Why Universal Health Care Is NOT Universal But Exclusive, Even Elitist?

"I read in Men's Health magazine that President Obama has two cardio days and four weightlifting days. You see, I don't have to exercise because I have health insurance." -- comedian Joe Wong, at last week's annual Radio and Television Correspondents Association dinner

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In his recent column on what some have called "ObamaCare," James Taranto shares a passage from a National Review interview with Democrat Congressman Bart Stupak, a pro-lifer from Michigan. Note what Stupak says other members of his party are saying about abortion and its relation to a publicly-financed health care system:

The arguments they have made to him in recent deliberations, he adds, "are a pretty sad commentary on the state of the Democratic party."

What are Democratic leaders saying? "If you pass the Stupak amendment, more children will be born, and therefore it will cost us millions more. That's one of the arguments I've been hearing," Stupak says. "Money is their hang-up. Is this how we now value life in America? If money is the issue--come on, we can find room in the budget. This is life we're talking about."

Alarming? Perhaps it is, at least to people who enjoy thinking things through to their logical conclusions. Indeed, abortion as a cost-cutting measure seems not only inevitable but undeniably -- and frighteningly -- frugal. 

Taranto goes on to ask

What would happen to a woman who received, say, a prenatal diagnosis of Down syndrome? She would be free (as she is today) to exercise her right to have an abortion. But would she be free to exercise her right not to have an abortion?

Presumably the government could not directly force her to abort, as this would provoke political outrage and run afoul of Roe v. Wade and subsequent rulings. But one can easily imagine softer forms of coercion coming into play. A government-run insurance plan, for instance, could deny or limit coverage for the treatment of certain conditions if diagnosed before fetal viability, on the ground that the taxpayer should not be forced to pay the costs of the woman's choice to carry her child to term.

I believe Taranto, in essence, has expressed what comedian Joe Wong (quoted above) intimated in his joke before America's radio and TV journalists. Namely, what Taranto is suggesting is that universal health care will be used to REMOVE people from health care coverage. Taranto (and Stupak) are correct to note that such denial of coverage will probably begin with the unborn, but it will not end there. All sorts of folks will be denied coverage in order to leverage them into complying with a set of public health standards.

An old Milton Friedman essay replayed in yesterday's Wall Street Journal called "A Way Out of Soviet-style Health Care," explores several passages from Alexander Solzhenitsyn's novel Cancer Ward in which two characters discuss the public takeover of health care. Friedman is right to note that the conclusion is prescient: that universal, public and free health care is not only NOT free, it results in depersonalization and sets patients and doctors in an adversarial relationship, with doctors acting as state (or HMO) spies to descry who his defrauding the system or wasting resources.

If health care becomes an entitlement, it will "dis-incentivize" people to really care for themselves: As Joe Wong states, he doesn't need to exercise -- as a preventative -- because he is covered by insurance; even his pre-existing conditions are covered.

Though Wong is pretending, he is not pretending about how people will treat the public health-fare system (it is health-fare, no?) -- they will simply take it for granted. People will not feel any incentive to eat well, lose weight, wear helmets, exercise, avoid tobacco or alcohol, and so on: SOME people will just blow off worrying about themselves because their finances are not one whit jeopardized by health care costs.

But what this will mean, then, is that doctors will HAVE to report such people who refuse to comply with basic health standards and expectations. Doctors, as employees of the state, will have to report those who willfully place an excessive burden on health care costs. And what will the state HAVE TO DO? That's right: the state will HAVE TO REMOVE such people† from the public health-fare rolls in an effort to motivate them to live healthier lives!

So, what does this mean? It means that universal health care coverage is really not universal at all, being only for those people who ARE healthy or CHOOSE to be healthy. In other words, the more fortunate people in America who are not a medical burden on the government will have coverage while those less fortunate who are an excessive burden on the system will be expelled from coverage.

In reality, then, universal health coverage is exclusive. Such exclusion will start with the unborn and extend out to those living souls who will not -- or cannot -- live the "right" way.

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†Or the state will have to charge such people a hefty co-payment or deductible, which means health care won't be "free".

Part II tomorrow? Maybe.

(You should read all of Milton Friedman's essay.)

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