In less than a week, we will find out what the American voter really cares about.  To the Democrats, the only thing Americans want is free medical coverage, which means a single payer.  This will only put private carriers out of business and increase the power and scope of the federal government.

To the leftist proponents, immigration, jobs, crime and the world situation is dwarfed by free medical coverage alone.  In Oklahoma, our part of the Medicaid bill has risen from $338 million to well over $2.2 billion.  The reason is we have added more well-bodied and childless people to the program.  Today, the aged, blind, disabled and poor make up 17 percent of the enrollees.

These expenses cannot go on forever – especially when the Left wants to add all illegal border crashers to the benefit roles.

We are fast approaching what the famous economist summed up with his “Stein’s Law.”  Herbert Stein said, “If something cannot go on forever, it will stop.”  Today, America is fast approaching the stop zone and most voters see the problem.

In September 2018 issue of Imprimis, John Steele Gordon wrote, “A Short History of American Medical Insurance.”  I think that the subject is very relevant given the political significance this year.

Mr. Gordon begins with a discussion of original hospital plans which contained the seeds of two major economic dislocations.  The first was the plans only paid off if the medical plans expenses were incurred in a hospital.  As a result, cases that could be treated on an outpatient basis were treated at the hospital, the most expensive form of medical care.  The second dislocation was that hospital plans were not indemnification coverage rather they paid all costs.  The customer never needed to shop around for services.

Another point is plans such as BlueCross are not regulated like regular insurance plans.  Had hospital insurance come to be regulated like other insurance, those offering it would have begun acting more like insurance companies, and the economic history of modern American medicine might have taken a very different turn.

Mr. Gordon says there were 7,000 hospitals in the United States in 1975 and today 5,500.  The reduction has not been nearly enough.  Because of the cost-plus way hospitals are paid, they don’t compete for patients by means of price -which has caused hospital costs on a per-patient per-day basis to skyrocket.

Doctors were paid for their services according to “reasonable and customary” changes.  In other words, doctors could bill whatever they wanted as long as others were charging roughly the same.

Medicare and Medicaid have allowed state governments to become the largest single source of funds for virtually every major hospital in the country.  As a result, policy decisions are increasingly made for political, rather than medical or economic reasons.

Mr. Gordons warns us not to accept a single payer system.

Simply look at the Veterans Health Administration, and the Indian Health Service, each of which is in shambles, noted for fraud, waste and corruption.  Why would we want to turn over all of American medicine to those who have proved themselves in one word – incompetent – to run large parts of it?

Medical service providers must make public their inclusive prices for all procedures.  We should reform how malpractice is handled.  No longer should both parties cover their legal expenses.  We should adopt the English rule-where the loser pays the expenses of both sides.

The time is ripe for confronting the enormous forces arrayed against these economically sensible reforms.