I have a significant number of friends who are in favor of a national government run health care insurance program.  They have touted its benefits.  Here are some questions I would like them to answer for me.  If you think they are leading questions with false or unfair premises, say so, but please try to answer them.

You think that state run insurance is a good idea.  You’ve seen in work well a fistful of countries.  You want to see it happen in the U.S..  Please consider and provide answers to the following questions:

1. The countries that you cite (France, Germany, Australia, Canada) as examples of successful state run health insurance have at most a population 1/4 the size of the United States. What makes you think that their systems can scale to the population of the U.S.?  Might there be cultural or governmental structure differences between the U.S. and these countries that would prevent their systems from translating correctly to a U.S. system?  Why or why not?

2. Why must state run health insurance be implemented at a national level instead of allowing individual states within the union to implement it at the state level if their own citizens want it?  Why must it be all states or none?  Massachusetts implemented mandatory health insurance with a state funded option for those who could not afford it under Governor Mitt Romney. Why not let it prove itself in state level laboratories? Why must it be national?

3. One astute technologist has observed: “any engineer knows that making large wholesale changes to complex open-loop dynamic systems (like the health care system) is a sure way to take a broken system and make it worse. If you’re a programmer, you’d never program like that. We don’t have to make public policy like that either. Refactoring 18% of the economy with one large bill is just plain nuts.”  Why must the changes to the health care system be implemented all at once right now?  Why not take an incremental approach?

4. Many of the same people who support a state run health insurance system also believe that big oil and other companies manipulated the national government during the Bush Administration to increase their profits by going to war. If big business can manipulate corrupt government in this way, what makes you think that if we give power to the government to control the medical industry that it wont be manipulated as well?  Your preferred party will not be in power forever.  Would you really want the party you disagree with to have the power you are granting?

5. Proponents of a national system often cite the supposed fact that 45 or more millions of people in the U.S. do not have health insurance.  However, a closer look at the numbers show that of those 45 million, there is a 6.4 million under-count of people who failed to report that they were on medicaid, 4.3 million who are eligible for medicaid or SCHIP but have not applied, 9.3 million who are not citizens of the U.S., and 5 million are single and young married adults without kids who choose to be uninsured.   If you believe that the Bush Administration “lied” about weapons of mass destruction in order to get us into the Iraq War, how is claiming 45 million uninsured in order to get us into a national health insurance system not a similar lie?  Are you okay with that?  Why or Why not?

6. Provided that you think that the system will scale, that it must be implemented on a national level and not a state level, that it must be implemented whole-hog and not incrementally,  that it will not be manipulated by corruption to unintended purposes, and that it is not being pushed using desceptive statistics– Upon what constitutional grounds does the national government claim power to run a state controlled insurance system that forces people to have insurance?  Interstate commerce clause? Preamble’s “general welfare” ?  How do you reconcile a national health insurance system with the 10th amendment?  Are there any existing national laws that force someone to purchase a product or service against their will?  What are the chances that the system will be found unconstitutional by the Supreme Court?

7. In order to get around the constraints imposed by the Constitution, a national health insurance program will likely have to be technically implemented by the states anyway with the threat of withheld funds from the national government. Many state Governors oppose the plan because they know that they will be the ones who have to implement it by national mandate. This hides some of the real cost by pushing off onto the states to keep it out of the national budget.  Are you okay with that?  Why?

8. Obama points to states where a single company has a complete monopoly on the health insurance industry, but he does not mention that companies are forbidden from competing across state lines by national law.  Would you be in favor of opening up health insurance competition across state lines as a way to bring costs down?  Why or why not?

9. In order to regulate health insurance on a national level, the government is going to have unprecedented access to your health care records and expenditures.  If you were against the Bush Administration’s warrantless wiretapping because of Constitutional privacy concerns, why do you not have similar concerns about the national governments invasion of private health information and profiling?

10.  The IRS will probably be the entity to audit health expenditure information on a national basis.  Considering the existing bureaucratic nightmare that is paying taxes, why do you trust the IRS to manage your health information?

11.  Part of the problem with the current system is that insurance plans do not move with the individual from job to job, or across state lines.  These are restrictions imposed or encouraged by the federal government.  Would you be in favor of eliminating these restrictions?  Why or why not?

I’m going to be out of the country for the next 12 days and wont have time to respond to comments during that time.  Take your time to consider the questions and provide some detailed answers and I will see what you have to say when I get back.

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