Rationing healthcare, step by step.

ITEM: The Associated Press for August 9 touted the healthcare plank in the Democratic Party platform: "Democrats shaped a set of principles Saturday that commits the party to guaranteed health care for all, heading off a potentially divisive debate and edging the party closer to the position of Barack Obama's defeated rival, Hillary Rodham Clinton....

"Obama, soon to be the Democratic nominee, has stopped short of proposing to mandate health coverage for all. He aims to achieve something close to universal coverage by making insurance more affordable and helping struggling families pay for it. Advisers to Obama and Clinton both told the party's platform meeting they were happy with the compromise, adopted without opposition or without explanation as to how health care would be guaranteed.

"In return for the guarantee, activists dropped a tougher platform amendment seeking a government-run, single-payer system and another amendment explicitly holding out Clinton's plan as the one to follow. The party now declares itself 'united behind a commitment that every American man, woman and child be guaranteed to have affordable, comprehensive health care.'"

ITEM: Columnist Paul Krugman, writing in the New York Times for August 11, comments: "Can Democrats deliver on that commitment? In principle, it should be easy. In practice, supporters of health care reform, myself included, will be hanging on by their fingernails until legislation is actually passed.

"What's easy about guaranteed health care for all? For one thing, we know that it's economically feasible: every wealthy country except the United States already has some form of guaranteed health care....

"The politics of guaranteed care are also easy, at least in one sense: if the Democrats do manage to establish a system of universal coverage, the nation will love it."

CORRECTION: In terms of restructuring the healthcare system in the United States, Democratic presidential candidate Barack Obama differs from economist Paul Krugman only in a matter of degree. Not having to face an electorate that might be skeptical of having too much micromanagement imposed by Washington, Krugman doesn't hide his long-term intentions as well as the senator.

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The economist actually believes and says publicly that other industrialized countries have better systems than does the United States and, given his druthers, he would establish a nationalized system immediately. The senator, who can't afford to tip his hand so candidly, has to take a piece meal approach.

Julie Novner, commenting on National Public Radio, gives the left-wing line, saying that what Obama is proposing isn't really government-run healthcare. His plan "doesn't even have a requirement for individuals to have coverage, like the plans offered by his main Democratic primary opponents, former North Carolina Sen. John Edwards and New York Sen. Hillary Clinton. Obama says that under his plan, if you already have insurance you like, you can keep it."

She quotes the senator: "But if you're one of the 45 million Americans who don't have health insurance, then you will have it available to you. No one will be turned away because of a pre-existing condition or illness." "If you can't afford coverage," says the NPR's healthcare correspondent, "you'll get a subsidy. Employers would have to offer coverage to their workers, but they'd get government help, too."

How all of this might be paid for is not mentioned.

In a valuable Policy Analysis published in March by the Cato Institute, entitled "The Grass Is Not Always Greener," Michael Tanner went into considerable detail about the problems as well as the strengths of healthcare systems elsewhere among developed countries. In essence, they do best when the market is allowed to work. Observed Tanner: "In countries weighted heavily toward government control, people are most likely to face waiting lists, rationing, restrictions on physician choice, and other obstacles to care. Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control."

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Proponents of nationalizing healthcare often seek out some pet aspect of another country's system as proof of how things should be changed in the United States. What they seldom mention is that even the wealthiest individuals in such countries prefer to come to the United States for advanced treatments rather than remain with their presumed utopias at home. After all, if you are from Spain, you realize that you cannot choose your physicians for either primary or specialized care; if you are from the U.K., you are probably aware that about three-quarters of a million Britons are waiting to get into a hospital run by the National Health Service; or if you are from other European countries or Canada, you know that lengthy waiting lines are just one of the means by which the government rations healthcare.

Speaking of the systems in France and the U.K., American Spectator editor in chief Emmett Tyrrell comments:

   Their systems remain socialist, or--
   To use modern American liberals'
   euphemism--"single-payer."
   The government
   pays, and the patient waits
   and waits. This is a point that never is
   mentioned by campaigning American
   Democrats, most notably the Prophet
   Obama. Liberal Democrats argue that
   health care costs are relatively low in
   Europe and quality care is superb--another
   government-run miracle.
   "They don't do miracles," responds
   Regina Herzlinger, author of "Who
   Killed Health Care? America's $2
   Trillion Medical Problem--and the
   Consumer-Driven Cure." How are European
   medical costs kept low? Herzlinger
   explains: "They do it through
   rationing care to the sick. That's an
   unacceptable way to control costs."

