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”

Leading the effort to sell his health care plan to the nation, President Obama has been appearing almost non-stop in almost any venue that will have him. There is growing opposition to his proposal, as the details come to light. But he presses on, convinced of his own infallible judgment, that he knows what’s best for the entire nation of 300 million plus people and that only his ideas can possibly solve the problem.

Economist Walter E. Williams noted, “I doubt whether there are many Americans who think Congress has either the right or competency to choose where they live, what clothes they wear or what cars they drive. Yet many Americans stand ready to allow Congress to decide what doctors they can use and what treatments they receive. We forget that once we have government-sponsored health care, it can be used to justify almost any restraint on liberty.”

And, columnist David Harsanyi commented, “The president claims that we must pass a government-run health insurance program — possibly the most wide-ranging and intricate government undertaking in decades — yesterday or a ‘ticking time bomb’ will explode. If all this terrifying talk sounds familiar, it might be because the president applies the same fear-infused vocabulary to nearly all his hard-to-defend policy positions. You’ll remember the stimulus plan had to be passed without a second’s delay or we would see 8.7 percent unemployment. We’re almost at 10.”

If the government is so efficient and capable of running large organizations, how is it that the post office and the railroads have never been able to operate at break even, let alone make a profit? So, why would a gigantic health care system that accounts for an estimated 18 percent of the nation’s total economic output be able to do any better?

Medicare is held up as an example of a government run health care system that covers a major portion of the population (about 13 percent), yet operates efficiently, with only about three percent administrative overhead, while providing almost unlimited care to seniors at a reasonable cost. Unfortunately, the reality is not quite as advertised.

For one thing, Medicare loses money. It is one of the nation’s biggest unfunded liabilities. So, the program may be efficient, but it loses money. The Peter G. Peterson Foundation notes: “… between Medicare’s three programs (hospital insurance, outpatient, and prescription drug), current and future promised Medicare benefits amounted to $36.3 trillion.”

Another little-known fact about Medicare is that the program is able to control costs only because it can dictate the prices it pays for services. In other words, the system employs price controls to keep costs down. However, it’s a well documented historical fact, dating as far back as the early Romans (Diocetianus, 244-301 A.D.), that price controls don’t work. For example, hospital fees for both inpatient and outpatient services are determined by the government, in its sole discretion.

Furthermore, prices are set according to a system established by Medicare, which then pays only 80 percent of the fees that it determines are or should be the proper charges. Still, Medicare loses money.

Another representation of the Obama administration and others who are pushing for national health coverage is that there are 47 million Americans who do not have any health insurance, which provides the basis for their haste to adopt a plan. Once again, however, at best this is simply inaccurate, at worst, it’s a gross misrepresentation. FactCheck.org offers the following information:

“Twenty-six percent of the uninsured are eligible for some form of public coverage but do not make use of it…this is sometimes, but not always a matter of choice.”

“Twenty percent of the uninsured have family incomes of greater than $75,000 per year, according to the Census Bureau.”

“Forty percent of the uninsured are young…many young people lack insurance because it’s not available to them, and people who turn down available insurance tend to be in worse health, not better…”

Star Parker has written, “Pulling immigrants out of the equation, we’re left with an uninsured population that can’t afford insurance that is about a third the size of the widely quoted 47 million. It’s a population that is generally poor, young, uneducated, and not working…We’re already set up to deal with these folks. Either through Medicaid or covering their emergency room visits.”

As usual, statistics are being misused or misrepresented to support a position that is not necessarily valid. In this case, the need for a government run health care program for everyone.

© 2009 Harris R. Sherline, All Rights Reserved

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