December 20, 2007

Out here in the Great State of California---land of sunshine, beautiful women, and government spending that gives new meaning to the term profligate---we have as our dear leader the ineffable Governator Arnold. Disciple of Milton Friedman. Motorcycle rider. Magnet for television cameras. True believer in the warm, warm church of AlGoreEarthWorship, HealthCareForEveryone, debt as a source of long term government finance, and other such institutional attitudes popular in the watering holes and expense-account restaurants of Hollywood.

Anyway, Arnold is promoting the Golden State version of salami-slice socialism in health care insurance, with an individual mandate, pay-or-play for employers, guaranteed issue, community rating, the whole nine yards. This proposal, an utter disaster in the making, is opposed by the California Nurses Association, which is pushing for a real single-payer system (Senate bill 840), with which the nurses' union could negotiate ever-richer contracts and retirement systems from public officials driven by short time horizons and all too happy to spend other people's money.

Dan Weintraub of the Sacramento Bee reported yesterday that the nurses are organizing a protest at the offices of Cigna because the evil insurer refused to pay for a liver transplant for a young girl, arguing that the procedure is experimental, and thus not covered under the terms of the insurance contract.

The nurses go on to argue that Arnold's healthcare proposal should be opposed because it "does not address the problem" of denial of care. But wait: SB840 does not do so either. Indeed, it would create an office of Administrator that would decide what treatments would be covered by the single-payer system. Just as bureaucrats now make identical decisions every day for MediCal (California Medicaid) patients.

Just as any system of insurance, self-insurance, etc., government or private, must make such decisions, because we live in a world in which resources are limited, always and everywhere. California, New York, Montana, Mississippi: There is not and cannot be "universal coverage," because some services will be too expensive to cover for some patients or for all, and the central policy question is whether those decisions will be made by individuals contracting voluntarily in the market, or by government officials who do not have "patients" or "customers," but who do face the crushing interest-group pressures of budget competition, 24/7.

The nurses have their own political goals, similar to those of any (public employee) union, and would be very, very happy to "negotiate" with public officials dependent upon their campaign contributions. And that is why government should be kept away from health care and most other markets as well, notwithstanding the usual blatherings about compassion and The Children.

Posted by Benjamin Zycher at December 20, 2007 11:01 AM

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