By William F. Buckley
The word among professional Democrats is that John Edwards
has set the stakes on the matter of health care, and no
one who wants to be president can offer less than he is
offering, which is -- of course -- guaranteed health. That
is to say, guaranteed free health care.
Mr. Edwards' primary complaint is that 47 million Americans
do not have health insurance. In a free society, one scans
this datum in search of its component parts.
If health insurance were without cost, one assumes that
everyone would have health insurance. A corollary of this
is that everyone, in a society of allegedly free health
care, would actually be paying the collective costs of
health care. The political challenge lies in disguising
When a commodity is quantifiably measurable, yet universal-
ly available, like air, one can talk about its being
"free". Only people in submarines need to measure air, and
to pay the cost of supplying it. Health care, unlike air,
can't be free, because doctors and nurses and drugs are
not in infinite supply. So can we generate what amounts to
a public subsidy by reducing the costs of health care?
To look that problem in the face, we search out relevant
figures. One set of these reveals that the cost of health
care for an American is twice what it is for a Western
European. If in Germany it costs $100 per day per patient
at a hospital, while a comparable hospital stay in the
United States costs $200, one reaches for an explanation.
Is it that American health care is twice as expensive
because it is twice as comprehensive, twice as resource-
ful? Or is it simply that, for other reasons, doctors
and nurses and drugs cost twice as much in the United
In any case, how do we go about reducing these costs?
Either you pass a law that doctors and nurses and drug
companies have to slash the cost of their services and
products by one-half -- a proposal nowhere hinted at by
Mr. Edwards -- or else we need to reduce the number of
people entitled to receive that health service. How do
you do that?
Not by going in the direction proposed by Candidate
Edwards, but by going in the opposite direction. His
proposal is that more people should be covered. But
if more people are insured, they will increase their
consumption of health care, and therefore increase the
total U.S. expenditure on health care.
But John Edwards calls for something different -- a fiscal
frumpery by which the cost of health care is somehow
dissipated. This is done by obscuring the agent by which
health care is provided. It has frequently been noticed by
social philosophers that from about 1943, when income taxes
were first collected so to speak at the source, via with-
holding, the average worker does not think of himself as
being taxed -- because the instrument by which the money
is taken is so automatic as to be more or less invisible.
When an American worker is hired at $700 per week, he
reckons his income not at $700, but at $500, which is the
size of his paycheck.
Mr. Edwards speaks grandly about health coverage for
47 million people who do not now have it. But unless there
is a diminution in the cost of health services, they will
be paid for by somebody. If it is so that the 47 million
without insurance are the identical 47 million who are the
nation's poorest, then it might be said that all we are
really engaging in is more redistribution. There is a case
to be made for this, and indeed, redistribution has been
accepted for years. The wealthiest 5 percent of Americans
pay 54 percent of all taxes, which means they are paying
taxes that would otherwise be paid by the 95 percent of
Americans whose tax rates are lower.
Therefore, Mr. Edwards is doing nothing more than to call
for increased taxes on the wealthy. They used to call
that socialized medicine, when it was instituted by Great
Britain after the war. It crossed the Atlantic into Canada,
which is a tidy country in which to get sick, provided you
can afford to travel across the border to an American