In addition to the cardiac and I.C.U. patients that Canada must send south to get proper care, women with high-risk pregnancies and sick babies are also being sent to the U.S. The Globe & Mail reports the following:

More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year.

Why? Because the bureaucrats who run the Canadian system failed to allocate enough beds:

The problem is due to bed closings that took place almost a decade ago, the absence of a national birthing initiative and too few staff.

And even when there is a bed, there’s a shortage of neonatologists:

When extra NICU beds were added in Victoria, it took about a year before they were operational due to the difficulty in recruiting a neonatologist.

This story resonated with me because, as it happens,  my eldest daughter was a premie. She was a “thirty-week baby,” fifteen inches long and weighing in at a little less than three pounds.

And how did she fare in the evil “profit-driven” U.S. system? Well, there was a bed for her … about 100 yards away. And a neonatologist was on hand to manage her care from the moment she took her first breath.

What kind of moron would want to exchange a system like that for a pig’s breakfast like the Canadian system?

The media have been reluctant to ask Barack Obama tough questions on health care, but his actual legislative record is a cautionary tale. He has consistently favored policies that contribute to health care inflation.

For example, his career as an Illinois state senator was marked by unwavering support for government mandates dictating the coverage health insurers must provide. The WSJ explains why this is bad:

A long list of studies show that mandates like the ones Mr. Obama has championed drive up the cost of insurance for the very people priced out of coverage.

And the cost increases caused by these mandates are significicant: 

A 2008 study by an insurance-industry supported research organization, the Council for Affordable Health Insurance (CAHI), estimates that mandates increase the cost of basic health coverage by 20% to 50%, depending on the state.

So, what’s the alternative?

If insurers were allowed to offer “bare-bones” plans – which would be cheaper because they would cover just essential care – many consumers who are priced out of health insurance now would likely buy these plans instead of living without insurance.

But that’s not what Obama is offering the American people as a presidential candidate. According to his web site, he is for “guaranteed eligibility” and “comprehensive benefits.” In other words, more of the same.

“Guaranteed eligibility” and “comprehensive benefits” sound good to many voters, but government mandates providing such things will keep insurance prices high. Does that sound like”change” to you?

McCain’s health care plan is by no means perfect, but it is vastly superior to that of the probable Democrat presidential nominee. Here’s an excerpt from my American Spectator article comparing McCain’s health care reform agenda to Obama’s:

McCain would emphasize consumer choice, markets and tax reform, while eschewing government-run health care. As he put it on April 28, at the launch of his “Call to Action” tour, “I am convinced that the wrong way to go is to turn over your lives to the government and hope it will all be fine.” Obama, on the other hand, places considerable faith in the state, favoring the shopworn tools of big-government liberalism: central planning, oppressive bureaucracy, and the creation of new entitlement programs.

To read the rest of the article, go here.

A few months ago, I wrote that the outcome of the SCHIP debate portended the demise of health care “reform” as envisioned by Hillary Clinton and Barack Obama. It appears that this reality has finally dawned on congressional Democrats. Per The Hill:

Congressional Democrats are backing away from healthcare reform promises made by their two presidential candidates, saying that even if their party controls the White House and Congress, sweeping change will be difficult.

But what about the grandiose promises of their presidential candidates?

‘We all know there is not enough money to do all this stuff,’ said Sen. Jay Rockefeller (D-W.Va.), a Finance Committee member and an Obama supporter, referring to the presidential candidates’ healthcare plans. ‘What they are doing is … laying out their ambitions.’

What they are actually “laying out,” of course, is BS. Neither Clinton nor Obama really care what they can actually accomplish. They mainly want to keep their credulous supporters on board—-people like the ever-clueless Ezra Klein:

I’ve got some calls out for clarification from the relevant offices. But in general, this articles reads strangely to me … The quotes speak more to the difficulty of the issue than anything else.

