Uninteded Consequences of Socialized Health Care

Socialized medicine in its truest form is government ownership of health care facilities, government employment of physicians, and government control of financial transactions between doctor and patient.

A less extreme form of socialized medicine has either privately run health care facilities receiving payment from public funds or publicly run facilities receiving private funds.

A more moderate form would entail a mixture of government run and private facilities receiving payments from both public and private funds. This form closely resembles the current system in the United States. VA hospitals are government run facilities with federally paid health care workers whose patients have a mix of private and public insurance plans to pay for care. For-profit hospitals accept Medicaid, Medicare, private insurance, and self-pay patients.

The Affordable Care Act (ACA) took this current, more moderate system and simply added a bunch of mandates and subsidies to it. By forcing citizens into insurance plans by threat of a tax penalty the ACA will drastically reduce the number of uninsured. Since our health care reformers in Washington DC have determined that insurance is a necessary middleman between patients and physicians, one can see from their perspective why forcing citizens into plans is a good thing.

Opponents of the ACA argue that the act is an infringement on personal liberty but have failed to explain how. Just saying that citizens should not be forced to purchase something is not a solid argument against it; after all, the government can force us to do all kinds of things like purchase car insurance if owning a car.

An overlooked infringement Republicans should be explaining is how a move toward true socialized medicine grants the government the authority to dictate what citizens eat and the lifestyles they choose to adopt.

If the government is paying for and/or providing health care it has a vested interest in promoting healthy life choices. An obese person long ago would choke on their own fat and die a premature death. A stuntman could bankrupt his family after suffering a debilitating injury. A poor person could be refused life-saving emergency care for failure to provide proof of payment. This was a harsh system, but one that encouraged people to independently make good decisions or else they, and no one else, would suffer the consequences of their actions. Under a government run system that covered everyone, these three people would drive up costs to the system. The obese person would have their diabetes meds, heart problems, and weight-loss surgeries paid for by the government. The stuntman would be pieced together like Humpty Dumpty after each fall, driving up system costs. The poor man who contributes little, if anything to the government run pool would be granted the life-saving care at the expense of every taxpayer in the nation.

The government wants to promote a healthy society in the same way in wants to promote an educated society. But when the health of a society becomes a budgetary issue, its intrusion into private lives could become more than even the most liberal proponent of socialized health care would want.

Higher utilization of care puts a strain on the health care system. Who uses more care than anyone? The sick, elderly, and daredevils. Washington DC, as the collector and payor of health care services in a more socialized system, has an interest in meeting its budget every year. A growing health care budget can be met by increasing premiums (taxes), diminishing services, and influencing a patient's lifestyle choices. Those citizens using the system more often - the sick, elderly, and daredevils - would be targets in this budget balancing act.

Sometimes the fear of being unhealthy is not a sufficient incentive by itself to promote healthy lifestyle choices. In fact, if cost is no issue to the individual, there is even less incentive to be healthy and avoid risk. Here are some ways in which the government could try to control a citizen's lifestyle in order to keep health care costs down:

Checking grocery items purchased under a shopper's card
Targeted mailings to households in areas with statistically higher obesity rates
Banning hazardous recreational activities like base jumping
Verifying purchases of prescriptions from Rx databases
Monitoring those with criminal records with drones
Keeping tabs on purchases for "sinful" services like prostitution, gambling, and drugs
Web purchase history
Frequency of clubbing, going to bars, or partying using geolocation
Checking online dating profiles for signs of risky behavior
Outlawing the most unhealthy foods like ice cream
Euthanasia/hospice/chronic elderly care decisions contrary to what an individual would choose

Some might dismiss these potential controls as paranoid. It cannot be denied that the technology for this type of intervention exists and is currently being used by advertising agencies and law enforcement.

Private health care has its own set of problems, the main one being the refusal of services to thsoe who cannot afford to pay. This can be addressed in its own time. Right now if Republicans want to start fixing our health care system they must acknowledge it is not working well, propose a way to fix it, then demonstrate how the ACA will only make things worse. The ACA can only be effectively opposed if there is a better alternative and if Republicans can show not just that the ACA will be more expensive but that it could lead toward greater government intrusion into people's lives.