Al Gore and the Liberal Dream

Published January 1, 2003

Former Vice President Al Gore recently began pounding the drum for health care reform. He told the nation what most of us already know: The U.S. health care system is in a state of crisis.

But in what has to be a classic example of intellectual exhaustion, Gore says he “reluctantly” arrived at the point where the reform he favors is the old, threadbare, and unworkable liberal dream: a single-payer health care system.

A few days after Gore’s announcement, a suspiciously timed report by the National Academy of Sciences said pretty much the same thing, except it proposed a more modest agenda, urging the Bush administration to “test” possible solutions, including single-payer insurance coverage, in a handful of states.

A day after the NAS report was issued, Gore reinvented himself one more time and said he thought “the single-payer system should be run by the private sector.”

Either antitrust after the Microsoft case really is dead, or Gore has now completely forgotten the difference between the private and public sectors.

Unless the former Vice President changes his mind once again, he apparently believes the money that pays for health care–including insurance premiums and tax dollars–should be collected by a single government agency in an approach similar to that taken by the dysfunctional health care systems of England, Canada, and our own Medicare.

A Universal Gripe

The people in Canada and the U.K. are no happier with their health care systems than we are with ours. Doctors and nurses trapped in government-run health care systems are leaving chosen careers, patients lack access to cutting-edge technology and facilities, and government health departments report record numbers of people dying while in queues.

Government-run systems in the United States, such as the Veterans Administration’s health care program, Medicare, and Medicaid, have many of the same problems. Government control of care hasn’t solved the underlying problem of unlimited demand and limited supply. It masks, shifts, and delays the tradeoffs that must eventually be made.

Gore’s approach is purely political and dangerously dishonest, while the NAS report is based on selective evidence and the old bureaucratic dodge of calling for experiments and more research.

It’s the Regulations

Instead of banging the drum loudly as a distraction, Gore and the NAS should have launched an honest and open discussion of how existing state and federal regulations, price controls, entitlement programs, and benefit mandates are responsible for the crisis in our health care system.

Over the past 40 years, 1,500 unfunded insurance mandates zipped through state legislatures and Congress because politicians saw them as an easy way to garner constituents’ votes without having to raise state taxes or spend more on public health issues. Now, we’re paying the price.

Government mandates require health insurance benefits to include everything from pastoral counseling to sperm-bank deposits. When combined with procedural mandates like “community rating” (which prevents insurers from basing premiums on risk factors like lifestyle choices) and “guaranteed issue” (which allows and encourages people to wait until they get sick before they buy health insurance), the bureaucratic chefs have created a toxic soup of regulations that is not-so-slowly and surely inflating the cost of private health insurance.

We Need a New Drummer

The average annual health insurance premium for an individual policyholder in California, which mandates neither community rating nor guaranteed issue, is $1,538. The average premium in highly regulated New York, which imposes both, is more than twice as much at $3,589. A Congressional Budget Office study revealed 200,000 people drop private health insurance every time premiums rise by 1 percent.

A recent PricewaterhouseCoopers study commissioned by the Association of Health Plans forecasted a health insurance premium increase of 13.7 percent for 2002. PwC attributed 15 percent of that increase to government mandates and regulations, 7 percent to litigation, and 5 percent to fraud and abuse.

If Gore or the NAS consider it important to warn the American people about the crisis in health care today, they also bear the responsibility to explain why that crisis exists. Public-sector failure, not market failure, lies at the root of today’s problems. Promising more government intervention to solve a problem caused by government is, well, pretty dumb.

Millions of Americans can’t afford the cost of insurance because of the mandates imposed by their representatives in government. What we need now is a drummer willing to criticize incumbent legislators who took the easy way out and helped cripple our market-based health care system–a drummer willing to lead the effort to eliminate existing regulations and mandates.

Al Gore, I’ve reluctantly concluded, is not that drummer.

Conrad F. Meier is managing editor of Health Care News