Klein is, of course, less interested in “clarification” than in reassurance. He wants someone to tell him that he’s not a dupe. But he, along with the rest of the ironically-styled ”reality-based” cummunity, has been rolled. Health care reform, for Democrats, is a slogan rather than a policy goal.

I think I’ll go into the pliers business and open up a franchise in Perfidious Albion. Soon everyone on that benighted isle will need a pair. The Daily Mail reports that half the country can’t find a dentist:

Half the population has received no dental care on the NHS in the last two years.

 So, where do they go for dental care?

Thousands of suffering patients are turning up at hospital emergency departments for treatment because they cannot find an NHS dentist.

And how are the NHS apparatchiks dealing with the problem? Denial!

Access to an NHS dentist has remained broadly stable since the introduction of the new contract.

Uh-huh. Access to NHS dentists is ”stable” in the same way that Yasser Arafat is “stable.” The system was moribund before and it remains at death’s door.

This is the kind of stability that government-run health care provides.

A couple of weeks ago I noted that congressional Democrats were working on a plan to effectively kill health savings accounts.  The WSJ reports that the plot continues apace:

This week, the House passed legislation that included a provision to require every HSA transaction be reviewed and verified as a legitimate medical expense … it adds a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs.

The Democrat plan is a typically dishonest piece of regulatory skulduggery designed to kill a promising free market innovation before it has a chance to really take root:

The new scheme purports to ensure that money saved tax-free in an HSA is actually used for health expenses. But this is a nonproblem: Any withdrawal from an HSA is already subject to a federal tax audit, just as individual tax returns are.

To discover the true agenda behind this legislative subterfuge, one need only ask which “representative of the people” is behind it:

A key player here is Ways and Means Health Subcommittee Chairman Pete Stark, whose main purpose in politics is to give the U.S. a government-run health-care system. He is a known opponent of HSAs.

This legislation will seriously restrict the ability of consumers to control their own money in their own health savings accounts. Sound crazy? Not to Democrats who want to impose government-run health care on the country.

Nothing makes creatures like Pete Stark more uneasy than empowered health care consumers making their own decisions. Congressional Democrats want to kill HSAs before the public figures out how well they work.

The credibility of single-payer advocates depends largely on their ability to present the Canadian health care system—-the closest real-world example of the medical delivery model they promote—-as superior to the U.S. system. In order to achieve that goal, however, they need some way of discrediting the stories that constantly appear in the media about the poor quality and long waiting lists to which the Canucks are routinely subjected.

One of the more ironic strategies the single-payer crowd has adopted to discredit these unflattering Press reports is to pretend, contrary to all the evidence, that the U.S. news media are somehow unsympathetic to their cause. They actually have the crust to claim that Canada’s woes have been exaggerated. Thus, we have risible assertions such as the following from that reliably mindless purveyer of the party line, Ezra Klein:

As described by the American press, Canada’s health-care system takes the form of one long queue. The line begins on the westernmost edge of Vancouver, stretches all the way to Ottawa … Sadly for those invested in this odd knock against the Canadian system, the wait times are largely hype.

And these people call themselves “reality-based”? Unfortunately for Ezra and others of his persuasion, it would appear that the Canadian news media are also in on the dark conspiracy to exaggerate the wait times endured by so many Canucks. A couple of weeks ago, The Province reported the following:

A young woman suffering severe abdominal pains spent an excruciating 28 hours at Surrey Memorial Hospital with suspected appendicitis … After arriving at ER, she was given a wait-list wristband without getting a chance to tell nurses what she was there for.

Apparently, the London Free Press is also in on the plot:

The night before her fatal heart attack, Amanda Trujillo spent seven hours in a London hospital emergency room, complaining of a strong pain in her left arm as she waited for a doctor who never came.

The only way for Klein and his fellow travelers to cling to their belief that Canadian health care is superior to ours is to pretend that the facts are not the facts. This is consistent with their habit of producing disingenuous analyses which, as I pointed out last week, is one of the reasons I have such difficulty taking them seriously. As long as they stay in denial about the obvious flaws of Canadian health care, their credibility will remain in the toilet.

