Free to choose?

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Free to choose?

 

E.J. Dionne, Jr. - Washington Post Writers Group

01.27.03 - WASHINGTON -- For decades, the political left was hung up on an old

Marxist notion. Because capitalism was inherently unjust, as the British Labor

Party once declared proudly, social justice could be guaranteed only by

government ownership of the “means of production, distribution and exchange.”

The idea succumbed to a slow but well-deserved death. Most of the left came to

realize that government ownership of basic industry bred inefficiencies,

retarded growth -- and rarely produced the benefits it promised. Government

could promote a more just society while leaving entrepreneurs ample room for

creativity. Freedom and fairness could be allies.

We are now confronted with a strange inversion. If the old left thought that

only government ownership could produce a just society, the new right seems to

think that free market solutions -- or solutions dressed up that way -- will

always produce greater efficiency. Preachers of the new doctrine believe as a

matter of faith that private companies are bound to do better than government.

Bear that in mind as you ponder President Bush's proposals designed, over the

long run, to privatize Medicare. Oh, these changes won't be sold that way. As

Amy Goldstein reported in a helpful scoop in The Washington Post last week, the

president wants to create a prescription drug benefit that would be offered to

elderly Americans who are willing to join a new version of the program based on

managed care.

In principle, seniors would be “free to choose,” and protections would be built

in for those in the system or about to join it. But depending upon how the

administration draws up the incentives, many of the elderly who need drug

coverage could eventually have little choice but to join the brave new plans

that Bush would create.

Advocates of a new approach lay heavy stress on the magic words “choice” and

“competition.” Here's the problem: the current Medicare system is popular and,

yes, costly, because it guarantees patients the most important choices of all --

over which doctor to see and what care to get. Yes, the system has bureaucratic

problems that lead some very good physicians to drop out, and there are serious

arguments over the system's reimbursement rates.

But the dirty little secret behind the newfangled managed care plans is that

they are all designed to control spending. That means limiting the very choices

Medicare recipients now have. The first step in this debate should be to get

that out there explicitly and not be deceived by fancy labels such as

“modernization.”

And the push to “modernize” Medicare along free-market lines misses the whole

reason why Medicare got created in the first place. The free market is very good

at providing goods and services where a profit can be made, and inequalities

among those goods and services are usually not morally troublesome. It doesn't

bother me if I drive a Saturn and you drive a Porsche. Both of us can get to

where we need to go.

But inequalities in basic health coverage are morally objectionable because they

literally affect the right to life. So it does bother me that while my family

might have decent prescription drug coverage, my elderly neighbor does not.

And you don't need to be an insurance company statistician to know that people

tend to get sicker, more often, as they age. Insurers can make money covering

the elderly by trying to “select out” those least likely to get sick, but it's

hard to turn a profit on very elderly people with high medical expenses.

Medicare was created precisely because we decided that the government should

step in where private insurers, for their own very good business reasons, would

not dare tread -- or would have to charge so much that they'd exclude most of

the elderly from meaningful health coverage.

There is thus no way to get the government out of the health care business,

especially where the elderly are concerned, and any plan to promote “market

competition” within -- or as an alternative to -- Medicare will still rely on

heavy government subsidies.

That's why the burden in this debate should be on those who would radically

alter Medicare. A strong case can be made that providing prescription drug

coverage through the existing Medicare program would be cheaper than the

alternatives because Medicare's enormous purchasing power could be used to push

down drug costs.

This debate should rest on facts and logic, not doctrine. Where the elderly are

concerned, let's be wary of those who claim that the free market will achieve

miracles it has never been able to produce before.

© 2003, Washington Post Writers Group

 

 

 

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