Hillary’s quest for the presidency is over, for now, and so Hillary-care will not be foisted upon Americans in the near future.
The Democrats’ approach to healthcare in general, though, rests upon a greatly expanded role for the state in the provision, funding and regulation of healthcare.
While many Americans are eager for healthcare reform, and an end to snags in accessing and paying for medical care, they should be extremely wary of any proposal to ameliorate these problems by moving towards socialized medicine. Single-payer systems are at the extreme end of government-provided care and yield some of the most disturbing examples of government monopolies harming patients, but any degree of government administration reduces the choice available to individuals.
This tendency can most readily be seen in the education sector. When the state assumes responsibility both for providing education and for regulating other providers, a structural conflict of interest results. Inevitable, meaningful school choice does not exist in most districts. Private schools often provide excellent and accountable educations for all levels of schooling, but with a price tag that puts it beyond the reach of many families. Increasing numbers are opting to homeschool, often with great outcomes, but this choice requires that a family be able to devote the bulk of at least one parent’s time to teaching — also not an option for all. Indirectly, many families manage within the limitations of public schooling by buying a house in a district with good schools, or by using private tutoring services as a supplement. Households with the most limited resources, unable to use any of these remedies, often make do with second-rate services.
So it is with government-provided healthcare. Public healthcare becomes the default option, but it never outperforms private or semi-private care, as exhaustive comparisons of European healthcare regimes show. State-of-the-art care becomes harder to access, as incentives for healthcare providers, administrators, and consumers are all skewed by artificial constraints. Those without the money to obtain the best treatment, or the connections to pull strings, find it increasingly hard to get appropriate medical care. The most pernicious aspect of government provided health care, though, is in the rationing of medical care and services. When the commodity being mismanaged is healthcare, the results include injury, disability, and death. Chilling examples from Canada show why single-payer, universal healthcare is not the way forward.
Canadians pay significantly higher taxes than Americans do. Many attempt to justify this by pointing to the services with which Canadians are provided. Comparing the quality of healthcare north of the border with that in the U.S. makes it clear that Canadians aren’t getting their money’s worth. While all insurers require that the treatments they fund be appropriate for the patients in question, in Canada government healthcare administrators have taken this a dystopian step further and now decide which people are deserving of treatment.
The most recent and outrageous example is the case of Samuel Golubchuk, an elderly Winnipeg man who died of natural causes in June, despite the best efforts of some of his caregivers to bring his life to an earlier close. Admitted to the hospital in fall of 2007 after contracting pneumonia, Golubchuk required a feeding tube and a ventilator. In November, his doctors decided to withdraw this care, despite the wishes of Golubchuk’s children and the patient’s own religious beliefs, which forbade the hastening of death. So strongly did the doctors in Golubchuk’s intensive care unit feel that their decision should override the wishes of the patient, expressed by his clergy and next of kin, that three of them resigned rather than comply with a court injunction obtained by the Golubchuk family against the withdrawal of life support. A local philosophy professor even characterized Golubchuk’s care as a waste of resources, endorsing the idea that doctors should decide who deserves treatment.