That’s all folks.

FEE Timely Classic:
“National Health Care: Medical Disaster” by Jarrett B. Wollstein

Paul Krugman, perhaps the most visible “Progressive” today, supports this bill because it vastly expands the scope of the state in our lives. Like most “Progressives,” Krugman believes many things about a state controlled by people he supports. Among the “Progressive” beliefs are:

• “Experts” should decide what is best for everyone;
• The executive branch of government must employ “experts” who can make rules for everyone else;
• Governmental executives (i.e., President of the United States) should not be impeded by legislators, most of whom are not “experts,” and who fail to have the interests of everyone in mind, unlike the “experts” of the executive branch;
• Therefore, the legislative branches of government should defer to the executive branch, provided the “right kind of people” are in the executive’s chair.

Few people actually know everything that exists in this long and convoluted bill. However, that is unimportant, for in the end, the executive branch and its bureaucracies, not Congress, will interpret what the bill contains.

Most people still have the civics book ideas in their heads regarding law and the three branches of government. Americans are taught from grammar school on that the federal government has three branches: Congress, the Executive Branch, and the Federal Courts. According to the civics lessons, Congress makes the laws, the Executive Branch carries out the laws, and the Federal Courts interpret the laws.

That “model” of government disappeared even before the Progressive Era gripped the country a century ago, but it gained in strength during the Great Depression. “Progressives” such as Theodore Roosevelt and Herbert Croly, believed that people had become so advanced through “science” that they no longer needed to be subjected to the messy and (to them) “chaotic” processes of private markets and legislative debate. The “experts” already knew what needed to be done, and anything done by legislatures and markets to delay the directives of the “experts” should be swept away.

Thus, Krugman can write the following, which is fully consistent with the Progressive ethos:

Now consider what lies ahead. We need fundamental financial reform. We need to deal with climate change. We need to deal with our long-run budget deficit. What are the chances that we can do all that — or, I’m tempted to say, any of it — if doing anything requires 60 votes in a deeply polarized Senate?

Translation: We need government action, not legislative debate. The legislative branch just gets in the way of what we need. (I do find it curious that a person who had advocated the most irresponsible spending in the history of the country now says we must “deal” with the “long-run budget deficit.” What he really means, of course, is that we have to raise taxes through the roof.)

Krugman need not fear, however, for the Obama administration really did not need this bill to take over medical care. Remember the 2009 GM/Chrysler bailouts? They came entirely through the executive branch, while in 1980, Congress had to pass legislation to aid Chrysler. In other words, the financial and regulatory role of Congress has shrunk massively even in the past 30 years.

Likewise, the EPA recently re-interpreted (with permission from the U.S. Supreme Court) the 1990 Clean Air Act Amendments to include carbon dioxide as a “dangerous pollutant.” The original law had no such language, but the EPA simply identified a new pollutant, and it legally can impose “solutions.”

In the end, the bill will be whatever the White House wants it to be. The ultimate legacy of “Progressivism” is that political debate no longer matters. The medical bill was bad legislation and everyone knew it, which was why the political tension was so great. However, now that Congress has given it permission to determine our medical futures, the Obama administration will waste no time imposing oppressive and costly new rules upon us, even if they are not contained in the actual bill Congress passed.

“All 58 Democrats and two independents voted to approve the first — and most crucial — of three motions needed to break off action, as the Senate entered a fourth week of debate on the bill. All Republicans voted no.” (Wall Street Journal, Monday)

Now let’s see if the public option gets added in committee.

FEE Timely Classic:
“Why Medicine is Slowly Dying in America” by Michael Hurd

That’s the polite way to put it.

FEE Timely Classic:
“Health Care Cons” by Sheldon Richman

Translation: Clearly there isn’t enough public support for “change,” so just shove it down their throats.

FEE Timely Classic:
“The Growth of Government in America” by Stephen Moore

Joe Lieberman comes back to haunt Democrats.

FEE Timely Classic:
“Rights Versus Entitlements” by Steven Yates

I guess not everyone likes throwing money into a bottomless pit.

FEE Timely Classic:
“Guess Who Paved the Road to Socialized Medicine?” by Sue Blevins

Crunch time.

