The government is once again making a push to assume a greater role in health care. This move is nominally to provide health care to the millions uninsured. This guise is at best well intentioned ignorance, and at worse a ruse for greater control. Yes there are millions uninsured. Firstly, the vast majority of these people are young health people who do not need insurance. The young and elderly are already covered under Medicaid and Medicare. Secondly, for those uninsured who needs health care, they have access to care as no hospital can turn away a sick patient. True an argument can be made that preventive care to avoid becoming sick is better than being treated once sick, but the data on preventive care remains rather soft. And for preventive care that does make a difference, like screening mammograms, there are plenty of programs that will provide free screenings. But this is where the truth can be found, in that if you are uninsured and needs treatment, you will be laden with a huge bill. The problem of health care in the US is not coverage of the uninsured, the problem of health care in the US is a problem of cost.
Put it another way. Why are there uninsured at all? Because either they choose not to buy health care insurance, or because they cannot afford health care insurance. If they choose not to buy, it is probably because they don't see the need for it. If it is because they cannot afford health care insurance, then this again is certainly the problem of health care cost rather than a problem of uninsured.
Does the high cost of US health care means better health care? Yes and no. We spend an exhorbitant amount of money keeping premature infants and the terminally ill patients alive as long as we can. Frequently we fail, and especially with the terminally ill, we only prolonged their lives by days or weeks rather than years. Is this a smart spending of our health care resources? This aspect deserves a serious conversation in our society and culture. But this is not being discussed because the politicians would much rather talk about providing universal coverage rather than smart spending.
Certainly this is out of concern of a slippery slope that if we restrict money to be spent for premies and the terminals, we might restrict money spent on other areas of health care as well. And this gets us back to the essential problem of health care, cost. And anyone will tell you that the solution to cost increases is to control cost. Initially cost reduction can be gained through better efficiency and better care process to reduce complications (another direct contributor to cost). However, these cost control gains will never be as much as projected. Many different forms of health care delivery has been tried in the US in the past 20 years, all promising to reduce health care cost. All has provided a few years of cost control only to be followed by rising cost along the previous trajectory. Part of the problem here with government heath care and cost is that the government is never cost effective or sufficiently cost conscientious. Then it will come down to either accepting the increasing cost of health care or reducing service available.
Will the government accept the increase cost of health care? Will the people accept increasing taxation? For a while yes, but only for a while. When the cost of taxation for government health care is too high, what typically would happen next is that services will slowly but surely be restricted. And what we would all end up with would be universal coverage with less health services.
One other consideration. We all get what we paid for. When we pay for our health care directly, service is owed to us. When the government pays for health care, service is owed to the government.