Last year I wrote a post suggesting that universal health care advocates are such prisoners of their ideology that facts have little or no meaning for them. Well, Paul Krugman has written a column that pretty much proves my case.

He begins by reciting a couple of anecdotes, including the tall tale that got Hillary in hot water recently. He then goes on to demonstrate that mere facts are incidental to the party line, defending the whopper as follows:

It turns out that while some of the details were slightly off … more important, Mrs. Clinton was making a valid point about the state of health care in this country.

No, she wasn’t making a valid point, and the important details of her story weren’t “slightly off.” They were lies deliberately deployed to paint a wildly inaccurate picture of American health care.

People like Mrs. Clinton and Krugman want to convince the public that the “cruelty and injustice” that allegedly pervade U.S. health care can only be corrected by allowing her to absorb the system into the federal collective:

We need universal health care, so that terrible stories like those of Monique White, Trina Bachtel and the thousands of other Americans who die each year from lack of insurance become a thing of the past.

This absurd statement reiterates Clinton’s whoppers about Bachtel, and it ignores the far more numerous horror stories that routinely fill the media in countries that already have ”universal health care.”

As William Safire pointed out more than a decade ago, Hillary is a congenital liar. And the credibility of Clinton lickspittles like Krugman doesn’t rise even to that lofty height.

Single-payer advocates are forever producing opinion polls that purport to show how the public or the medical community support some version of nationalized health care.  Invariably, such surveys turn out to have been conducted using tendentious methodology.

Oddly, legitimate surveys using reputable methods always seem to produce different results. A good example is the latest Rasmussen poll. That survey of 1,000 adults shows considerable ambivalence about government-run health care:

Twenty-nine percent (29%) of American adults favor a national health insurance program overseen by the Federal Government … 39% oppose such a government-led initiative while 31% are not sure.

The survey also reveals considerable public concern about the quality and cost of government-run health care:

The survey also found that 46% believe the quality of care would decrease under a national health insurance program while … 42% believe the cost of health care would increase.

The results of  this poll are particularly interesting considering that the electorate has been subjected to incessant propaganda in favor of nationalized health care. It would appear that hoi polloi aren’t quite as dumb as single-payer advocates and the media believe them to be.

The bête noire of the nanny state liberal is the autonomous citizen making her own decisions without interference from the government. Thus, congressional Democrats intend to throttle consumer-driven health care in the cradle. This policy brief from the RSC explains how they plan to do it:

Democrats are considering requiring “substantiation” of all HSA transactions from an independent third party …This oversight of every single account transaction would make HSAs similar to Flexible Spending Arrangements (FSAs).

What’s so bad about that?

One of the prime differences between the two account-based models lies in the control source for the funds in the account. The Internal Revenue Code makes clear that FSA accounts are held by employers, while HSA funds remain exclusively the property of the employee.

In other words, the Democrat plan would seriously restrict the ability of consumers to control the money in their own health savings accounts. An HSA modeled on the FSA would require that the patient pay for a covered service, then go hat-in-hand to the plan administrator for reimbursement—-from her own money.

Obviously, very few sensible people will be willing to participate in such an idiotic scheme, and this is precisely what the Democrats want. Nothing makes them more nervous than empowered health care consumers making their own decisions. Such people might learn that they don’t need the nanny state.

We are always being told by the socialized medicine crowd that Americans are uniquely dissatisfied with our health care and that a government-run system would fix that. Well, Great Britain’s patients evidently didn’t get the memo. Per the Telegraph:

A growing number of NHS complaints are being upheld amid falling nursing standards and rushed GP appointments, according to a report published today.

Nursing care complaints included the following:

Patients reported that they did not receive regular baths or showers and, in some cases, were left for hours in soiled bedding or clothes … In some cases call bells were left out of reach and elderly patients were not given help with eating.

