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The Road to Serfdom, Health Care Edition

Candidate Barack Obama’s key theme in promoting his health care plan was the claim that if you like the health insurance you have, you can keep it. Over time, we learned that wasn’t true. In fact, video of Obama surfaced (on this site, among others) in which he explained to a friendly crowd that his plan was designed to drive all private health insurance out of the market over a period of years, leaving only the government to pay for health care.

Some people, however, are still shilling for the idea that Obamacare will leave some residue of choice in the marketplace. And, when you hear the word “shill,” your first thought should be of Paul Krugman. Greg Mankiw takes on Krugman’s latest happy talk:

Paul Krugman writes:

But nobody is proposing that the government deny you the right to have whatever medical care you want at your own expense. We’re only talking about what medical care will be paid for by the government.

I wish that Paul were correct, but I am not convinced that he is. Chills went down my spine a few days ago when I read the following proposal from the Center for American Progress, a think tank with strong ties to the Democratic party:

Thus we also include a failsafe mechanism that would ensure significant savings. Our failsafe would be triggered if, starting in 2020, total economywide health care expenditures grow at a rate faster than the economy. Should that happen, we would empower the IPAB [the panel of experts set up by President Obama's health care law] to extend successful reforms in Medicare and other public programs to insurance plans offered in the health care exchanges and then potentially to all health care plans, such that the target is met. This will ensure that costs are constrained across the health care sector, preventing cost-shifting and maintaining access for all.*

That is, under the likely scenario that healthcare spending keeps rising faster than GDP, the Center for American Progress would give government the power to prohibit people from buying expensive health plans with their own money. That is not my idea of progress.

Nor mine. In any socialized medicine scheme, the government inevitably tries to stamp out all provision of medical services that is outside of its control. A reader emails:

Krugman is either naively mistaken or, more likely, a liar….

Controlling all medical expenditures is exactly what the principal design feature of Obamacare is….it is de facto single payer on the installment plan. Any provider who accepts ANY government subsidized patient or any patient obtaining any insurance through the exchanges — which will within five years come to be approximately 99.9% of the population — will have to offer the government approved price schedule and treatment protocols for ALL patients. This will leave a very tiny “private” medical practice of providers who accept only direct pay patients….all but outlawing private medicine….so, sure…..you can use your own money to buy health care, but with the government controlling essentially all provision you will need good luck to find anyone willing or able to take your money…..like in Canada. Of course, they come to the U.S. when they get stuck in their system…where will we go?…..Cuba?

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