The Boy Party vs. the Girl Party

A quick glance at last night’s New Hampshire election results tells us that Democrat voters are most concerned with health care and climate change. It makes good sense. Now that the Democratic Party has become the Girl Party, its policies all aim at a more motherly government, one that preserves and protects womanly values.

You might think that gender is socially constructed. But, one finds it very strange that, in today's defiantly unisex world, our political parties have divided along strict traditional gender lines.

The Republican Party has become the Boy Party. Republicans defend gun rights and tend to be more willing to fight wars.

The Girl Party wants to take everyone’s guns away-- an absurdly unrealistic proposal-- and tends to be anti-war, even to the point of being cowardly.

The Boy Party wants people to compete in the marketplace. The Girl Party does not accept the results of fair competition. Believing that the marketplace is rigged, it always leans toward regulating the marketplace, not allowing free competition. The Girl Party is risk averse, while the Boy Party is more willing to take risks. Just measure the shrieks of fear coming from the Girl Party when President Trump undertakes a risky foreign policy initiative... as in killing Qassim Soleimani.

Being a cult to the Nature Goddess, the Girl Party opposes industry, manufacturing, commerce and especially anything that involves energy. The Boy Party embraces the Industrial Revolution for all it has brought to all of us.

And naturally the Girl Party wants to provide great free healthcare for everyone. It does not concern itself with the practicalities of Medicare for All or with single payer health care. It prefers sentimentality and caring to the cold hard light of reason.

Like people who have never had to deal with the consequences of their decisions the Girl Party believes that wishing will make it so and that the money will always be there. It sounds like a group that has never made a living or balanced a check book. If you don’t believe me listen to Bernie Sanders. 

Medicare for all sounds good. Single payer healthcare sounds more economical. And yet, when Sally Pipes crunched the numbers, the gauzy promises and noble sentiments behind the proposal come tumbling down to earth.

When politicians promise that we can have more of the same at a lower price you should grab hold of your checkbook. They are coming for your money. And they will end up providing less for less. If it is going to cost less you will probably receive less care. 

The first salient point, Pipes remarks, is that Medicare reimbursement rates are significantly lower than insurance reimbursement rates:

A single-payer program would pay doctors at rates similar to Medicare reimbursement levels, already at least 25% less than private insurance pays, according to estimates by Charles Blahous of the Mercatus Center. Under the current legislative drafts of Medicare for All, government rates over the first decade would be 40% lower than those paid by private insurers.

The first casualty would be physician salaries. After all, that is what happens when other countries embrace single payer systems:

That amounts to an enormous pay cut for doctors. U.S. physicians earned on average $313,000 in 2019, according to Medscape’s international physician compensation report. The average physician in the U.K. earned only $138,000. The Commonwealth Fund reports that American general practitioners earned a little more than $218,000 on average in 2016, compared with $146,000 in Canada and $134,000 in the U.K.

And this does not consider the cost of malpractice insurance. As best as I can tell none of the plans are proposing that we get lawyers out of the healthcare business… something that would surely lower healthcare costs, if only through the practice of less defensive medicine.

Lower salaries would cause physicians to give up their practice. So, single payer health care means fewer physicians and thus less care. It means waiting longer for an appointment to see a physician and unconscionably long waits for various surgeries:

Drastic pay cuts would inevitably drive physicians to give up the practice. Patients can’t afford an exodus of doctors. Nearly 80 million people live in areas with too few primary-care professionals, the Kaiser Family Foundation reports. Even under current policies, the country may face a shortage of as many as 120,000 doctors in a decade, according to the Association of American Medical Colleges.

And then, Pipes sagely notes, bright young people have other options. Nothing obliges them to practice medicine. They might well find more lucrative and less stressful ways to make a living. Thus, those who will be going into medicine will be less bright and less capable. Is that something you look for in choosing a physician?

The prospect of lower pay and stressful work would also discourage young people from entering the profession. Medical school is expensive; the median graduate takes on $200,000 in debt. It’s time-consuming, too. The typical doctor spends four years in medical school, followed by three to seven years in residency and fellowship. Lucrative jobs in finance, technology and law require far less preparation time.

So, Medicare for all means less medical care for all. One understands that some physicians and some clinics will still be available for those who want to pay out of pocket. Thus, we will have a two-tiered system, one for the rich and one for the rest.

One report from FTI Consulting found that Medicare for All would reduce the projected number of U.S. physicians in 2050 by about 44,000, including more than 10,000 primary-care doctors. Patients would have to compete for appointments with a dwindling number of overloaded and underpaid doctors. Everyone would have coverage, but that’s not the same thing as care.