Our problems remain epistemological.

Friday, January 11, 2008

Brezhnev Lives!

Yes, it is official: Universal coverage is the opposite of health care. Don't believe it? Well, then, please pay attention to the position of the federal government---yes, that same federal government that many believe should guarantee health care coverage for all---in a lawsuit filed by a couple of veterans' groups arguing that the VA health care system "illegally denies care and benefits..."

As reported by the San Francisco Chronicle (January 11): "The government had argued that it was required to provide only as much care as the VA's budget allowed in a given year."

Now, it is absolutely clear that the Constitution vests the power of the purse in Congress, and not the judiciary. Congress has the power to spend whatever it chooses, and if given interest groups deem that amount insufficient, they have every right to petition the Government for a redress of grievances.

But let us shunt that legal/constitutional issue aside. What is fascinating is the policy dimension: The bureaucracy has just agreed that resources are limited---duh!---and therefore that not everything can be covered and that the beneficiaries of government spending programs might not get everything they would like. In other words: They will not be fully "covered" despite future promises of "universal coverage."

And that is for a small (and politically untouchable) population of beneficiaries: veterans. What would the system "cover" when everyone is the special interest, competing with everyone else for slices of the federal pie in the context of health care expenditures skyrocketing? The short answer: Not everything, not the universe, and not the free lunch that so many believe is within reach.

This little spat reminds me of the old joke about the time that the great Leonid Brezhnev was on the phone listening to the desperate pleas of Todor Zhivkov, the general secretary of the Bulgarian Communist Party, as he begged Brezhnev for increased economic aid. "Comrade Leonid Ilyichovich, we desperately need 10 million tons of grain." Brezhnev: "You will have them." "We need 25 million tons of oil." "You will have them." "We need 5 million tons of steel, 40 million tons of cement, 10 million pairs of shoes, 15 million winter coats, and 25 million tons of potatoes." "Fear not, Todor Hristovich: You will have them."

"Leonid Ilyichovich, you are a giant among the defenders of the proletariat, and the savior of the Bulgarian workers. But I have only one question. Do you really think that the Czechs will be able to deliver?"

[cross-posted from www.medicalprogresstoday.com/blog/]

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