“If you like your doctor, you can keep your doctor. If you like your health insurance plan, you can keep your health insurance plan. Period.” That was the mantra that we heard over and over when the so-called Affordable Care Act (ACA) was being foisted upon the American people. It held the promise of significantly reduced cost, more coverage, expanded access, and higher quality. Of course anybody who actually read the bill without blinders on knew from the start that they were simply attempts to overcome popular resistance using dishonesty.
You could keep your plan as long as it remained frozen in time, but every plan changes, to at least some small degree, on a fairly regular basis, whether because of regulatory changes, union contract negotiations, or any other reason. In other words, you couldn’t keep your plan. It would be forced to comply with all of the ridiculous requirements of the act, or you would be forced into one of the mandated plans. Premiums, fees, and co-pays did not fall, they rose, often dramatically.
From the start, the ACA was not meant to be the end point. It was intended as just a step toward universal healthcare, with the Scandinavian model held up as the ideal. After all, look at Sweden or Denmark. They have (sort of) free health care for everyone. The Swedish government pays about 84%, with fees and co-pays paid by families making up most of the rest, but the systems are in a state of crisis. As we head into a new presidential election cycle, progressive politicians and media still promote the model as the target to aim for. A friend who has lived in Sweden his whole life has a different take on the Swedish healthcare miracle. Without the rose-colored glasses, he actually knows Swedish healthcare first hand.
Healthcare, as with every economic good, is subject to scarcity. Resources are limited, and new resources to replace those that have been consumed come, not from taxes and money creation, but only from production, from people actually creating things of value. As the people of Sweden are finding out, you can’t have unlimited free stuff and also increase access, decrease costs, and increase quality of care at the same time. Something has to give. Supporters of universal healthcare don’t like to recognize the reality of rationing, but even free markets ration goods and services. The difference is who does it. In a market society, consumers/patients do the rationing. They spend their money where it will give them the most benefit. With central planning, which describes universal care, bureaucrats do the rationing.
Healthcare planners have a couple of methods to allocate scarce resources while still pretending to have universal access. They can extend wait times and they can limit physical availability. Swedish healthcare planners do both. Local hospitals have been closed down, regionalizing facilities to cut costs, increasing personal burdens and restricting services. In one case, all doctors left a health center because of mismanagement and patient safety issues. In another instance, a pregnant woman under distress lost her baby because there was no room for her and no nurses available. In June, one person received notice that she would have to wait five years for necessary dental work. These are not isolated cases, but some of the many varied examples.
The irony is that Sweden and other countries held up as models are getting disenchanted with universal healthcare, and socialism in general. Over decades, they moved away from outright socialism, finding that economic reality doesn’t bend to emotions or good intentions. Choices must necessarily be made, but central planners can’t and don’t make, or even know, what the right decisions are for the individuals and families.