Is it cynical to think that the Democrats are playing Brer
Rabbit in begging not to be thrown into the briar patch called
Republican reform of Medicare?
Maybe. But Im tempted to think it nonetheless.
Democrats such as Sen. Edward M. Kennedy complain that the
Republican approach to Medicare in general and
prescription-drug coverage in particular is the first step toward
a
total dismantling of Medicare. Their gripe is that the
just-passed bill subsidizes private companies ostensibly to
provide competition for the traditional fee-for-service
Medicare. Well leave aside the fact that Medicare has
been driving doctors into early retirement with price controls,
suffocating bureaucracy, and threats of imprisonment for
billing errors and other rule infractions. Well also
ignore that Medicare will soon be bankrupt and will require
huge tax increases. In other words, Medicare is dismantling
Medicare.
Heres why I believe the Democrats are cagey, not stupid.
(Republicans are another story.) The Brer Rabbit Democrats cry
to the Brer Fox Republicans, Please dont give
subsidies to private companies to encourage them to compete
with traditional Medicare. That will destroy Medicare. Please
dont do it!
The first question to ask is, will it destroy Medicare? If by
Medicare we mean government control of the
medical care of retirees, the answer has to be No.
Theres only one thing that would destroy Medicare:
freeing the taxpayers from having to pay for it. Does the
Republican plan do that? No way! Under the plan just passed,
the taxpayers are on the hook, at a minimum, for $400 billion
over the next decade (and probably more), with $2 trillion more
the decade after that. If thats taxpayer freedom,
Ill take servitude.
The Democrats surely understand that control of the money is
what counts. How that money is funneled to service providers
is a matter of cosmetics. Kennedys beloved Medicare,
after all, pays money to private physicians and hospitals. If the
formal status of the payees matters, why doesnt he call
for an end to private practice and make all doctors government
employees? He might like that, but he probably realizes it
wouldnt make much difference.
A Democratic hero, John Maynard Keynes, understood this point.
He once wrote, It is not the ownership of
instruments of production which it is important for the state
to assume. If the state is able to determine the aggregate
amount of resources devoted to augmenting the instruments and
the basic rate of reward to those who can own them it will
have accomplished all that is necessary. Translation: he
who controls the money controls everything.
The U.S. Supreme Court affirmed this view in 1941 when it
said, in denying a participant in the farm program the freedom
to grow more wheat than he was assigned, It is hardly
lack of due process for the Government to regulate that which
it subsidizes. Translation: if you take tax money you
cant complain about the conditions.
If the Democrats are as scheming as I think, they are aware
that in America today the most efficient way for the
government to run the medical-care system is for it to
subsidize HMOs, hospitals, insurance companies, and even
pharmaceutical companies. The controls wont be far
behind.
We only have to look at past instances of subsidies to see this
principle in action. Indeed, Medicare itself is an example.
Then why do the Democrats make such a fuss? Politics, of
course. They want to beat President Bush next year and regain
control of Congress. So they accuse the GOP of selling out to
special interests. (No special interests support the Democrats.)
And they accuse the GOP of harming the elderly. Its
what Democrats do.
And the Republicans? They long ago made the welfare state
their own. As one of their gray eminences, George Will, has
written, A prescription drug entitlement is not
inherently unconservative, unless the welfare state itself is
and it isnt.
But to retain the partys shrinking element that still
abhors bald socialism, they have erected a façade of private
enterprise and competition. Need it be pointed out that private
enterprise tethered by subsidy is hardly worthy of the name?
Sheldon Richman is senior fellow at The Future of Freedom Foundation, author of Tethered Citizens: Time to Repeal the Welfare State, and editor of Ideas on Liberty magazine. Send him email.
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