The State of the Union
In this year’s State of the Union address, it was said by many that President Bush would have to clearly make the case for war with Iraq before the American people to answer the fears of a wavering public. In the President’s speech before the nation, that case was made. The President outlined Iraq’s failure to account for and eliminate its weapons of mass destruction. The President outlined how Iraq’s defiance threatens the peace and safety of the world. Yet most significantly, the President outlined a declaration, not to Iraq, but to the rest of the world: America will act without the United Nations if it must in order to de-fang Iraq.
“We will consult, but let there be no misunderstanding: If Saddam Hussein does not fully disarm, for the safety of our people, and for the peace of the world, we will lead a coalition to disarm him,” said the President.
Those are brave words—perhaps the bravest words to be spoken by an American president in many principle-starved years. In one sentence, the President has reasserted that the security of America comes first, before the opinion of the UN.
As I observed last year, if on the eve of American independence, the founders had asked the world's permission before they revolted against the English crown, America would not exist as it does today. Yet today, in the name of “engagement,” it is commonly held that America must genuflect before the opinion of a less than free and envious world.
Yet it is not the place of the world to approve or disapprove of a just nation acting to protect the freedom and security of its people against a ruthless tyrant. While the Iraqi situation is certainly a crisis, the true crisis existed within America’s own soul: would the government posses the moral courage to stand alone against world opinion if necessary? Before tonight, the President’s answer to that question was in doubt. Tonight, President Bush gave the first indication that America still possesses the courage befitting a free people.
For all the faults and contradictions I find with President Bush's domestic agenda, I am heartened by the first real glimpse of bravery I have seen in many months in the President’s foreign policy agenda. I only hope that the President's brave words are met with equally brave deeds.
In terms of domestic affirms, the President presented a contradictory message on health care. On the one hand, he praised the "skill and innovation" of America's medical system. But he also said that the role of the federal government was to ensure "high quality, affordable" health insurance for all Americans. The president acts like he can have it both ways-the best medical system in the world for no money down. Indeed, while the president invoked "choice" as a centerpiece of his health reform policies, the alternative his administration presents is roughly akin to the "choice" between living under fascism and communism.
If the Democrats had their way, private health care would be abolished in this country. Since the failure of the Clinton health care plan nine years ago, Democrats have convinced themselves that the only solution to rising health costs is to nationalize the whole system along the lines of Canada's failed single-payer plan. But in the meantime, most Democrats are content to chip away at the vestiges of the free market-reducing patent protections for pharmaceutical innovation, pouring more money into Medicare, giving trial lawyers greater leeway to litigate disputes.
And what of the Republicans? Well, President Bush talks the talk of free-market choice, but his proposals are not morally distinguishable from Democratic ideals. The president believes in Medicare-which he called the "binding commitment of a caring society" last night-even though the system is the principal culprit in the nation's health care crisis. After all, it's Medicare reimbursement rates that set the tone for what HMOs and private insurers pay their own doctors. In essence, you have government rationing of healthcare by default.
And now President Bush wants to give Medicare $400 billion more over the next decade. He claims this money will be used to "reform" the system. But reform is impossible. Medicare is the cause of artificially high health care costs, not the solution. But if you accept the president's assertion that Medicare is "binding," than we're faced with a pivotal question: Are we a "caring society" or are we a rational society?
In a rational, capitalist system, there is no government intervention in health care, just as there's no government intervention in religion. Under a capitalist system, not only would Medicare cease to exist, but HMOs would as well. Many people mistakenly believe HMOs are private, capitalist entities, but that's at best misleading. HMOs only exist because government regulation maintains their status in the market. For example, many employers are compelled to offer HMO plans to their employees. In fact, the president's prescription drug plan would encourage more people to join HMOs. In return, these consumers will receive inferior service at an inflated price, because rationing-which the president nominally disdains-is the HMO's core business model.
A capitalist system would not require HMOs or similar cartels. Instead, consumers of health care, such as individuals and businesses, could deal directly with hospitals and physician networks to obtain the services they need. Insurance would still exist, but it would operate far more rationally once freed of government constraints on who and what an insurance plan must cover. Such a system would not provide the kind of "universal" coverage sought by government regulators, but it would guarantee a high-quality, lower-cost system that places individual rights ahead of social engineering.
Finally, the president spoke of the threat posed by excessive malpractice litigation. On this point, we largely concur with the president's sentiments and proposals. As Mr. Bush eloquently noted, "No one has ever been healed by a frivolous lawsuit." It's advice, however, that the president himself should take to heart. For while malpractice litigation is a major threat to physicians, antitrust litigation is a potentially bigger threat.
Even as the president spoke last night, lawyers at his own Justice Department and Federal Trade Commission continue to prosecute doctors who attempt to collectively bargain with HMOs and other insurers. For years, regulators have imposed an arbitrary rule that states doctors possess no inherent collective bargaining rights, a ban unique among American professionals. The official reasoning is simple: if we let doctors bargain, the cost to HMOs will rise, thus harming consumers through higher premiums. What the government really means to say is: if we let doctors bargain, they'll hold Medicare hostage, and the government-financed health system will collapse.
In all the talk about the rights of patients, there is little compassion in the president's words for doctors-the producers of medical services. The rights of the physician have no place in this administration, and so long as the president continues to talk of Medicare "reform," his antitrust underlings will continue to go after doctors. In one sense, it's a scapegoating campaign-we have to blame somebody for our failures, so why not doctors?
Where was the president's compassion when the Justice Department decided to shut down Mountain Health Care, a thriving physician network in Asheville, North Carolina? Mountain provided quality services to local businesses, yet this success did not stand in the way of antitrust lawyers. The ordered Mountain dissolved because an out-of-state HMO-Cigna-wanted to come into the market and setup their own physician network. Rather than compete fairly for doctors, Cigna ran to their government allies and got them to run the local competition out of town. This certainly contradicts President Bush's statement that he wants to "put doctors...and patients back in charge of the American medicine." Yet the White House has stood by and done nothing as Mountain is dismantled piece-by-piece under government decree.
Before the president starts lecturing Congress on the need for reform, he needs to get his own branch of government in order. The president may not be able to reverse the damage done by 40 years of costly government intervention in the healthcare industry, but he can prevent certain abuses from continuing. Ending antitrust prosecution of physicians would be an excellent start. He might also consider abandoning his nonsensical "prescription drug" plan and actually stand up for the rights of pharmaceutical manufacturers over the demands of senior citizen lobbies.
Ultimately, President Bush's vision of health care is one of nominally private companies carrying out government directives. In the 1940's, we called that fascism. Today it's called "compassionate conservatism." It may sound like a better alternative to the naked socialism of Democrats, but in the end the result is the same-the abdication of capitalist principles and the destruction of individual rights.
—S. M. Oliva
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