Government-run Health Care: Can it Work?

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With Congressional discussion of nationalized health care geared up,  the public is weighing what to think about such proposals.

One way to investigate the possibilities is to look at government-run health care that already exists.

That would include military health care and medical services provided by the Veterans Administration. In addition, state programs such as ones in Massachusetts and Oregon can help citizens think through the issues.

But first there's a question few are asking: Is providing national medical coverage legitimate under the Constitution? Indeed, the Founding Fathers had an approach to national health care. They ignored it altogether.

CBN News Reporter Gailon Totheroh got serveral perspectives on the possiblities of government-run health care.  Scroll down for a list of links to watch these interviews.  Related Blog: National Medical Models: Issues and Info

Learning from the Past

Legal scholar Michael Farris, chancellor of Patrick Henry College, said there was a consensus.

"The government can only spend money on things that were consistent with its enumerated power. And there's no enumerated power on this at all," he said.

Farris added that means all direct federal spending on medicine is in violation of the original intent of the Constitution.  Indirect spending for health care wouldn't be a Constitutional problem if the purpose is for an enumerated power such as defense.

Farris says that principle of limited spending guided our legislators from the time of the nation's founding. Then the Supreme Court adopted the minority view of Alexander Hamilton.

"Alexander Hamilton thought they could spend money basically on anything they wanted," Farris explained.

That spending concept was enabled by the switched vote of one Supreme Court justice, Owen Roberts in the 1936 case of United States vs. Butler. That expanded government power to spend.

Roberts, no relation to the current Supreme Court chief justice, cast that deciding vote perhaps because of pressure from the Roosevelt administration. Owen never explained his reasoning and mysteriously had his personal papers burned before his death, providing speculation but no solid answers.

An Example: Military Health Care

Many in Congress still think of spending in the Hamiltonian  way, and that's one reason why they're considering some form of nationalized health care.

Other reasons are that we have the world's most expensive healthcare system, millions lack health insurance, and the quality of care is uneven.

But what would government-run health care look like in the U.S?  Military health care may provide an example for comparison. Farris does note that federal medical spending for the military is legitimate in the Constitution's grant of authority to provide for national defense. 

Tom Herring, now a pastor, retired from the military after over 20 years of service. He says he's seen quality care for his family and quality medicine in war zones like Iraq.

"The physicians that you're seeing are highly educated, highly trained, highly qualified physicians," he said.  "So I would say on a national basis, that government health care is a great system to pattern."

Bud Richardson, a retired marine, says his whole family also received excellent medical care during his years of service and ever since. Still he doesn't favor using the military pattern.  Richardson is reluctant about nationalized medicine.

"I think it needs to be studied a lot more," he said.  "Again, you're talking about the military, you got a small group in relatively good health, stay in relatively good health. And you're talking about having the great unwashed come in. I just envision it's going to be tough."

Tackling the Costs

A major concern about the military as an example is the cost. Expenses have already more than doubled from $19 billion in 2001 to today. Projections for 2015 run to $64 billion. 

Yet politics keeps Congress from raising the out-of-pocket expenses for service personnel to deal with the increasing costs. A number of analysts have even suggested solving the military money problem by cutting the number of individuals serving.

But rising costs, raising fees, and cutting people out are exactly what proponents of socialized health care say it will cure. Those desired results don't seem to be happening in the military.

Care like America's Vets?

Another government institution, the Veterans Administration (VA), provides health care mostly to those who've served shorter stints in the military. That includes tens of thousands who've been wounded in Iraq and Afghanistan.

Fernando Rivera, Director of the VA Medical Center in Washington, DC, says the quality of care provides a good model.

"We tend to take care of patients for their entire life, so in that sense it's a very good connection with what we could do to improve the quality of life of all Americans," he said. 

Critics note there have been serious problems -- including some horror stories at a number of facilities. Rivera says that shouldn't detract from an overall positive and improving track record.

Dr. Ross Fletcher, the head of the medical staff, has directed their efforts in advanced medical recordkeeping. That could provide the basis for a national system for Americans wherever they move or in emergency rooms:

"The information that is available in our records can be made available to those physicians relatively easily," he explained.  "We think it makes for a safer, better healthcare experience wherever the patient is."

The records even contain medical images for the medical staff to explain health problems to patients.  That has been a benefit for patients like Richard Williams, Jr., who has faced serious lung problems.

The system does have extensive security, but critics say a national program could potentially be abused to force patients into medical decisions that aren't the best for their health. Others worry about the rising costs for the nearly five million receiving VA care.

States with Government-run Health Care

Some states already have government-run health care.  Oregon adopted statewide health care in 1994. Physician Frank Rosenbloom says it was expensive, so care was rationed.

"[In] a couple of very famous cases, people who had cancer were denied treatment for their cancer but were offered fifty dollars or a hundred dollars to kill themselvesm," he recalled.

Now Oregon is coming up with a new health plan -- which Rosenbloom predicts will fail because it's more of the same at time when the state can't even afford to pay for its schools.

Massachusetts has been hailed as a health care model after the state enacted broad medical coverage in 2005. Many have received good medical care, but it has proven inefficient.

Rosenbloom, author of the forthcoming book Mismanaged Care: How to Prevent a Health Care Disaster, explained, "It was initially supposed to cost $1.7-1.8 billion. The cost has doubled over a very short time. The amount of money spent for deductibles has increased over that time. And the plan itself is running out of money."

Failed Policies?

Health policy analyst Michael Tanner at the Cato Institute says the plan has failed on two other counts. First, it has not restrained the growth in health-care costs.

Plus, the legislation has not produced its stated primary goal of universal coverage. Estimates indicate more than 200,000 residents remain uninsured.

Tanner says much of the reason for today's healthcare problems is that state and federal governments already control fifty cents of every health dollar. He notes that of every dollar spent for healthcare in this country "only 13 cents is actually spent by the person consuming the health care. That means that governments and insurance companies are in charge, not patients."

The question of who is to be in charge remains at the crux of the controversy - while the only universal agreement about a national health plan is that the status quo needs to change.

*Originally aired July 9, 2009

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Gailon Totheroh

Gailon Totheroh

CBN News Science & Medical Reporter

Over the years, CBN viewers have come to recognize Gailon Totheroh as a valuable asset in reporting on a variety of issues, especially current health and science issues. 

His recent popular reports have covered the dangers of MSG, adult stem cell treatments, the otherwise unreported benefits of vitamin C, longevity research on special forms of resveratrol, and the relative merits and risks of different types of seafood. He has also done several investigative reports on such controversial issues as the development of "designer" embryos and the intelligent design movement.