Sunday, August 20, 2006

Crunching the Numbers, Being the Grownup

Facing reality is not fun, at least in the short term. Being the Grownup, that is, the one who has to tell the kids that what they want to do is going to get them into trouble, is also no fun. At times, the Grownup or the Reality Facer comes off as “mean” or ungenerous, sometimes even immoral. Yet reality must be faced, and the warnings of grownups must be heeded, or the trouble that will come of it will outweigh the joy of any pleasant fantasy or youthful indiscretion.

That is the case with the dispute over whether or not the state should provide the funds for prenatal care for illegal aliens. I was visiting with some young friends of mine, great folks, none finer. We agree on most issues politically, but on this one they were of the strong opinion that the government should provide even non-emergency prenatal care for all persons, legal or not. When I pointed out that only nine states had such a program even for their own citizens, they answered that all should. When I asked what exactly should be provided they had a specific answer- maybe not vitamins, but monthly checkups including blood tests and weekly checkups in the last month or so. The cost per checkup, a friend who was a nurse noted, is about $125-$150 a checkup.

I felt like a coldhearted skinflint for disagreeing. I mean these are children we are talking about here. Why not just say, “The government should provide free health care for all?” It makes one sound so charitable, so generous. Since they felt everyone should have access to taxpayer funds for prenatal care, I asked them if that meant that America should pay for prenatal care for the entire world. They immediately said “yes” and that they would be willing to pay more taxes for that. Once again, I was the cold-hearted skinflint, the immoral person even, who would force people to find their own best solutions- even if their best is not good- rather than have the government provide a good solution for everyone. I would risk some pregnant mother having untreated diabetes during pregnancy rather than with a wave of the hand proclaim that “government should provide free high-quality pre-natal care for all.”

What was wrong with me? Why did I insist on missing out on all of the fun of considering myself a generous person by simply agreeing that the government of the United States should provide free prenatal care for all, legal or illegal? They had insisted that they would be willing to pay more taxes for such a program- up to and including for the whole world.

I decided to do what Realists and Grownups do before making such decisions, and that is count the costs before I signed up. The cost of the program in Arkansas has already escalated far beyond what was originally anticipated. What would be the cost, I wondered, if America did indeed insure that every pregnant woman had quality prenatal care? Just the checkups mind you.

(continued- click SUNDAY below and scroll down for rest of column, or if sent straight here just scroll down)

2 Comments:

Blogger Mark Moore (Moderator) said...

Well with a 2% birthrate, which is the average world-wide, there are 140,000,000 million babies born each year. We can assume that Western European countries already have such government paid for care, but they are too overtaxed to afford children. They are not having many of those babies. Not one child in twenty is a citizen of those nations. You could also assume that once people in poor countries knew that America was footing the bills for prenatal care, a few more of them would have children, so let’s stick with the 140,000,000 number.

Twelve checkups at $150 a pop seemed to be the program they were advocating, so $1800 is the cost per pregnancy for checkups. That is $1800 X 140,000,000. So the annual cost of such a program is a staggering $25,200,000,000,000. That $25 billion price tag would be spread among all U.S. taxpayers. There were 110 million tax returns filed in America last year, but remember that the top 50% of taxpayers pay 96% of all personal income taxes! The bottom 50% pays only 4%, and a good slice of that population are people who file returns to “get back” more than they put in through the so-called “earned income tax credit”. So we are really talking about 55 million Americans paying for this.

That comes out to $4,581 and some change per year. Since both had tax returns that I believe put them (barely) in the top half, make it just over $9,000 per year. So now I must ask if I want to cripple their financial future by saddling them and every American with a household income above $38,000 with a $9,000 a year additional obligation. This is in addition to the national debt laid on them by all the other give-away programs that non-adult politicians have already said “yes” to. The total for those obligations is $30,000 dollars per taxfiler- so $60,000 per taxpayer who is actually paying taxes, so $120,000 for a household of two such people- and the figures do NOT include any obligation for Social Security or Medicare.

And of course, once you say that “every child in the world deserves high-quality prenatal care even if the state has to pay for it” then surely you are in favor of insuring them high-quality health care and day care and everything else in the world. Once you say it is the government’s responsibility to take care of people, there is no end to the number of “needs” that arise.

You may say that my figures are off because many Americans already have health insurance through work. True, but the fact is that once the government starts doing something for free, insurance companies quite building it into their plans. Employers quit paying for it- shifting those costs onto the taxpayer since the government now believes it should provide these things “for all”. It is also a fact that if someone else is paying, users will tend to demand higher quality care than if they were paying themselves. The phrase to describe this is “if you are paying, I’ll have the filet mignon”.

To counter that effect, governments that provide health care develop a very stringent set of rules to determine who gets treatment and how good that treatment is. The result is that the most virtuous person in the country and the lowest, most selfish villain in the country get the same quality of healthcare- lousy. You see, more health care does not magically become available just because the government is paying for it. The government has to get that payment from your pockets, and those are only so deep. Someone must ration health care. If the government provides it, they will be the rationer. If people provide their own then they will be their own rationer. A person who has lived a life of virtue is more likely to get help from private individuals or friends if their own resources fail. When the government provides it, the person who has lived the most selfish, lowest life is going to get just as much as the most noble and selfless person. And everyone will be too broke paying the taxes for it to help them.

In the end, I do want all babies, even those born of illegal aliens, to be healthy. I want them to have nice houses and cars, and health care and day care and vacations and education. But the grownup in me, the realist, knows that if we try to do that through government there will be no end to it. It sounds good, but it is not a realistic option. Rather than being a way to give all those nice things to all people, it will simply lead to a situation where those who now have these good things lose them. That is the way it has worked in every socialist country in the whole world throughout human history. As I look at our latest bunch of politicians I realize that they are NOT the ones smart enough to find a way to change that.

12:05 PM, August 20, 2006  
Anonymous Anonymous said...

This is the best, most complete explanation that I've ever read for why we shouldn't go to socialized medicine. If you don't mind, I think I'll make it available to all of MY good-hearted but economically challenged friends! Thanks!

4:34 PM, August 20, 2006  

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