Months into the great health care debate, it remains enveloped in a fog of unreality. Everyone has a preferred plan, complete with a finely drawn schematic diagram and no idea how it will turn out in real life.
Those opposing Clinton’s nationalization plan like to say that if you like how government runs the post office, you’ll love what they’ll do to health care. But that is comparing apples and oranges, say the plan’s defenders. Okay, then let’s compare apples and apples. One Clinton health care program has already been enacted: the Vaccines for Children (VFC) initiative passed last year to guarantee universal access to vaccination.
Clinton identified the problem: the scandalous undervaccination of American children under 2 years of age. He identified the cause: drug companies engaged in “unconscionable” profiteering on vaccine prices. He identified the cure: government, which would abolish the corrupted market, buy up all the vaccine and distribute it free to every child in America.
It was pointed out that because much of this free vaccine would go to middle-class people who already pay for theirs, this would be yet another unnecessary and expensive government service. So Clinton compromised. The government would buy one-third of the national supply, package it, house it, and distribute it starting Oct. 1, 1994, to every child who needs it.
That was the promise. Even then, however, some were skeptical. Sen. Nancy Kassebaum (R-Kan.) warned at the time that the reason for our low immunization rates was not the cost of vaccine but that “too many parents do not know the value of immunizations.” Or as one local physician put it, “Vaccines are available. The problem is the kids are not available.”
Proof of the proposition that the problem is not high cost but neglectful parents is this fact: While barely more than half of American 2-year-olds are fully immunized, 96 percent of 5-year-olds are. Why? Because 5-year-olds cannot get into kindergarten unless they are immunized. That seems to concentrate the mind of the parents on the need for vaccination.
Moreover, poor people have the worst vaccination rates and for them vaccine is already free. Undaunted, Clinton’s social engineers plunged ahead with a program that nationalizes the issue with free vaccine given out by a benevolent federal bureaucracy.
And how has the federal bureaucracy done with this microcosm of Clintoncare? On July 18, the General Accounting Office, the congressional investigative agency, issued a progress report. It found the administration (1) way behind in letting purchase contracts, (2) way behind in evaluating whether the system could efficiently process orders from the 70,000 doctors and clinics that will get the stuff, (3) unprepared to adequately test whether its packaging and delivery system would retain vaccine potency. (Vaccines require very strict temperature control.)
The plan has two basic problems, familiar to any student of the Soviet five-year-plan system: centralization and bureaucratization. One-third of the country’s vaccine supply is to be sent to a single distribution point, a General Services Administration warehouse in New Jersey that stores paper clips and flammable paint solvents among other bric-a-brac. It is entrusted, notes Sen. Dale Bumpers (D-Ark.), to an agency that has never shipped a dose of vaccine in its history and must now care for 30 percent of the entire nation’s supply.
And centralization begets bureaucratization. Currently, when a doctor needs more vaccine he contacts the manufacturer to get it. Under the administration’s “disastrously flawed” plan, says Bumpers, the doctor will have to go through a long series of transactions before the actual order is packaged and sent out by GSA.
As the British learned to their chagrin after World War II, nationalization schemes suffer much in the passage from the mind of the social engineer to the hands of the bureaucrat. On paper, VFC looks good. Universal vaccination of toddlers, like universal health care, sounds wonderful, energetic, Rooseveltian. Who could be against it?
Yet in practice things turn out differently. “In conclusion,” says the GAO, “our review indicates that it is unlikely that (the government) can fully implement the VFC Program by Oct. 1, 1994, and raises questions about whether VFC, when fully implemented, can be expected to substantially raise vaccination rates.” Translation from the polite: They can’t do it, and even if they can, it won’t make a dime’s worth of difference.
But as with most great government failures, who will know? GAO notes that the VFC program neglects to collect baseline data, so that evaluating its effectiveness will be difficult. In the end “we may be unable to determine its impact on vaccination rates.”
Which means that VFC will live forever. Even if it achieves nothing in reality, we won’t know. And who is going to vote to kill something called “Vaccines for Children”?