More and more articles are surfacing about the bankruptcy of the British National Health Service.  As a government organization, they will never go bankrupt, of course, they will just stop offering certain services.  This is called rationing.  Ah…the advantages of a monopoly.  The NHS is looking for 20 billion in cuts.  This is not something they want to phase in.  They are looking for it now.  This outfit is in trouble and the Brits, long accustomed to paying nothing, are very angry about the possibility that some services will be eliminated or privatized.  One of the most popular tweets circulating now is that the Brits “earned our health care in a war.”  This Ponzi scheme did, in fact, start in 1947 shortly after WWII.  I’m not sure I understand the connection with free health care as some sort of reward for having endured a war, but the popularity of this quote gives you some idea of the entitlement mentality of the Brits.

The bankruptcy of the Canadian Health System has been looming for over a decade.  Were it not for their monopoly and control of access, they would have disappeared long ago.  There is little to no difference in not paying your bills and simply denying or delaying care to people.  I have written at length on this blog about the Canadians that travel to our facility to avoid a wait of 2 years or more for the most routine surgical procedures.  This rationing by delay would translate to bankruptcy in the private sector.  Not surprisingly, more and more articles about partial to complete privatization of the Canadian system are surfacing from think tanks and journalists not known for their love of the free market.

That said, I think it is rational to think of Medicare as our National Health Service.  I have thought this for some time.  Medicare has no competitors and in the effort to create a “health care is free for anyone enrolled” has brought bankruptcy within sight.  As P.J. O’Rourke has written, “if you think health care is expensive now, wait until it’s free.”  Consistent with the national schemes in Britain and Canada, the Medicare bureaucrats are dealing out their brand of rationing here in the U.S.  This has initially taken the form of payments to physicians so low that fewer and fewer doctors are willing to see patients enrolled in Medicare.  This, of course, works beautifully for the rationers as it makes the physician look like the bad guy.  This is the game of government, it seems.  Engage in Draconian control  and make sure someone else takes the fall for the consequences.  Simultaneously, the consequences to physicians who run afoul of the incomprehensible Medicare codes and regulations are subject to fines and imprisonment.  This coupled with the low payment makes the cost/benefit ratio even more problematic for the physician contemplating seeing Medicare patients. 

Here’s a new one, though.  A friend of mine told me recently that Medicare is conducting “audits” of payments to a facility where he does orthopedic surgery.  This audit procedure is delaying payment for total joint replacements for up to two years.  This is actually worse than the rationing activities in Canada.  At least in Canada when they run out of money, the doctors stop working.  With our national health service, the physicians and facilities are providing a line of credit to Medicare, who should be paying their bills.  Once again, this would be declared bankruptcy in the private sector.  Once again, the physicians will look like the rationers, the bad guys, and the Ponzi scheme will continue and those running it will get off scott-free.

What makes anyone think that Obamacare will be any different?  Someone famously said years ago, “the only thing that’s new to you is the history you don’t know.”

G. Keith Smith, M.D.