So we can either let spending skyrocket and have patients see their doctors, or we can control spending and endure the wrath of Medicare and Medicaid patients who have health-care coverage in theory but limited access to medical care in reality. Politically, this is a great deal easier to do with Medicaid than with Medicare, because old people vote and nobody cares about the poor. But those are still some fairly unattractive options.
The other thing we can do is draft the doctors, conscripting them into accepting Medicare and Medicaid patients, and those patients with new Obamacare policies that inevitably will end up looking a lot like Medicaid. Kathleen Murphy, a Democratic candidate for the Virginia state house, proposed exactly that during a recent candidates’ forum. Hers is the voice of the future. And it is not without precedent: In Canada, it was long illegal for doctors to accept payment for services that patients would otherwise receive for “free” (there’s no such thing as free health care) under the country’s national health-care system, though in reality that law was only half-heartedly enforced.
As radical as conscription seems, it is logically consistent with the Democrats’ approach to health-care “reform” going back to the Johnson administration, an approach that treats patients and doctors alike as villeins to be apportioned by the lords in Washington. The main obstacle to reducing Medicare and Medicaid spending is the fact that physicians have a choice about whether to participate in the programs. In the long run, the fact that physicians have a choice about whom they see and where they practice is the most significant challenge to the full implementation of Obamacare. The logical thing — politically and economically — is to eliminate that choice. You don’t have to formally nationalize the health-care industry; you just nationalize 40 percent of each physician’s practice and call it his “fair share.”
Doctors, like all licensed professionals, are utterly at the mercy of the state. Obamacare effectively has put the federal government and the states in the insurance business (for the healthy, young, and middle class for the first time), which means that the powers that control physicians’ licensing now have economic interests that are adverse to those of the doctors themselves. It is easy to imagine yet another episode of “fair share” rhetoric being deployed to conscript doctors in trying to make this unworkable mess work. Senator Warren’s totalitarian analysis — that the government has a claim on your property in the present and future because it exerted a claim on the property of others in the past — is entirely applicable here: Ambulances move on public roads, the government supports medical research, etc. You didn’t build that. So here’s your federally mandated portion of money-losing Medicare and Medicaid patients. They won’t call it conscription; they’ll call it shared sacrifice.
Another force at work here is the fact that government intervention in health care has for years been sending doctors out of general practice and into specializations that are far removed from Washington’s interference. Obamacare will almost certainly intensify that trend, producing a surplus of specialists such as cosmetic surgeons even as the nation experiences a shortage of primary-care physicians. The legacy of Democratic health-care reform very well may turn out to be cheaper boob jobs, a fitting comeuppance for the boobs who put this program in place and the boobs who elected them.
The only long-term means of achieving Obamacare’s twin objectives of lowering health-care spending while increasing access to medical care is to force providers to provide on the government’s terms, in effect making government employees out of physicians. That or a free market, but we all know how the Democrats feel about that.
— Kevin D. Williamson is roving correspondent for National Review.