Thus, I am glad to be home and not waiting in an emergency room, say, in London. Health care officials in Britain discovered that patients were lingering in emergency rooms for days before being treated. Incensed by this, the bureaucrats magisterially ordered that emergency room patients be treated within four hours. The consequences were reported in the Daily Mail. Hundreds of "seriously ill patients" simply were kept longer in ambulances before being admitted to the emergency rooms. Hence, there were fewer ambulances available for subsequent emergencies. As Herzlinger notes, the consequence of socialized medicine is "rationing." Canada's healthcare system is often touted by those who don't have to avail themselves of it personally. Canadian Shona Holmes found out the system's flaws when she developed a brain tumor and she had to travel to the United States for treatment rather than risk death waiting for the health bureaucracy to respond in her own country. "Canada's cost-conscious, government-run system wasn't there for me when I needed it most," she writes in Investor's Business Daily. "Even worse, it continues to overlook the most fundamental rule of health care--that patients ought to come first."

Holmes, by the way, is suing the government in Ontario for preventing its citizens from buying private health insurance. She continues:

   The national health care system in
   my country is racked by agonizingly
   long waits and rationing of many
   vital medical services, starting with
   a severe shortage of the family physicians
   who are gatekeepers of our
   care.

      More than 800,000 Canadians currently
   are in long holding patterns for
   operations that would be done in the
   U.S. in a few weeks after the initial
   diagnosis. Sadly, many will die before
   they make it to the head of the
   line. Those who can find a way flee to
   the U.S. for the quality medical service
   so often lacking at home.

      The benchmark question for any
   nation's health care system is whether
   their citizens are forced to go abroad
   for quality accessible health care
   treatment. The answer in America is
   obvious.

None of this is meant to suggest that the current system in the United States is without many flaws. That is certainly not the case. The market here has been distorted by bureaucracies, regulations, and price-control systems, such as Medicaid and Medicare, as well as counter-productive tax policies, to name but a few obstacles. The U.S. healthcare system, as noted by Charles Phelps, a health economist at the University of Rochester, "while among the most 'market oriented' in the industrialized world, remains the most intensively regulated sector of the U.S. economy."

There is plenty of room to improve how U.S. healthcare is handled, especially if the moves would be in the direction of freeing the marketplace and maximizing patients' choices. Costs have become high here, as they also have overseas, because governments have become involved in delivery or have interfered with paying for services.

Demand jumps and prices rise for healthcare, just as in other businesses, if customers think "someone else" is going to pay for it. But subsidies and guarantees don't fall like manna from the skies just because the state pretends they do. The state itself, as French economist Frederic Bastiat put it about 160 years ago, "is the great fiction through which everybody endeavors to live at the expense of everybody else." Many, if not most, of the problems in healthcare in this country revolve around that truism. We don't need more of the same.

Overall, according to the latest Cato Handbook for Congress, "every dollar spent on personal health care in the United States comes from someone other than the patient. Despite enjoying the world's freest health care system, the United States pays for a greater share of its health care through third parties than do 17 other developed countries, including Canada and other socialist systems."

Still, those who would nationalize healthcare in the United States even further are not being honest when they rank the United States below other nations as a way to prove how their particular fixes are needed.

Glen Whitman, an economics professor at Cal State in Northridge, hits the rankings of the World Health Organization in this regard, one of which places the United States in 37th place among nations. Of course WHO actually penalizes the United States for permitting Health Savings Accounts. To employ WHO rankings to justify more government healthcare involvement, points out Whitman, "is to engage in circular reasoning because those rankings are designed [emphasis in original] in a manner that favors greater government involvement."

It should be little surprise that big-government advocates find favor with solutions that reinforce their prejudices, as unhealthy and as uneconomical as they might be. However, honest observers, to leave Messrs. Krugman and Obama out of the equation, should realize that the fact that there are problems with healthcare in this nation does not justify prescribing the nationalization of the system.