The GP complaints were primarily related to the physician shortage. Britain’s sparce supply of GPs are overloaded, with following results:

Complaints over GPs included claims that they were too busy to spend enough time with patients … More than 20 per cent of those who complained about GP service said that the diagnosis of their illness had been incorrect or delayed because of the lack of time. Most of these cases involved the eventual diagnosis of cancer.

So, I’ll ask the question again: If, in addition to producing poor medical results,  government-run health care also fails the patient-satisfaction test, why should we implement such a system in the U.S.?

Cancer patient U.S.-bound for scan 

Another day, another phony survey. Most doctors favor socialized medicine according to a report from Reuters:

Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program.

Seem counterintuitive? It should. The lead author of this “survey” is Aaron E. Carroll, a single-payer zealot on the Board of the activist group “Physicians for a National Health Program.”

This guy routinely produces “studies” and “surveys” that somehow always show that Americans in general and the medical community in particular want government-run health care. Here’s a typical passage from one of his articles:

Medicare-for-all could save enough on administrative waste ($350 billion) to cover all the 47 million uninsured and improve coverage for everyone else.

This character obviously has an ax to grind, and the PNHP crowd is notorious for producing tendentious studies. This one is particularly suspect because its basic claim is preposterous on its face.

Think about it: There are about 800,000 physicians in the U.S. and this guy claims 59% of them (472K) support a nationalized health care system. If this is true, why does PNHP only have 14,000 (less than 2%) members?

Yet there will be no shortage of gullible people to buy Dr. Carroll’s snake oil in the belief that it contains a cure for the ills of U.S. health care. Sorry, folks, this “survey” is obviously BS and should be relegated to the circular file. 

Should people be forced to buy health insurance, even if they feel they don’t need it?

Senators Clinton and Obama have taken opposing positions on this question, with much hot rhetoric exchanged between them.  Senator Clinton may not win the nomination, but seems to be on the winning side of the argument – the idea has caught the imagination of state politicians from New Jersey to Colorado.

Manhattan Institute Senior Fellow Paul Howard and I weigh in, with a City Journal essay (reprinted in yesterday’s Investor’s Business Daily and featured on Real Clear Politics).

Single-payer activists tell us that Medicare-for-All would be nothing like socialized medicine because health care providers would not be directly owned and operated by our masters in D.C.  In the real world, however, the golden rule (He who has the gold, rules.) applies to health care just as it does to everything else.

If government bureaucrats control who gets paid and how much, they may as well employ the doctors and own the hospitals. Anyone doubting this should read Jerry Cromwell’s post at Health Affairs, in which he describes how Medicare’s clumsy cost control strategies have destabilized acute care hospitals:

Stability reigned until Medicare’s per case bundled payment arrived, reinforced by aggressive government denials of inpatient coverage for simpler procedures (e.g., laser eye surgery). Stays became shorter, and less complex surgery migrated to ambulatory settings …

Meanwhile:

Acute inpatient surgery became far more complex and much more costly, on average. It also involved a higher proportion of uninsured patients as ASCs siphoned off better-paying patients … the industry was hemorrhaging inpatient cases that left many fixed costs of operating a full service facility uncovered.

All of this disruption might have been worth it if the goal of saving money had been reached. But health care inflation continues apace, Medicare is in serious financial trouble, and the patients are coughing up more out-of-pocket money than ever before. Moreover, it has created a whole new problem—-physician-owned ASCs and specialty hospitals:

ASC and specialty hospital physician-owners refer uninsured and Medicaid patients to acute hospitals more often … ASCs and specialty hospitals reap the benefits of physicians referring more complex, costly patients to acute general hospitals while focusing on less complex, more profitable patients …

This has, of course, done considerable damage to acute care hospitals. And the vicious cycle of meddling continues as various interested parties request (you guessed it) more government intervention. Cromwell himself, apparently missing the larger significance of his own analysis, thinks the solution is government-imposed “universal coverage.”

