The Road to Serfdom and Dr. Donald Berwick
It really is amazing how much The Road to Serfdom can tell us about today’s world. The following passage jumped out at me during the reading this week:
The power of the planner over our private lives would be no less complete if he chose not to exercise it by direct control of our consumption. Although a planned society would probably to some extent employ rationing and similar devices, the power of the planner over our private lives does not depend on this and would be hardly less effective if the consumer were nominally free to spend his income as he pleased. The source of this power over all consumption which in a planned society the authority would possess would be its control over production.
I want to look at this passage in the context of the health care debate. Dr. Donald Berwick has been named as a recess appointment by the President to be Administrator of the Centers for Medicare and Medicaid Services. Let’s put aside for this discussion how this is incompatible with the President’s campaign promise of bringing transparency to government. Dr. Berwick has made public statements advocating rationing. Medicare and Medicaid are both in serious financial troubles. How does anyone not believe that this will lead to reduced service and coverage for those people on Medicare and Medicaid. Remember, under Obamacare, many states will be pushed into registering many, many new people on Medicare or Medicaid.
The passage above warns us that rationing and “death panels” aren’t the only potential loss of freedom we should watch for. Dr. Berwick will now have power to decide if new procedures or drugs are covered by medicare. Lets say that someone is able to create a new drug that cures Alzheimer’s. Let’s also say this drug is very expensive. Dr. Berwick (or any other planner / statist) might decide that the drug is simply to expensive for Medicare to cover. What happens if Medicare (through the increased “membership” from Obamacare) represents a large enough sector of the public that the manufacturer decides he can’t make money off his new drug? Perhaps he won’t produce it. Or perhaps he will produce it, but due to the much smaller market, it may cost three times as much as normal. This could significantly impact whether or not individuals who have somehow been lucky enough to keep their non-government insurance are able to get this drug. This is one of the dangers The Road to Serfdom warns us about with central planning. Dr. Berwick doesn’t have to deny specific individuals coverage in order to impact their ability to decide their own medical treatment.
This is the danger of a massive government run healthcare system. The government becomes so powerful that its decisions to not cover a specific treatment or drug can affect whether a person who is able to buy their own insurance, and thus not under any government run plan, can get the treatment they want and are able to pay for.
The solution? Government should get out of the healthcare business. Instead of increasing the number of people that are dependent on the government for medical care, we should look for ways to decrease the number of people on Medicare and Medicaid. The less power the government has, the more free each of us are to make our own choices.
For next week I want to cover chapters Nine and Ten. I believe I will have The Road to Serfdom finished by the first or second week of August. If there is a specific book you would like to cover next, let me know. I have two (Witness by Whittaker Chambers or Mere Christianity by C. S. Lewis) that I am considering, but I could read either of these or something else.