The best-laid plans for socialized medicine....

I've been looking for examples of socialized medicine in the USA, that is, the programs sponsored by the states. Keep running across an article that was released on the AP wire service that claims Hawaii has a wonderful system -- covers more than 95% of the population, lowest costs in the nation, etc. On somewhat closer inspection, this seems to be a load of crap, or possibly based entirely on information gleaned from some service provider's press release.

Seems to be two major problems with Hawaiian health care: 1.) The reimbursement rates to physicians are so low they can't keep doctors in the state; and 2.) employers are mandated to cover full-time employees, so many businesses hire only part-time workers. Even the State of Hawaii employs a large number of part-time workers to keep its health insurance costs in line. Apparently in Hawaii, unlike the proposals in front of congress, the government gets the same ho-hum health coverage it inflicts upon ordinary citizens.

Hawaii's current system is actually something like the third or fourth attempt at some kind of universal, socialized system. The first one -- starting back in the 1970s and 1980s -- nearly bankrupted the state. (There's an extensive article about this in the Heritage Foundation's archives.) A key problem was that citizens and legislators kept piling on the benefits without much thought to the costs. If you had a big enough lobby or a popular enough representative, you could get your little hobby-horse illness or health service covered by the state's health care program.

More recently, Hawaii launched a program to cover children who did not have insurance, but from families with incomes high enough that would disqualify them for Medicaid. That program was canceled in October, 2008, after only seven months, because the state saw a mad rush of people giving up their other insurance and enrolling their kids for the "free" care. Costs skyrocketed.

Hm-m-m-m, so what about Tennessee? They had TennCare, which combined Medicaid funds in some kind of cooperative program involving five HMOs. TennCare seemed to work for the first couple of years, then one HMO withdrew, three went bankrupt, and the last one was taken over by the state. Now Tennessee has split up its benefits programs and is currently returning those eligible for Medicaid to Medicaid and canceling benefits for others. They have some kind of program for the chronically ill -- those who are denied insurance by private carriers -- that "ensures" they have access to care, but the program's premium price is so high enrollments have been much less than expected.

Tennessee also has/had a program that subsidizes pharmaceutical costs. Problem with that is what the state calls "doctor-shopping." Apparently many people go from one doctor to another, collecting prescriptions either to feed their own habits or to re-sell the medications on the street. The Tennessee Bureau of Investigation has been very busy, and very efficient, cracking down on this kind of fraud and other innovative criminal schemes. Last year, 264 arrests were made; this year, 109 so far.

One news story said the diagnosis for the revamped TennCare program isn't looking too bright. Apparently all the bankrupt HMOs and other facilities and care providers are pressing the state to make good on its unpaid bills from years back, so any new funding will probably be due to creditors instead of being invested in any expanded type of program.

Then there's Massachusetts. What a nightmare and still unfolding. From the July 11 Wall Street Journal:

Well, the returns are rolling in, and a useful case study comes from the community-based health plan Harvard-Pilgrim. CEO Charlie Baker reports that his company has seen an "astonishing" uptick in people buying coverage for a few months at a time, running up high medical bills, and then dumping the policy after treatment is completed and paid for. Harvard-Pilgrim estimates that between April 2008 and March 2009, about 40% of its new enrollees stayed with it for fewer than five months and on average incurred about $2,400 per person in monthly medical expenses. That's about 600% higher than Harvard-Pilgrim would have otherwise expected.

The individual mandate penalty for not having coverage is only about $900, so people seem to be gaming the Massachusetts system.

Do ya think?

And Barron's, July 27, reports, "Three years after enactment, the commonwealth of Massachusetts is unable to afford its dream of universal coverage. Last week, as part of a short-term fix, Gov. Deval Patrick ordered officials to stop automatic enrollment of low-income people in the state's Commonwealth Care public insurance plan."

Massachusetts is also eliminating state-sponsored health insurance for about 30,000 legal immigrants. Why just immigrants? Why not 31-year-olds, punk rockers, or Baptists? I mean, why legal immigrants? Don't they pay taxes? Maybe they just drew the short stick?

Barron's continues: "The savings are likely to be illusory, buried under a heap of cost-shifting and delayed payments. Uninsured people don't just curl up and die; they go to hospital emergency rooms, where federal law requires that they be treated, even if they don't pay. The cost falls to the hospitals."

Still? Even with socialized medicine? I'm shocked... shocked!

I had a friend a few years ago who was committed to personal liberty and free markets. He was a very happy-go-lucky, funny guy, also had a wife and kids and entirely devoted to them. We got into a discussion one time about how red tape and regulations destroy free markets and therefore also economic growth, social civility, and personal ambition. But somehow the human compulsion to thrive finds a way through the maze -- or the rubble.

Wish I recalled his exact words, but he very cheerfully said something like, "That's what I just love about the human race. No matter how hard anyone tries to control us, no matter how many laws, regulations, taxes they pile on... we always find some way around it."

We're talking about people who tamed the West, you know. Harnessed electricity and the tar oozing up in the soil. People who invented telephones and eradicated polio. Who broke Hitler's back and even in less than a decade bouncd back from 9/11. The USA made human aspiration, curiosity, greed, and imagination legal, and even nurtures and encourages them. These are our species' survival tools, and they're valued here, because they're the engines of creativity and growth. The Great American Experiment has been successful beyond the wildest dreams of the Founding Fathers. Freedom works.

Why abandon that for what can only be crappy, rationed, substandard health care -- or black markets gone wild? As long as you're free, you'll be able to get health care -- or anything else you want. People will invent it. They'll find a way to do it on their own, with or without some governing board passing out diktats. But when you give up individual rights and political freedom, you're just stuck with whatever "the powers that be" want to give you -- after they deduct the tribute you owe them.