I propose the following anti-crime program for America: federal funds for midnight basketball in Washington, D.C., eligibility limited to the White House gang-bangers who concocted the Clinton Health Care fiasco. Those Generation Xers have all that energy and nothing to do late at night but cook up predatory social welfare schemes. I say: Put 'em on the court and keep 'em off the computer terminals where they will do real harm, tearing up markets and destroying family-doctor relationships decades in the making. And, while you're at it, you might toss in a little supervisorial grant to me, Tom Hazlett. I could referee—it would give me a chance to blow the whistle on those neighborhood toughs.
Many accuse the Clintonites of concocting a hastily contrived, ill-thought-out health-reform plan. The naysayers simply fail to see its intricate logic. For instance, with all the unemployment the Plan would have wrought, queuing up in long lines at the doctor's office wouldn't have imposed much of a social cost. Jobless folks have time to kill. Now that's planning ahead.
Hillary's theory is that we are oppressed by drug companies and heartless insurance executives, and that her plan to shove everyone into regulated co-ops will allow us to bargain down the moneychangers with tough spending caps.
A second opinion is in order. Mine is this: The top-down approach to health care aims to control costs by reducing quality. The price controls, both implicit and explicit, are a scam.
One doesn't lower "costs" by giving a patient who is screaming for 100 ccs of Demerol two tablets of Tylenol instead. Tell the patient who's about to have a cold, shiny, stainless steel probe shoved up his digestive tract that the more accurate survey device, an MRI machine, is beyond his Alliance's global budgetary guidelines. Now, sir, bend over. This may be the one pain our president fails to feel.
I have lived in a Japanese hospital, survived on Japanese hospital food, and sampled their health-care system firsthand. They have their successes-that's—why I traveled there—but on average, there is no match: You'd rather get sick in America. And not just because we still speak English.
Having comparison shopped, I can vouch for it: The American system is outstanding. It is too damned expensive, and reforms that promote genuine competition (such as letting midwives deliver babies and nurses give physicals) would be superb. But exploding costs are tied directly to third-party payment systems, particularly the government's. Medicare/Medicaid expenses grow exponentially; the ballooning federal deficit is propelled by them. While private insurers are moving to HMOs and pre-paid plans that attempt to rationalize expenditures, I get just a bit itchy when I am told that the federal government has got a grand plan. Would you hire the architect who built the ramshackle hovel down the road?
And the Clintonites have already engineered a health-care slum: the vaunted children's vaccination program. The plan called for the Good People in Washington to rationalize and nationalize the inoculation of America's youth. Isn't it preposterous that we can put a man on the moon but can't get preschoolers their shots? (Never mind that most everyone is already getting them.)
Administration officials vilified the private sector while portraying their own trickle-down approach as enlightened and humane. They touted it as a demonstration of federal sweetness to come. What came instead was reality. After spending $700,000 on a plan to store the bulk of the nation's vaccine supply, they've junked their government-issue refrigerators and the plan is a shambles. The federal scheme may even result in fewer children getting their shots.
Oops. This was supposed to be the easy way to start. Indeed, Friend of Hillary Marian Wright Edelman, chairwoman of the Children's Defense Fund, was a strong proponent of the national vaccine plan. As late as June 1994 she wrote: "The storage and delivery of vaccines is not a difficult task. It is a function the states have performed efficiently for years." By August, the administration had given up on this no-brainer. I can't wait until they get to the hard parts.
Alas, we face an incredibly steep learning curve. The New York Times editorial page, staring straight at the vaccine debacle, fears it was a tactical error to make the vaccine program an example of what the administration wanted to do to us: "Some officials recklessly advertised the vaccine distribution program as a dress rehearsal for their efforts to restructure the entire health care delivery system," the Times opined. "That was unfortunate. The larger goal…should not be made to suffer from one silly but correctable blunder."
If failing to inoculate children is "silly," perhaps messing up our kidney dialysis system would be characterized as "zany." Here we have the smoking gun—and the "wacky" Times wants to bar the evidence. Let's hope there's no exclusionary rule in the court of public opinion and that the jury remembers the Clintons' brave testimony when the health-care verdict is at long last handed down.
Contributing Editor Thomas W. Hazlett teaches economics and public policy at the University of California, Davis.
This article originally appeared in print under the headline "Medical Malpractice".