The Clintons' Lethal Paternalism

THE DEBATE ABOUT THE CLINTONS' HEALTH CARE PLAN IS, literally, a matter of life and death. If anything like that plan becomes law, there will be much unnecessary premature death and other suffering. The plan would reduce the quantity and quality of health care and medical technologies by vastly expanding government's coercive role. To see why support for the plan plummets as analysis of it proceeds, see the analysis in The New Republic by Elizabeth McCaughey of the Manhattan Institute.

The plan authorizes seven presidential appointees, the National Health Board, to guess the nation's health care needs and decree how much the nation may spend meeting them. Everyone would be locked into one system of low-budget health plans picked by the government. Fifteen presidential appointees, the National Quality Management Council, not you and your doctor, would define the "medically necessary" and "appropriate" care a doctor could give you. Escaping government control to choose your doctor or buy other care would be virtually impossible. Doctors could be paid only by the government-approved plans, at rates set by the government. It would be illegal for doctors to accept money directly from patients, and there would be 15-year jail terms for people driven to bribery for care they feel they need but the government does not deem "necessary."

Government would define a minimum level of care and herd people in particular regions into dependence on the lowest-cost organization able to deliver that level. Doctors would be driven into organizations in which they would be punished financially for giving more treatment than the organizations' budget targets permit. The primary care physician assigned to you would be, McCaughey notes, a gatekeeper with an incentive to limit your access to specialists and high-tech medicine. The premise of the Clintons' plan is not just that government knows best, but that government knows everything relevant, including how many specialists there should be no more than 45 percent of all doctors. McCaughey says many medical students will be told that the specialties they prefer are closed, or closed to them because they are not the right race or ethnicity. Yes, the plan subordinates medical values to "diversity."

To further suppress, through rationing, consumption of other than low-budget, low-tech medicine, the plan would empower a presidential appointee (the secretary of HHS) to control the price of any new drug. Control would be based on the development cost and profitability of each drug, rather than a company's full range of drug development outlays. But for every drug that becomes profitable 1,000 do not. Thus the Clintons' plan would certainly suppress research that might spare millions of persons some of the ravages of AIDS, Alzheimer's, breast and ovarian cancer and other diseases.

The Clintons' plan's subtractions from public health and personal freedom would be preposterous prices to pay even to give insurance to 38 million uninsured Americans. But the actual number of chronically uninsured-those uninsured involuntarily and for prolonged periods-is only about 6 million, less than 3 percent of the population, and they are not denied medical care. Indeed, per capita spending on them is 60 percent of per capita expenditures on the insured pre-Medicare population, according to Irwin Stelzer.

Writing in Commentary, Stelzer refutes the notion that we must be spending "too much" on health care because other nations spend less, or because we spend more than we used to, or because the results are not commensurate with the expenditures. Yes, other nations spend smaller percentages of GDP on health care. But when did, say, Japanese living standards (Japanese doctors see an average of 49 patients a day for an average of five minutes per visit) become America's aspiration? Canada? There are 1.4 million Canadians queuing for care and 45 percent of those awaiting surgery say they are in pain. America spends twice as much per student on higher education than the average for 24 industrial nations. Stelzer wonders: How many professors endorsing the Clintons' "global budgets" to limit health care spending would favor capping professors' salaries?

American values are one reason health costs are high. About 30 percent are incurred in the last six months of patients' lives. American behavior-violence, diet, unsafe sex, drug abuse, teenage illegitimacy (severely underweight babies cost an average of 8158,000 in care) -produces health costs that cannot be blamed on inefficiencies in the system.

The Clintons' "projection" that without their plan health care spending, currently 14 percent of GDP, will reach 26 percent by 2030 is akin to the government's projection-remember?--of oil at $100 per barrel. Market forces--new discoveries, conservation, alternative fuels--refuted the hysterics who trumpeted the "energy crisis" as an excuse for expanding governmental command of the economy. Government is even less competent to anticipate the future of medicine.

Health care cost 5 percent of GDP in 1960. All in favor of spending at 1960 levels signify by saying let's do without bypass operations (300,000 this year), CAT and PETT scans, MRIs, endoscopes and other diagnostic technologies, laser microsurgery and all the other capabilities that have come with increased costs.

Roy Porter, a medical historian, limns the astonishing acceleration of medical advance in our lifetimes. Since the 1930s sulfa drugs and antibiotics have made childbirth safe for mother and child. In 1940 penicillin was still being tested on mice, and pneumonia, meningitis and comparable infections were frequently fatal. The 1950s produced polio vaccines, psychotropic drugs for mental illnesses and medicines for biochemical abnormalities. Pediatric cardiology leapt forward as did, in the 1960s, organ transplants. Treating prostate cancer with hormones and arthritis with cortisone, deciphering the role of slow viruses in chronic diseases of the central nervous system--these and many more marvels constitute a therapeutic revolution in a half century.

All this success is driven by a subtle symbiosis among complex, mature professions and institutions. It is horrifying to think of these life-enhancing jewels of our civilization coming under the control of political bureaucracies. The Clintons' plan presents the face of paternalistic liberalism, of government that is bullying because it is arrogant, and arrogant because it does not know what it does not know. It is unlovely and, literally, lethal.