Healthcare: A House Divided Cannot Stand

by Thomas L. Knapp…….

The latest healthcare initiative from the Trump administration and the Republican Party’s leaders in Congress seems set to sink just like the last version. Mitch McConnell can’t seem to round up the votes to push it through the Senate, if anything the House is more likely to tear apart than pass the Senate version, and the White House isn’t getting anywhere with its attempt to mobilize the nation’s governors behind attempts to modify the Affordable Care Act, aka “ObamaCare.”

Good. Even the most ambitious proposal up for serious consideration — repealing ObamaCare and reverting to pre-2010 rules — is just nibbling around the edges of the problems of maximizing care availability and minimizing costs, as was ObamaCare itself. Sooner or later (and the sooner the better) one of two radical solutions will be adopted.

Note: “Radical” does not mean “extreme.” Per Oxford Dictionaries, it means “relating to or affecting the fundamental nature of something; far-reaching or thorough.”

Let me define the problem by mangling a famous Abraham Lincoln speech: A house divided against itself cannot stand. I believe this healthcare system cannot endure, permanently, half government-run and half kind-sorta private. I do not expect healthcare to disappear — but I do expect it will cease to be divided. It will become all one thing or all the other.

The two real alternatives before us are:

Adopting a “single-payer” system in which the state takes complete top-to-bottom charge of healthcare; or

Radically reducing — even eliminating — the state’s role in healthcare.

As a libertarian, I support the latter course. Every government involvement in healthcare, starting with guild socialism and occupational licensure in the late 19th century (at the urging of the American Medical Association, to prop up profits for doctors) and proceeding through socialized healthcare for veterans (the VA), socialized healthcare for the elderly (Medicare), socialized healthcare for the poor (Medicaid) and partially socialized healthcare for everyone (from the Health Maintenance Organization Act to ObamaCare) has impeded care and raised costs at the expense of patients. A constitutional amendment requiring separation of medicine and state would be the best possible outcome.

But that seems unlikely to happen, doesn’t it? The big business players in healthcare (pharmaceutical companies, hospitals, “insurance” companies, et al.) would rather use government to protect their monopolies and pass burgeoning administrative costs on to the rest of us than compete in a free market. And the customers (patients) themselves have good reason to distrust what’s been falsely advertised to them as a “private sector” system.

I predict that the US government will adopt a “single-payer” healthcare system no later than 2030, and probably sooner. And while I oppose that outcome and believe its results will be far worse than a real free-market system would produce, I also suspect that those results will be better than the current half-fish, half-fowl, largely socialized but with fake “private” players sucking it dry, system.

Ultimately, it must be free-market or “single-payer.” Either way, I mostly just wish the politicians would stop tinkering and make up their minds.


Thomas L. Knapp (Twitter: @thomaslknapp) is director and senior news analyst at the William Lloyd Garrison Center for Libertarian Advocacy Journalism ( He lives and works in north central Florida.

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5 thoughts on “Healthcare: A House Divided Cannot Stand

  1. Hard to say what will happen. When Obama was first running for president, and the popular claim was that his campaign fund was nearly all individuals, I wondered, “Who really owns Obama?” Blue Cross and CitiBank were the chief players getting him into his political career. Now look back at what he did for them as president. People expected a one-payer government health scheme like much of the civilized world, but got forced private insurance instead.
    We already pay for the several government health care payers mentioned, and you can’t realistically expect to disband Medicare without a lot of extremely angry seniors with not much left to lose taking a few politicians with them. Likewise VA. We may as well just foot the bill for everyone and eliminate the medical premiums on every type of insurance available, including but not limited to private health insurance. Think that will happen? I think not likely because the politicians are owned. Expect an expensive, burdensome, confusing, unsatisfactory mess for many years to come.
    One worry with government medical for all is mandatory vaccines that cause more harm than protection (like sterility instead of HPV protection for young girls), and other such Big Corporation-initiated nanny-state “for the common good” schemes that always seem to align well with Agenda 21 goals… coincidence or not. I recall the legislation passed in Florida and elsewhere, but not actually enforced, calling for mandatory flu shots to prevent a deadly epidemic. Think about it: if the vaccine works and you chose to take it, what risk does an unvaccinated person pose to you? If he wants to take the risk on himself, that is his choice.

  2. Another commendable column, Thomas! Thank you for boiling it all down to the nitty gritty: In effect, Universal Health Care (UHC) -or- the mythical “free market”…take your pick.

    Needless to say, I come down firmly on the side of UHC…imperfect as it is. I have been the recipient of Medicare (CMS) services and I like their style. I’m acquainted with many veterans who receive services from VA/Tricare…who feel the same way. Yes, there are notable deficiencies/inadequacies inherent in both systems. But, those very same deficiencies/inadequacies are also inherent in this “free market” system: In fact, it is due to the problems within that very system that engendered this long-running debate in the first place.

    What is forgotten (or denied) in this “free market” mess…is that EVERY taxpayer winds up paying the freight for health care. As you might guess, an exhaustive list of the subsidies, grants, tax breaks, tax advantages, incentives, etc., etc. provided by the government to the “free market” can be readily compiled. So much for “free”, huh?

    This is why I remain mystified by the intentions behind the fabled “Obamacare”. As I see it, this thing appears intent upon a singular purpose: To guarantee health care…to the INSURANCE INDUSTRY. That ain’t right!


    1. Dickford,

      Thanks! But I will take issue with the idea that there has been anything remotely resembling free market in medical care in the US in living memory. We’ve had guild socialism (occupational licensure and a monopoly for the American Medical Association in defining standards so as to limit and regulate supply) since the 1870s, and increasing point of provision socialism since the New Deal/WWII era. Whether one supports a free market system or not, that non-existent system can hardly be blamed for the problems of the existing system.

      1. I couldn’t agree more, Thomas! So…from where does this “free market” nonsense emanate?

        As long as I have been drawing breath, I have yet to witness a “free market” in ANY facet of our economy. That’s why I call it a myth. Let’s face it: We live in a socialist world. We like it like that…

        Keep up the good work, eh?


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