With the following proviso: Reprinted by Permission from Imprimis, a publication of Hillsdale College, Common Sense University finds the timing of this article very appropriate. It was adapted from a speech given by U.S. Representative Paul Ryan on January 13, 2010, in Washington, D.C., at an event sponsored by Hillsdale College’s Allan P. Kirby, Jr. Center for Constitutional Studies and Citizenship.
SOMEONE once said that before there was the New Deal, there was the Wisconsin Deal. In my home state, the University of Wisconsin was an early hotbed of progressivism, whose goal was to reorder society along lines other than those of the Constitution. The best known Wisconsin progressive in American politics was Robert LaFollette. “Fighting Bob,” as he was called, was a Republican—as was Theodore Roosevelt, another early progressive. Today we tend to associate progressivism mostly with Democrats, and trace it back to Woodrow Wilson. But it had its roots in both parties.
The social and political programs of the progressives came in on two great waves: the New Deal of the 1930s and the Great Society of the 1960s. Today, President Obama often invokes progressivism and hopes to generate its third great wave of public policy. In thinking about what this would mean, we need look no farther than the health care reform program he is promoting along with the leadership in Congress.
Let me say here at the beginning that even though survey after survey shows that 75 percent or more of Americans are satisfied with the quality of their health care, no one I know in Congress denies that health care reform is needed. Everyone understands that health care in our country has grown needlessly expensive, and that some who want coverage cannot afford it. The ongoing debate over health care, then, is not about whether there should be reform; it is about what the principle of that reform ought to be.
Under the terms of our Constitution, every individual has a right to care for their health, just as they have a right to eat. These rights are integral to our natural right to life—and it is government’s chief purpose to secure our natural rights. But the right to care for one’s health does not imply that government must provide health care, any more than our right to eat, in order to live, requires government to own the farms and raise the crops.
Government’s constitutional obligations in regard to protecting such rights are normally met by establishing the conditions for free markets—markets which historically provide an abundance of goods and services, at an affordable cost, for the largest number. When free markets seem to be failing to meet this goal—and I would argue that the delivery of health care today is an example of where this is the case—government, rather than seeking to supply the need itself, should look to see if its own interventions are the root of the problem, and should make adjustments to unleash competition and choice.
With good reason, the Constitution left the administration of public health—like that of most public goods—decentralized. If there is any doubt that control of health care services should not have been placed in the federal government, we need only look at the history of Medicare and Medicaid—a history in which fraud has proliferated despite all efforts to stop it and failure to control costs has become a national nightmare. In 1966 the cost of Medicare to the taxpayers was about $3 billion. The House Ways and Means Committee estimated that it would cost $12 billion (adjusted for inflation) by 1990. The actual cost in 1990 was nearly nine times that—$107 billion. By 2009 Medicare costs reached $427 billion, with Medicaid boosting that by an additional $255 billion. And this doesn’t take into account the Medicaid expansion in last year’s “stimulus.”
The health care reform bills that emerged from the House and the Senate late last year would only exacerbate this crisis. The federal takeover of health care that those bills represent would subsume approximately one-sixth of our national economy. Combined with spending at all levels, government would then control about 50 percent of total national production.
The good news is that we have a choice. There are three basic models for health care delivery that are available to us: (1) today’s business-government partnership or “crony capitalism” model, in which bureaucratized insurance companies monopolize the field in most states; (2) the progressive model promoted by the Obama administration and congressional leaders, in which federal bureaucrats tell us which services they will allow; and (3) the model consistent with our Constitution, in which health care providers compete in a free and transparent market, and in which individual consumers are in control.
We are urged today—out of compassion—to support the progressive model; but placing control of health care in the hands of government bureaucrats is not compassionate. Bureaucrats don’t make decisions about health care according to personal need or preference; they ration resources according to a dollar-driven social calculus. Dr. Ezekiel Emanuel, one of the administration’s point people on health care, advocates what he calls a “whole life system”—a system in which government makes treatment decisions for individuals using a statistical formula based on average life expectancy and “social usefulness.” In keeping with this, the plans that recently emerged from Congress have a Medicare board of unelected specialists whose job it would be to determine the program’s treatment protocols as a method of limiting costs.
President Obama said in December: “If we don’t pass [this health care reform legislation]…the federal government will go bankrupt, because Medicare and Medicaid are on a trajectory that are [sic] unsustainable….” On first hearing, this argument appears ludicrous: We must stop the nation from going broke by enacting a program costing $800 billion or more in its first decade alone? On the other hand, if the President means what he says, there is only one way to achieve his stated goal under the new program: through deep and comprehensive government rationing of health care.
The idea that the government should make decisions about how long people should live and who should be denied care is something that Americans find repugnant. As is true of the supply of every service or product, the supply of health care is finite. But it is a mistake to conclude that government should ration it, rather than allowing individuals to order their needs and allocate their resources among competing options. Those who are sick, special needs patients, and seniors are the ones who will be most at risk when the government involves itself in these difficult choices—as government must, once it takes upon itself management of American health care.
The very idea of government-run health care conflicts with the American idea of a free society and the constitutional principles underlying it—the principles of individual rights and free markets. And from a practical perspective it makes no sense, given that our current health care system is the best in the world—even drawing patients from other advanced countries that have suffered by adopting the government-run model.