FEE Timely Classic:
“Are We Really all Healthcare Collectivists Now?” by Sheldon Richman

There is much talk of doctors’ leaving their profession if ObamaCare—that is, burgeoning government control of the practice of medicine—passes. However, the odds are great that although ObamaCare will pass, there won’t be any dramatic job stoppage. No Galt’s Gulch will form where masses of physicians on strike will live in peace and solitude, some building cars and others mining copper, all vowing never to return to medicine until their demands are met. Such is the nature of fiction. But the reality is much worse.

What will happen will be more insidious, though over time no less damaging. There will be an increase in early retirement, as more physicians tire of their jobs.  More will take time off and let their practices suffer at the margin. Patients will have slightly more difficulty making appointments each year–year after year–though never so quickly as to lead to mass complaints or a recognition that things are obviously worse.

Coverage will be shunted to physician assistants, nurse practitioners, emergency department physicians, hospitalists, and partners. Fewer patients will feel they have their own doctors. This will not necessarily be worse—I don’t feel I have my own McDonald’s, yet the food remains as I expect—but it may be worse to the extent quality of care depends on background knowledge of individuals.

And the filter determining who gets into medical school will change. Fewer will enter the field due to intellectual curiosity. More and more people who cannot tolerate bureaucracy will be weeded out. Questioning authority will become as dangerous in medicine as in policing or the military. The 40-hour physician work week, on the other hand, will become commonplace, and the type of person attracted to medicine will not be the type willing to work any longer or any harder.

Slowly and gradually, community hospitals will resemble VA hospitals. Centers of excellence will be advocated in theory—“evidence-based medicine” will be the byword to “bend the cost curve downward” by eliminating “inefficiencies.” But will they really be excellent, or will they merely be better than whatever else is available? Will they be free to innovate? Will they be free to profit if their innovations are successful? Or will they simply be the medical equivalents of the best cars on the road in Cuba?

Pharmaceutical innovation, produced by those evil for-profit companies that even doctors love to denounce, will drop off–not precipitously but eventually. And people will die, as they have died from time immemorial, without anyone ever knowing what drugs might have improved or extended their lives, if only there had been greater incentives available to produce them.

Imaging studies will become more important, as fewer physicians learn how to do detailed physical exams—it’s not as if they’ll have the time per patient to do such exams in any case—but imaging studies will also become more difficult to schedule. And the quality spectrum between optimally interpreted exams and standardly interpreted exams will continue to widen. The CPT (Current Procedural Terminology) codes are the same, independent of the quality of the interpretation.

There is already a spectrum of quality available in medicine, and those with means can obtain better medical care, just as O. J. was able to obtain better legal services. But that spectrum risks becoming more rigidified. What in America has been health care for the poor will become healthcare for all but the very rich. But the “cost curve” will bend downward.

Or will it? Medical salaries will bend downward, certainly. But administrative costs associated with government programs are always huge, and always underestimated. Medicare spending now is an order of magnitude higher than the projections made in 1965. But we do know this: Bending the cost curve of medical care in either direction has costs of its own.

If it’s bent downwards people will wait longer for health care that is not as good as it could have been. We often buy things “not as good as they could have been”—Chryslers rather than Cadillacs, Range Rovers rather than Rolls Royces–but we make those choices at the individual level; they’re not forced on us by “society.”

Or the cost curve can bend upward, perhaps due to hidden governmental administrative costs, perhaps because AARP is a strong lobby. And we’ll feel the pinch in other areas, as our debt grows and our prosperity lags and falters, and becomes a quaint piece of history we teach our children (or perhaps, in our guilt, hide from them).

We’ll pride ourselves, as we do now, on “the best healthcare system in the world,” as we also brag that we have universal care, just like the great nations of Europe. And we’ll suffer with double-digit unemployment, just like the great nations of Europe. And we’ll have lower productivity growth, just like the great nations of Europe. And we’ll have smaller houses and cars, just like the great nations of Europe.

But it will be all right, because we’ll have a right to health care . . . for which we’ll wait . . . and wait . . . and wait.

Never mind the federal government’s own indispensable role as an enabler in the crisis, from its reckless monetary policy to its jawboning banks into making dubious mortgage loans. Never mind the long-term danger of its assumption of colossal new obligations and the moral hazard in the message its intervention sends. My response to my friend was of a more narrow focus. “Thank God we have the private sector to bail out the federal government not just last week, but every week!” I exclaimed.

