Socialized Medicine at the Back Door

Published December 1, 2001

What’s happening in Portland, Maine (see the news story on page 1 and The Pulse, page 3) is not just activists chanting their favorite leftist sound-bites, nor is it the action of “well-intended” people unaware of the “unintended” consequences of their actions. These people know exactly what they are doing.

I am not inclined to think, as some do, that the Maine effort is some sort of “publicity stunt.” While the non-binding Portland referendum passed by only a thin margin in the state’s largest, most liberal city, the results may have broad implications for the direction of Maine health care when lawmakers reconvene in January.

At the center of the effort is the 26-state National Labor Party and its local affiliate, the Southern Maine Labor Party. In addition, there’s the Maine Peoples’ Alliance, Portland Democratic Committee, Portland Independent Greens, Consumers for Affordable Health Care, and Maine’s AFL-CIO.

All these left-leaning groups are affiliated with national organizations. I fear we are witnessing the first of 50 well-funded “astroturf” campaigns planned and financed at the national level by people with a socialist agenda.

Make no mistake about it, their agenda calls for the elimination of the health insurance industry and the health insurance component of worker’s compensation in favor of a government health care monopoly. Once that monopoly is established, I see a natural progression to the elimination of private life insurance, private auto insurance, private mortgage insurance, and private retirement plans.

These private insurance sectors represent individual freedom and consumer power—neither of which exists in a socialized environment.

Dr. Duncan Wright, a member of the Southern Maine Labor Party who helped launch the signature drive for the Maine referendum, called single-payer health care “a collective obligation we have as a society. We each hold up a little part of the weight.”

Physicians for a National Health Program (PNHP) has a Web site ( that features this statement: “Rats and roaches live by competition under the laws of supply and demand.”

PNHP views “this [single-payer] campaign as part of social justice in the United States,” not just Maine. “PNHP opposes for-profit control, and especially corporate control, of the health system and favors democratic control, public administration, and single-payer financing. PNHP believes this program should be financed by truly progressive taxation.”

Moral Hazard in the Buffet Line

Single-payer means government is the insurance company. It doesn’t charge “premiums,” but instead raises taxes.

Single-payer also means government is the provider for all medical services. This necessarily requires government to control not only the financing, but also who gets what services, the quality of what they get, when they get it, and if they get it. A single-payer system is one big HMO, without the discipline and accountability achieved by competition. Expect it to be as efficient as the U.S. Postal Service, with the compassion of the IRS.

Every day, in every aspect of our lives, we balance cost against quality and convenience. Sometimes we’re willing to spend more for something that is high quality or more convenient. At other times, the quality or convenience difference isn’t enough to persuade us to pay more.

But when we are insulated from the true cost of something—in this case health care—the money side of the equation becomes much less important. To paraphrase Milton Friedman, nobody spends their own money like they spend someone else’s.

At the all-you-can-eat, $5.99 smorgasbord, many of us eat (or leave behind on our plates) more than we would have been willing to pay for. We think we’re getting something for nothing. The sucker who had only one helping subsidizes our second or third trip to the buffet.

If over-consumption at the buffet line gets out of hand, the price will eventually go up, or the amount we’re permitted to eat may be rationed. The same holds true for health care.

They Just Don’t Get It

For physicians, single-payer means working for a single employer—just like the HMO arrangement they already dislike. But some are tempted by the promise of being freed from the burden of setting prices and collecting payments. Something for nothing?

For patients, single-payer means less care, and lower-quality care. After being assigned to a physician (no, you can’t choose), getting in to see that physician may not be easy—just ask patients enrolled in Medicare or Medicaid. Doctors in single-payer systems around the world complain they can’t spend quality time with patients when they have to see 40 or 50 patients a day. Patients’ rights? Those laws don’t apply to government-run health care.

For the politicians, single-payer means being able to promise voters more than the other candidate does. Only later will health care budgets strain under the pressure of increased demand for “free” care. Taxes will have to be increased if services are to be maintained . . . but that will come after the election. State legislators in Tennessee are experiencing the inevitable hangover.

At some point, taxes will be raised as high as taxpayers will stand, and the revenues will still not be enough. Then, the whole system implodes—witness England and Canada . . . or Kentucky, Washington, Colorado, Tennessee, Maryland, and California, all of which have dabbled in single-payer experiments.

Single-payer systems are notorious for passing the buck. Government bureaucrats set the budget, but doctors, hospitals, and other health care providers must make the tough rationing decisions needed to operate within that budget. At the bottom of the pecking order we find the most vulnerable of all populations, patients who require high maintenance and expensive care: seniors and the chronically ill.

Maybe folks in Portland think they are smarter than the collective experience of troubled single-payer plans here and abroad. My advice to folks in the Pine Tree State would be, “be careful of what you ask for, you just might get it.”

Or maybe Martin Luther King said it better: “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.”