The real solution is, however, less rather than more government. There’s a lesson here for anyone capable of thinking outside of the ideological box: When government controls the purse strings, it can and will control the health care delivery system. Thus, there would be no practical difference between Medicare-for-All and socialized medicine.

The ugly face of Canada’s medicare.

Yesterday, two friends with finely-tuned BS detectors e-mailed me the link to Jacob Hacker’s recent paean to government-run health care. I’m glad they did, for if ever an article needed debunking this is it. I realized that when I saw that Hacker begins the piece a red herring:

‘Socialized medicine’ is the bogeyman that just won’t die … The epithet has been hurled at every national health plan since the New Deal … Republicans from President Bush on down have invoked the specter of socialism …

Yawn … Needless to say, none of this BS addresses the serious arguments that have been made against government-run health care. When Hacker finally gets to the substance of the debate, he deploys the usual tired canards. He even drags out the hoary “just look at Medicare” meme:

To see the advantages of public insurance, just look at the program that once prompted the fiercest charges of socialized medicine, Medicare. Since the introduction of cost controls in the 1980s, Medicare’s expenditures have grown at a substantially slower rate than spending on private insurance …

Evidently, Hacker hasn’t heard that Medicare is going broke. Just this week, the Medicare trustees called (yet again) for serious reforms that will prevent a fiscal train wreck. Having thus demonstrated his ignorance about Medicare, Hacker then proves he knows nothing about health care inflation:

Medical inflation in most of the industrialized world has slowed dramatically, as the health policy specialist Chapin White has shown. But without such coordinated restraint, U.S. spending on health care has continued to rise rapidly.

Sorry, dude, wrong again. As Michael Tanner demonstrates in a recent analysis (to which I link in this post), rampant health care inflation is a global phenomenon. Hacker also demonstrates that he hasn’t done his homework on the history of health care in the United States:

Back in the 1940s and ’50s, corporate America promoted private benefits as an alternative to government insurance on the grounds that they offered better value … Corporate America, too, seems more ambivalent than ever about the Faustian bargain it made to kill national health insurance in the 1940s.

As anyone who has bothered to do the reading knows, corporate America got involved in health care when the government froze wages while making insurance premiums tax free. In other words, the government that Hacker so admires created the mother of all perverse incentives.

These items represent but a taste of the dishonesty and ignorance that pervade Hacker’s op-ed. Nonethless, the usual suspects have quoted this drivel as if it were a serious contribution to the debate. By doing so, they demonstrate that they are so steeped in their ideology that they are incapable of critical thinking.

Michael Tanner of the Cato Institute has written an excellent policy analyis showing that the health care systems of other countries often don’t live up to the claims made for them by American advocates of government-run health care. His findings include the following:

• Health insurance does not mean universal access to health care.

• Rising health care costs are not a uniquely American phenomenon.

• In countries emphasizing government control, patients face waiting lists and rationing.

• The most successful nationalized systems incorporate market mechanisms.

One of the most interesting features of Tanner’s analysis is his international comparison of out-of-pocket patient spending. In 8 of the 12 countries examined, patients cough up more of their own money as percentage of total health care expenditures than we do in the U.S.

As shown on page 27 (figure 4), the citizens of Canada, Norway, Japan, Italy, Portugal, Spain, Switzerland and Greece face higher out-of-pocket expenditures than Americans. Moreover, out-of-pocket expenditures in France and Germany are about the same as ours.

This is a long paper (about 35 pages, not including the notes), but it is well worth the time it takes to digest it.

The National Federation of Independent Business recently hosted a mandate debate between Michael Cannon of the Cato Institute, Sherry Glied of Columbia University, Bob Moffit of the Heritage Foundation, and Peter Harbage of the Center for American Progress.

