“The Road to Hell is Paved with Good Intentions”

Everyone who is a conservative at heart is faced with an enormous dilemma when it comes to the question of Medicare.  Putting aside, just for a moment, the fatal flaws of the program, it is a socialistic scheme that does not meet with the intent of the Constitution and the founders’ framework for a limited federal government.  On the other hand, Medicare is now ingrained into the nation’s mindset as an entitlement that is no longer to be questioned, as the Left knew it would be when they sent us down this road.  People like my parents have come to depend on it.  Consequently conservative politicians are in a no-win situation on this topic.  They cannot propose scrapping the program and still remain viable candidates, and yet to propose ways of “saving” Medicare – at least to my way of thinking – is contrary to conservative ideology.  It seems conservative voters have little choice but to accept a candidate who, by standing up for Medicare, promises not only to continue but to further enshrine the systems we oppose and which are guaranteed to contribute to our eventual failure as a nation.

For this reason I’ve given a lot of thought as to how we could have it both ways – save Medicare but do it in a way that requires the application of conservative principals such as personal responsibility.  I have concluded, upon deep reflection, that it cannot be done. The Medicare system is too deeply and inherently flawed to save it at all, never mind do so in a way that satisfies a conservative like me.  Consequently we need a candidate who is brave enough to do the unthinkable and propose ending it.  We won’t get one, of course, but as long as I’m dreaming here’s what I think that candidate should say:

“Imagine if I gave a stranger a credit card with no spending limit and then I arranged for the bill to go to you.  What do you think might happen?  Do you think the stranger would be a wise and careful consumer with your hard-earned money like you are?  Would he make tough choices and show concern for your financial security?  Or do you think he might forget about that and spend without regard to the way it affects you?  If you can understand what could go wrong with this arrangement, then you should understand the inherent flaw of the Medicare system.

Under Medicare the consumer has little to no natural incentive to restrict or curtail consumption.  The predictable result is an unnaturally high demand for healthcare services, which in turn leads to shortages and/or skyrocketing healthcare costs, as we’ve all witnessed in the past several decades.  Next, well-intentioned politicians with no understanding of economics will step in and further exacerbate the problem by placing artificial controls on the prices of Medicare services, which further limits availability and drives prices higher yet for everyone else.  We then have what is commonly referred to as “a mess.”

‘At its start, in 1966, Medicare cost $3 billion, ..."The House Ways and Means Committee estimated that Medicare would cost only about $12 billion by 1990 (a figure that included an allowance for inflation). This was supposedly a 'conservative' estimate. But in 1990 Medicare actually cost $107 billion."’¹   In 2011 that amount rose to $485 billion, and by 2021 it is forecast to be nearly $821 billion. ²     Do you think maybe the politicians don’t know what they’re doing here?

Medicare spending has grown at a much faster rate than our gross domestic product and every year it consumes a larger and larger share of our national budget.  “...CBO’s projections suggest that in the absence of changes in federal law... Federal spending on Medicare (net of beneficiaries’ premiums) and Medicaid would rise from 4 percent of GDP in 2007 to 7 percent in 2025, 12 percent in 2050, and 19 percent in 2082.³

Most Americans recognize that we are already in dire financial straits even as I speak.  How can anyone believe that we can continue on this road any longer? 

For some, the concept of healthcare as a limited commodity is uncomfortable to accept, but that is the reality.  Healthcare in and of itself is not a constitutionally guaranteed right.  How can it be when such a guarantee would require that others be indentured to that obligation?  Healthcare is ultimately the product of the labor of other people.  We become dangerous to our fellow man when we presume the right to that labor, or the right to the labor of younger generations who must bear the cost.  So to those who claim Medicare is a moral issue, I say, “Yes it is.” It is immoral for people to use the power of the state to force others to pay for their healthcare without limitation. 

But all of this does not mean that people must forego good quality healthcare once they retire, as certain folks would like us to believe.  Our undue reliance on government to solve these problems has severely damaged the free market process, but it can be restored because all of the necessary elements remain in place.  We have willing suppliers ready to provide a market for willing consumers.  We must begin by getting the federal government out of the healthcare business, which brings me to the subject of Medicaid. 

By now the story should ring familiar.  When started in 1966 Medicaid initially covered 4 million people at a cost of about $1 billion.  Today, Medicaid.gov (“Keeping America Healthy!”) proudly informs us that “Medicaid and CHIP provides health coverage to nearly 60 million Americans.”⁴   The cost? Well it was nearly $400 billion in 2011 excluding administrative costs.⁵    This is what happens when the decisions about spending are taken out of the hands of local communities and placed far away in the hands of bureaucrats.

Government run health programs don’t fix our healthcare problems they multiply them.  They remove free market conditions that are necessary for the system to work, and they invite massive fraud, allowing dishonest people to get rich at taxpayer expense and away from taxpayer control.   Someone once said, "The road to hell is paved with good intentions."  It's time for us to take heed of that advice and get off this road we're on.

¹http://reason.com/archives/2003/11/28/medicare-fraud

² http://www.cbo.gov/budget/factsheets/2011b/medicare.pdf

³ http://www.cbo.gov/ftpdocs/87xx/doc8758/maintext.3.1.shtml

⁴ http://www.medicaid.gov/

⁵ http://www.reuters.com/article/2011/12/13/us-usa-states-medicaid-idUSTRE7BC25420111213