations, all of which lead to intolerable costs, taxes and the erosion of the value of the dollar. Obamacare is going to result in greater administrative waste plus rationing of care.   

" (3) The model consistent with our Constitution, in which health care providers compete in a free and transparent market, and in which individual consumers are in control."

 The government's chief purpose is to secure our natural rights by leveling the playing field for all the stakeholders and enforcing the rules. It is essential that the rules are transparent and simple.

The patients must be empowered to be responsible for their healthcare dollars and their health. Entitlements do not promote personal responsibility

One of Paul Ryan’s concluding points is,

“The answer is that the current health care debate is not really about how we can most effectively bring down costs.”

 It is a debate less about policy than about ideology. It is a debate over whether we should reform health care in a way compatible with our Constitution and our free society, or whether we should abandon our free market economic model for a full-fledged European-style social welfare state.

 This, I believe, is the true goal of those promoting government-run health care."

My Ideal Medical Saving Account can be an extremely democratic and fair model. By changing a couple of existing healthcare insurance rules the administration would create a truly free competitive free market for healthcare consumption.

The government should also educate patients to assess the value of the medical care they freely choose. It should be the consumer’s decision, not the government’s decision.

These actions would reduce the cost of healthcare and create a sustainable healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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