Think about it. Taxes on the private sector pay a majority of the federal government’s bills. For most of the rest, the government borrows by selling its debt obligations, mostly to private-sector entities–including banks, insurance companies, and individuals.

The federal government is the world’s biggest taxer and the world’s biggest debtor. If those of us in the private sector didn’t pay our taxes or didn’t buy Washington’s paper, the feds would have gone belly-up decades ago. We’ve rescued Washington to the tune of tens of trillions of dollars over the years. A big difference between Washington’s bailing out the private sector and the private sector’s bailing out Washington is that the private sector has to work, invest, employ people, and produce goods to come up with the cash. It can’t create it out of thin air like Ben Bernanke can.

Our friends in Washington have blessed us with future burdens almost too astronomical to comprehend.  In the name of taking care of us in our old age, we are saddled with no less than $6 trillion in Social Security payouts over the next 75 years–for which there are no presently earmarked funding streams. According to Brian Riedl of the Heritage Foundation, the unfunded obligations for the new federal prescription drug program, enacted under President Bush, total another $8 trillion.

On and on it goes. The private sector has an awful lot of bailing out to do in the coming decades. I shudder to think how deeply we taxpayers will have to dig in the not-too-distant future to pay the bills of our benevolent, compassionate, and forward-thinking government.

Since Barack Obama took office in January 2009, the federal government has spent a full billion dollars every single hour. Before his term is half over, federal spending will have doubled in just a decade. The deficit in one year’s budget is now as large as the entire budget in George W. Bush’s first year as president, 2001–and I thought not very long ago that the spending spree he and the Republicans gave us would be tough to beat! The flood of red ink is now adding to the national debt to the tune of about $4 billion every day. At well over $11 trillion, that debt amounts to $37,000 for every living American.

Too Big to Succeed?

We’re told by the wise planners in Washington that certain private firms are “too big to fail.” So we’re handing big chunks of them over to the government.

The question we all should be asking ourselves is this: Are we trusting our economy and our lives to a government that is too big to succeed?

Once upon a time in America, most citizens expected government to keep the peace and otherwise leave them alone. We built a vibrant, self-reliant, entrepreneurial culture with strong families and solid values. We respected property and largely kept the spirit of the Eighth and Tenth Commandments against coveting and stealing. We understood that government didn’t have anything to give anybody except what it first took from somebody and that a government big enough to give us everything we want would be big enough to take away everything we’ve got. We practiced fiscal discipline in our personal lives and expected nothing less from the people in the government we elected, or we threw them out.

But somewhere along the way we lost our moral compass. And just like the Roman Republic that rose on integrity and collapsed in turpitude, we thought the “bread and circuses” the government could provide us would buy us comfort and security.

We gave the government the responsibility to educate our children, though government can never be counted on to teach well the main ingredients of a free society–liberty and character–or just about anything else, for that matter. We asked the government to give us health care, welfare, pensions, college education, and farm subsidies, and now our politicians are bankrupting the country to pay the bills. This welfare state of ours has become one big circle of 305 million people, each with his hand in the next fellow’s pocket.

This is a government whose reach even before the financial crisis scarcely left an aspect of American life untouched, from the cradle to the grave and the volume of our toilet-bowl water in between. As a portion of our personal income, its tax and regulatory burden consumes at least five times what it did just a century ago. But to the majority on the Potomac, government is nowhere yet big enough. This is madness writ large.

Stick to the Knitting

Remember In Search of Excellence, the 1982 best-selling management book by Tom Peters and Robert Waterman? One of its salient points is that an organization gets off track when it no longer “sticks to the knitting.” When it allows its mission to blur and stretch far beyond its founding design, when it becomes distracted by endless and dubious new responsibilities, its core competency evaporates. It will fail to do what it is supposed to do, because it’s doing too much of what it’s not supposed to do.

It may come as a surprise to those who see aspirin made in Washington as the cure for every ailment, but the federal government is not God. It can’t even be a good Santa Claus. It’s no Mother Teresa either, because on those occasions when it does some good it usually costs an arm and a leg and sends a big part of the bill to generations yet unborn. The fact is, the bigger government gets, the more it starts to look like Moe, Larry, and Curly.

Accentuating the madness of the present day, the cover of Newsweek declared last March, “We are all socialists now.” Pardon me, but I’m not about to sign on to a proven flop.