January 10, 2008

Robert Reich opined in yesterday's Wall Street Journal about the mudfight among the Democratic presidential candidates on the issue of whose individual "mandate" (a requirement that health insurance be acquired) would yield the most extensive coverage. And Reich is right: The differences are small, and the most extensive (or more stringently enforced) mandates are a way of imposing a tax on the young and healthy so as to subsidize other purchasers of health insurance. And thus does the great struggle over health care and "the children" boil down, as usual, to a fight over who gets to have greater snout privileges at the federal trough.

Reich claims that all the Democratic plans would cover roughly the same number of people; but nowhere does he delve into the issue of precisely what "coverage" means in a world in which government mandates insurance. Even apart from the larger reality that all the Democratic plans would lead toward a single-payer system and all the perversities thereto pertaining, government does not have infinite resources, and so must make choices about whom to "cover" and for what. And this dynamic proceeeds in the context of the eternal struggle over budget dollars, in which patients are just another interest group among many.

And that is why "universal coverage" is the opposite of health care, as government squeezes patients and providers so as to engender "savings" that can be used for other budget priorities. Where does the quality of actual care fit in that Beltway universe? The question answers itself, just as it has in the UK and Canada and other places where government compassion reigns supreme.

Posted by Benjamin Zycher at January 10, 2008 06:49 PM

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