US Health Care Reform, As Seen From the Trenches (Part 4 of a 6-Part Series)

12/08/2010 02:37 pm ET | Updated May 25, 2011
  • S.I. Adam, M.D. Otorhinolaryngology-Head and Neck Surgery Residency, Yale.

The health care legislation threatens to incapacitate the current social welfare state through curtailing economic growth and national well-being, potentially bankrupting the United States. The origins of the modern social welfare state in the United States came about during the Great Depression of the 1930's under President Franklin Roosevelt. The federal government expanded to unprecedented levels in order to provide social and economic support during a decade when unemployment was over 20 percent, concomitant with nearly 5 percent negative annual growth in the GDP.

Social security, financial legislation, and the "alphabet soup" of New Deal government programs were established to supply short term relief. While these programs provided essential hope and inspiration to the struggling masses, none of them ended the Great Depression. Negative economic growth and high unemployment ended with the inception of World War II and the subsequent acceleration of industrial contracts.

The military-industrial complex took route for the next 70 years. The synergism of military-driven government contracts allotted to private sector business delivered consistent economic growth. The Cold War fueled the military-industrial syndicate, resulting in continuous research and development and civilian technologies such as RCA's shadow mask color picture tube. These factors legitimized such a consortium to the civilian population. At the same time, the end of World War II brought about the "cradle to grave" concept, especially popularized in Britain. National governments began taking responsibility for their citizens from birth until death. A comfortable standard of living became expected as right, not privilege.

Varying positions have been established regarding the level and degree of social welfare from administration to administration in the balancing act of the U.S. mixed economy since the 1950's. However, the steady linear progression of government support for those citizens who cannot avail themselves with minimal provision for a "good life" has occurred in the United States.

Fast forward to today, where the current administration uses rhetoric and health care reform to stretch the veil of the welfare state. Government power is being extended by creating increased dependence on its agencies. However, government gains power at the expense of its citizens' loss of civil liberty in a zero sum game. (Power is always a zero sum game; one party gains at the diametrically opposed party's loss.) Such is the dynamic articulated by the 17th century British political philosophers John Locke and Thomas Hobbes. These empiricists built the core of the U.S. founding fathers' political beliefs. Locke and Hobbes's theories are thus manifest throughout the United States paper democracy. It is the duty and right of U.S. citizens to check and curtail government power in order to avoid authoritarianism, just as it is the federal government's duty to limit citizen power to evade the slippery slope to anarchy.

The above digression now elucidates the pertinent point. The health care legislation is window dressing for government power. No matter what rhetorical skills the current administration uses to substantiate the health care bill, there is no circumventing the fact that it will be the driving force for historically insuperable levels of wealth redistribution in the United States. As a result, the ever shrinking number of federal tax payers (about 50 percent of the population in 2009) will pay for the social well-being of an increasing number of social welfare dependent citizens.

Moreover, the social welfare state is being stretched to the limits by immigrants arriving to United States through dishonest means. The U.S. was founded by immigrants and everyone living within its borders is ultimately an immigrant. Additionally, the contributions of many current immigrants are insurmountable. However, reliance on the welfare system by groups who do not naturalize, scrupulously adds significant expenditure to the annual health care bill. Emergency rooms across the country are the interface where illegal immigrants receive free health care, with hospitals absorbing the unreimbursed costs as mandated by the Emergency Medical Treatment and Active Labor Act of 1986. While illegal immigrant health care aggregate expenditure is difficult to calculate, the financial burden creates cost-shifting to patients covered by either government or private insurance plans. The collective economic impact of illegal immigration to the United States is a subject of great interest and debate, in terms of merits and hardships. Medical costs and resulting social welfare strain are clear consequences, with strong implications on the national health care forum demanding attention. Nonetheless, this issue was neglected in the national health care bill.

The health care legislation is paving the way for the U.S. social welfare state to spread its cover to historic levels by required inclusion of new groups to established government health insurance programs. These additions are associated with costs essentially covered by tax dollars (income tax, excise tax, etc.), creating challenges inherent to this process and debate among those footing the bill. The common good of a population with better access to consistent health care should ultimately win these debates. However, the legislation unfortunately failed to address the costs of unreimbursed medical expenses by groups such as illegal immigrants and other indigent populations. These increased costs strain the social welfare state to either liquidate non-health care related agencies or place the cost-shift levy on state and federal tax payers. In bottom-line analysis, the health care legislation transfers the balance of the U.S. mixed economy in favor of government programs, possibly starting to unravel the fabric of the social welfare state stretched too thin. The health care bill at least adds to federal fiscal challenges and most-likely generates dilemmas for bequest to future generations.