Cannon, at one point in the discussion, questioned the fairness of forcing healthy young people to buy insurance when they may wish to use their resources for other priorities. Glied, who supports mandates,  responded with the following example of liberal fascism:

I don’t think there is anything objectionable to the idea of the government saying, ‘Look, you may have your own list of priorities, but we want you to reorder them a little bit.’

The other day, I wrote a post about the paternalism that animates the pro-mandate crowd. Well, one could hardly ask for a clearer confirmation of their condescending attitude than Glied’s statement. They believe that government is more qualified to set your personal priorities than you are.

Moffit also makes some good points against mandates. A video link to the whole debate can be found at Cannon’s latest post at the Cato blog.

Megan McArdle is uneasy with the condescending attitude toward the hoi polloi that informs ”progressive” enthusiasm for health insurance mandates:

I’m persistently disturbed by the notion that most of our fellow citizens are intellectual children who need to be forced to do what is good for them even at massive cost to their liberty, and ours.

This was written in response to the following blather from the ever-clueless Ezra Klein:

Mandates matter because, sometimes, folks have to be protected from their worst instincts. That’s why we force everyone to pay into fire departments through taxes.

The fire department meme is, of course, a perennial favorite of single-payer advocates, and McArdle exposes its essential ignorance:

This is not true. We force everyone to pay into fire departments because fires have very bad negative externalities: if your house catches on fire, unless you live on a rural farm, there’s a good chance that your neighbor’s house will burn down too.

Klein—like most advocates of government-run health care—is too lazy to learn the fundamentals of economics, yet he and his fellow travelers want to “protect” us from ourselves.

McArdle is right to be disturbed by the paternalism that animates single-payer advocates. At bottom they are nothing more than busybodies who want to run our lives for us.

It is from them that we need to be protected.  

The vaunted Massachusetts “universal coverage” plan has let so many patients fall through the cracks that a key Boston health care system is going broke providing care to the uninsured. The Boston Globe reports that Cambridge Health Alliance is facing a “catastrophic” loss:

The alliance … says it is being hit hard by the state’s new healthcare reform law, which has left it responsible for providing free care for those without insurance while reducing the hospitals’ compensation for such services.

This system has historically treated a lot of uninsured patients and been compensated by the state for doing so. But when “reform” was enacted, funding for such care was slashed. No one panicked, though, because the plan was going to fix the uninsured problem. Oops!

Despite the state’s efforts to enroll all low-income residents in free or subsidized insurance programs, many still do not have coverage.

The result will be a $25 million loss for the Cambridge Health Alliance and a probable reduction in force affecting 300 jobs. And, the fantasies of “progressive” health care wonks notwithstanding, no hospital system can survive for long in the face of such losses.

How could this happen? The Massachusetts health care initiative was all about universal coverage. It even came with the kind of health insurance mandate that politicians and pundits keep telling us is the key to making reform work.  So, what gives?

What gives is reality. The whole universal coverage movement is based on the myth that the uninsured problem is the primary challenge facing American health care and that government can fix it with some silver bullet (like mandates).

As I have said before, the uninsured problem is a symptom. Any reform effort that focuses on that issue without addressing the underlying disease (government interference in health care)  is doomed to failure. How many hospitals and doctors will be driven out of business before our “leaders” face this reality?

The WSJ Health Blog notes that Wal-Mart has saved its customers more than $1 billion with its $4 generics program:

Wal-Mart’s doing a bit of chest thumping this morning, claiming that its $4 generics program has saved consumers $1 billion — $1,032,573,012.61 as of March 10, to be precise.

These savings were brought about not by government cost controls but by that bête noire of faux-progressives everywhere—free market competition. And it is probable that actual consumer savings far exceed the Wal-Mart numbers:

The ripple effects of the program may have driven additional consumer savings, the company pointed out. Competitors including Kroger and Target followed Wal-Mart with their own $4 generics programs.

The market works, folks. Wal-Mart wants customers in its stores rather than those of its competitors, so it provides cheap genereic drugs to draw them in. If the government would get the hell out of the way, similar things would happen throughout health care.

