Morally wrong and fiscally unsound.

The New York Times this morning in a curious combination of op-ed pieces combines a plea by Nicholas Kristof for animal rights with a piece advocating no rights for people who do not buy health insurance by Ramesh Ponnuru.

Ponnuru concludes his article opposing universal health care with the statement; “Some people would, of course, chose to go with out it (health insurance). But that would be their call, as it should be in a free country.” In addition being a rather appalling moral judgment, it ignores those who would be without health insurance regardless of how cheap it is, because they would rather eat, those who are mentally so confused they cannot make a rational judgment, those too ignorant to understand they are making a choice, the spouse of a person who is too cheap to buy the insurance, those who because of their age do not have the right of choice, or the unborn who die because their mother or father gambles wrong.

There is good reason to question the assertion that cost shifting from the uninsured to the insured amounts to an increase in premiums of only 1.7%. In The Cost Shift from the Uninsured the writers claim the shift is 8%. The writer of the Times article does not name the article that is the source of his figure. The writer goes on to assert that government mandated insurance would specify the type of coverage that must be afforded as this was an evil. Without some criteria as to what constitutes “health insurance” the mandate would be meaningless. He then drifts off into speculation that these mandates would include fertility specialists and massage therapists and that we would end up with costs-shifting and no savings. Of course, there would be costs-shifting that is the whole purpose of mandated insurance coverage. To place the cost on medical care on those that elect not to buy health insurance rather than force the insured to pay the cost of the uninsured as the present system does.

Ponnuru then admits that a strong case can be made for universal coverage to see that the poor and near poor have decent medical care. He then seems to say that the cost would be less if we used clinics, reducing medical errors or nutrition. Government funded clinics would be an effective method of providing some medical services to the destitute, poor or near poor, but that is a more radical solution than mandated health insurance. It would involve an army of government employed doctors, buying the necessary equipment and housing the clinics. Reducing medical errors would certainly reduce medical costs, but how would the be accomplished, by another army of beurocrats to police the doctors. Lots of luck with that. Better nutrition would certainly help the poor, but that involves case workers to teach the poor how to cook and eat. This was done in the south in the 30’s with great success, but was abandoned when the war started. I doubt that it would reduce medical costs much. None of these things, good as they might be, address the cost shifting in hospitals where most of it currently occurs. The poor simply don’t go to individual doctors or clinics because of the cost.

Ponnuru asserts that universal coverage reduces the quality of health care or retards medical innovation. Since we rank 15^th in the world by the commonly used standards of health care and 1^st in the amount of money spent on health care, I don’t see that the present system is doing such a hot job. I do not think our lowered life expectancy, and high infant mortality rates are because our doctors or hospitals are inferior. They are because of the misdistribution health care.

Ponnuru would replace our present employer based health insurance with private individual policies. He proposing abolishing the tax deduction to employers and substituting a tax credit for individual policies. No employer would maintain a costly health insurance program if it was not tax deductable. A tax credit does no good if you aren’t paying any taxes. Who would pay for the health insurance if an individual is unemployed?

This is one of the worst articles written in a major publication concerning health care issues. It is both morally and fiscally unsound.