Basically, choice in medical matters is almost always good. In my life I have had different strategies at different times. I used an HMO when I was young and healthy. It was cheap and they were good at simple stuff. When I developed a heart problem, one of the HMO docs advised me to get my own cardiologist because the HMO’s weren’t very good. I did. and then I joined a PPO that included my cardiologist. Now that I am retired I have a fee for service plan that is good in many states. My secret? I was in the Federal Employee Health Benefit Progrram.

Let me disclose that not all of the millions of folks covered by this program are geniuses. We have something called “open season” and there are pamphlets and charts and websites that help you make informed decisions. It is really not that hard.

The Congressional Budget Office included an option to extend the FEHB to all citizens and employers in its December, 2008 Budget Options document which outlined 115 possible methods to lower costs. This option actually saved expenditures over our current system! But it was projected to lose tax revenue because some employers might reduce taxable salaries to offer this benefit. Of course, that was before the many current proposals still on the Congressional table to tax such benefits.

Of course the paragraph about evil pharma, insurance companies and specialists is the entire playbook of the true communitarian health lackies. First of all, President Obama has included all these evil folks (especially PhRMA) in deals – estimates are that PhRMA gave up $80 billion in price cuts to get $3.6 trillion in revenue. PhRMA loves the proposed reforms because they exactly emphasize “pill medicine” by GP’s over the more costly interventions performed by specialists. This bias has now been reinforced by the decision to tax medical devices that are used and implanted in such procedures. I could go on and on, but I am getting bored – I will just point out that, in the end, a Government- administered (or just mandated on private insurers) system will have lower efficiencies than our current system – pushing most of the cost of that inefficiency down onto the patient in the form of delays and onto the doctor in fee cuts. The only actual operational advantage that the Government has is that it can print its own money whereas actual evil insurance companies must have “cash reserves” set aside. Apart from the delays and cuts expect huge bureaucracies, hand-tying regulations, guidelines for practice that supersede the doctor-patient relationship etc. etc.

When I hear folks talk about Canada or Europe, I just don’t get it. American bureaucracy is uniquely onerous and pernicious because our legal system is “positivistic” as opposed to the “natural law”-based systems in most of the Socialist democracies. Believe me when I say that a U.S. Government-guided system will be one bureacratic mutha with no wiggle room for doctor or patient choice. The hatred we now harbor for our insurance companies will be reserved for our Government – not that it will matter – because we will have no recourse.