Just about everyone, left, right and center, seems to be weighing in on the health care debate: nationalize the health care system (as in Canada and the UK), require health insurers to provide coverage for everyone, merge Medicare and Medicaid into one common health care plan for everyone, provide health care to the immigrant population, reduce costs by cutting Medicare payments to doctors and hospitals, etc.

The arguments rage back and forth, many anecdotal, others statistical or numbers based, but they all boil down to one basic issue: less government involvement vs more government involvement in health care.

Having run a hospital for seven years, I have given this problem a lot of thought and would like offer the following observations:

First, I must admit that my bias is against any form of universal or nationalized health care, “public option” or otherwise. My experience is that a major part of the cause of the problems in health care today is the extent of government involvement, federal and state, that already exists. For example, the costs that hospitals are forced to absorb as a result of government regulation, mandating everything from details of construction and maintenance to cleanliness to the ratio of nurses to patients. One of the principal reasons for high hospital costs is government mandates, all of which drive up costs.

Some simple things could be done that would go a long way toward improving the health care situation in the U.S.: Tort reform, removing barriers that prevent health insurance companies from insuring people across state lines, allowing insurance companies to offer a wide-range of policies, fewer government mandates on health insurance policies (such as pre-existing conditions), and Medical Savings Accounts, for starters.

ABC’s “20/20″ co-anchor John Stossel, noted: “‘Choice, competition, reducing costs — those are the things that I want to see accomplished in this health reform bill,’ President Obama told talk-show host Michael Smerconish last week. Choice and competition would be good. They would indeed reduce costs. If only the president meant it. Or understood it. In a free market, a business that is complacent about costs learns that its prices are too high when it sees lower-cost competitors winning over its customers. The market — actually, the consumer — holds businesses accountable and keeps them honest. No ‘public option’ is needed. So the hope for reducing medical costs indeed lies in competition and choice. Today competition is squelched by government regulation and privilege. But Obama’s so-called reforms would not create real competition and choice. They would prohibit it.”

And, economist Walter E. Williams commented, “President Obama and congressional supporters estimate that his health care plan will cost between $50 and $65 billion a year. Such cost estimates are lies whether they come from a Democratic president and Congress, or a Republican president and Congress. … At its start, in 1966, Medicare cost $3 billion. The House Ways and Means Committee, along with President Johnson, estimated that Medicare would cost an inflation-adjusted $12 billion by 1990. In 1990, Medicare topped $107 billion. That’s nine times Congress’ prediction. Today’s Medicare tab comes to $420 billion with no signs of leveling off. How much confidence can we have in any cost estimates by the White House or Congress? Another part of the Medicare lie is found in Section 1801 of the 1965 Medicare Act that reads: ‘Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services.’ Ask your doctor or hospital whether this is true.”

I’m always struck by the disconnect that seems to exist when people complain about how ineffectively the government runs programs, yet they are willing to trust that same government to manage something as big and complex as health care. President Obama summed up the inefficiency of big government organizations pretty well when he said, “Fed Ex and UPS are doing just fine, it’s the post office that’s always having problems.”

The following commentary on the health care plan that recently circulated on the Internet sums up the situation rather neatly: “Let me get this straight. We’re going to maybe have a health care plan written by a committee whose head says he doesn’t understand it, passed by a Congress that hasn’t read it but exempts themselves from it, signed by a president who also hasn’t read it and who smokes, with funding administered by a Treasury chief who didn’t pay his taxes, overseen by a surgeon general who is obese, and financed by a country that’s nearly broke. What could possibly go wrong?”

In the final analysis, perhaps the biggest problem with health care reform is that Americans do not trust the politicians who are trying to reform the system.

© 2009 Harris R. Sherline, All Rights Reserved

Read more of Harris Sherline’s commentaries on his blog at “www.opinionfest.com”

How to pay for a national health care plan is one of the big obstacles the Obama administration must hurdle in order to reach its goal of providing health insurance coverage for every American. The question is whether it can be done at all without literally breaking the bank – especially following on the heels of the approximately $10 trillion in expenditures over the next few years that have already been approved by Congress and signed into law.

So, how do Obama and Congress plan to get this done?

First, they talk almost incessantly about between $1 trillion and $2 trillion in cost savings that can be achieved in the current health care system. He problem is that there is no way to measure it. Not really. It’s just talk.

A number of other ideas are also being floated to pay for universal health care coverage, and the ultimate choice will probably include some combination of the following:

Taxing the “rich”: This source couldn’t possibly cover all the proposed costs of a national health care plan. A graphic illustration can be seen in the fact that if you tax away the profits of the entire Fortune 500 list of companies, it would only bring in around $100 billion. In 2008, the number was $99 billion. This assumes that these businesses would continue to operate if everything they earned is confiscated by the government, in addition to the income taxes they already pay. As for the individual “rich” taxpayers, the result would be much the same. The combined net worth of the Forbes 400 richest Americans is about $1.2 trillion. If the government took everything they have to fund universal health care, it would only be a one-time fix, leaving nothing to tax in the future.

Taxing health care benefits that employees currently receive tax-free from their employers: No doubt this can be accomplished, but not without reducing the incentive employers have to provide health care coverage for their employees. The idea also includes tinkering around the edges of income tax deductions on individual tax returns, such as reducing the deductibility of various expenses. This can certainly generate more taxes, but hardly enough to pay for universal health care on an ongoing basis.

Cutting costs in the current health care system by improving technology, reducing unnecessary or duplicative procedures also really can’t be measured with any degree of confidence. There are simply too many moving parts, all interacting in different ways at different times and continuously changing at the same time.

Reducing payments to doctors and hospitals for Medicare and Medicaid patients: Contrary to the public perception, doctors are already being underpaid by both Medicare and Medicaid, with the result that many physicians are no longer willing to accept patients whose care is paid for by these programs. Furthermore, the government is notoriously “slow pay,” especially the state Medicaid programs. For instance, in California, MediCal is so slow and underpays for services so severely that many doctors refuse to accept their patients. An actual situation I encountered while I was running a hospital illustrate the point: a general surgeon was paid ten cents for a $50 fee that he charged for an emergency room consultation. On another occasion, a neurologist received only 17 cents for an ER consult. Such cases were not all that unusual. So, you can cut payments, but unless you are willing to conscript doctors, you can’t force them to treat patients whose bills are paid by the government.

Lowering the cost of health care insurance by creating a program that will compete with private sector insurance plans seems like a good idea on paper. But the reality is that a government funded health insurance program has unlimited financing available, which means that any losses they might experience will be funded regardless of whether the plan is profitable or not. The private sector can’t compete with this and will eventually be forced out of business, leaving the government plan as the only remaining option. It’s unfair competition, but it won’t be viewed that way by most politicos. There are laws designed to prevent this sort of predatory behavior by private citizens and businesses, but it’s generally OK when the government does it.

It never ceases to amaze me how often people in government seem to think that they are smart enough to structure programs that can control and regulate human behavior without imposing autocratic control over people. It has been repeatedly tried throughout history, and it always fails – eventually. The evidence is abundantly clear in the universal health care plans of other countries that have already adopted such programs.

© 2009 Harris R. Sherline, All Rights Reserved

Read more of Harris Sherline’s commentaries on his blog at “www.opinionfest.com”