An Ontario woman did not rate timely care despite a cancer diagnosis and a huge tumor. Per the Globe & Mail:

Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada.

So, where do you suppose she had to go to get treatment? She was, of course, forced to seek care south of the border:

Fighting for her life, the Windsor woman headed to the United States. In Pontiac, Mich., a surgeon excised the tumour - 35 centimetres at its longest - along with her ovaries, appendix, fallopian tubes, uterus and cervix.

A happy ending? Not quite. Canada’s vaunted health care system decided to add insult to injury:

The Ontario Health Insurance Plan says it won’t pay for the $60,000 cancer treatment because Ms. de Vries did not fill out the correct form seeking preapproval for out-of-country care.

This is typical of Canadian health care folks: lousy care, long waits, and bureaucratic paperwork.

And yet our “progressive” friends want us to emulate Canada’s system. Are they really that dumb?

Shawn Tully advises the readers of Fortune Magazine that John McCain’s health care plan is better than the alternatives offered by Hillary Clinton and Barack Obama:

For all its problems, at least it puts the consumer in charge … It will create a world where health care is treated as the precious resource that it is, rather than a costless entitlement; where nationwide competition pushes down the price of catastrophic care and consumers focus their attention and budgets on what’s really crucial to their health.

And what do the Democrat presidential candidates offer?

The Democrat plan exacerbates the fundamental problem in the American health-care system, which is that no one has any incentive to care about price. Creating a huge new medical superstructure would shift far more spending to third-party providers … giving consumers even less incentive to concern themselves with the price of an MRI …

Tully closes with a statement of fact that should be blindingly obvious to any economically literate observer.

The price of health care is never going to get under control until patients get what they deserve: the right to be customers too.

McCain’s health care plan makes it clear that he understands this. It is not by any means perfect, but it is vastly superior to the alternative.

Free market reform advocates object to single-payer health care for a variety of reasons, including our belief that such a system would involve government micromanagement of hospitals and doctors. As if to prove our point, Medicare is about to send out an army of auditors whose primary mission is to put the clinical and billing decisions of providers under the microscope:

‘What we have here is bureaucrats and government contractors coming in and trying to second guess what doctors and nurses have done in a hospital setting,’ said Don May, vice president for policy at the American Hospital Association.

The ostensible purpose of the nationwide audit is to recover overpayments made by Medicare, which sounds innocuous enough. But the CMS bureaucrats have devised a system whose incentives are virtually guaranteed to produce corruption among the auditors. Hows that? Because these private auditing outfits don’t get paid unless they find “errors.”

The program’s critics say that contractors have too much incentive to question as many claims as possible. That’s because they get to keep about 20 percent of the overpayments … The auditors will keep a tidy percentage for their services.

Robert Centor is among those who finds this incentive structure disturbing:

I hope that … bothers you as much as it does me. Clearly the auditors have a financial incentive to err for their own profit.

Why would a physician be worried about this? Well, in a pilot project conducted in three states, a primary (and highly controversial) source of “recoveries” involved the alleged lack of medical necessity for a variety of services:

What gets health care providers most upset is when auditors determined a procedure or hospital admission was not medically necessary.

The auditors will be looking at medical charts for patients long ago discharged from the hospital and deciding retroactively that the doctor should not have ordered a given medical procedure or hospital admission. In other words, CMS has authorized commission-paid hirelings to overrule the decisions of your doctor. 

Once the flying monkeys have descended upon your community hospital and “discovered” all of the “errors,” Medicare automatically deducts the money from current payments. And if the hospital or doctor believes the finding to be unfair, they can appeal to …. Medicare. Anyone want to guess how many decisions get overturned?

This is exactly how a single-payer health care system would work—arbitrary bureaucratic decisions from on high. If this doesn’t scare you, you’re not paying attention. There is no such thing as benign government management.