Bureaucrats and Health Care

April 26, 2009
Posted by Jay Livingston

My health care plan will make it easier for more Americans to find and keep good health care insurance. His plan will . . . force families into a government-run health care system where a bureaucrat...(AUDIENCE BOOS)... where a bureaucrat stands between you and your doctor.(AUDIENCE BOOS)

That was John McCain addressing the Republican convention last September. It’s the official party line on health care. Bobby Jindal said the same thing in the Republican response to the State of the Union speech.

Health care decisions should be made by doctors and patients, not by government bureaucrats.

Maybe these guys never have to deal with insurance companies – like George Bush Sr. not knowing about checkout-line scanners – or maybe their non-Weberian definition of bureaucrat includes only those who work for the government.

I’ve got news for them. Insurance companies are bureaucracies. And unlike the government, they are in business to make a profit. They make a profit by taking in as much as possible in premiums and paying out as little as possible in claims.

Does this goal affect the decisions of their employees (i.e., bureaucrats)? Here’s a chart from a NPR/Kaiser Family Foundation/Harvard School of Public Health survey.*

(Click on the chart for a larger view.)

One-fourth of the people had, within the last year, experienced exactly what the Republicans are talking about: a doctor’s decision was overridden by a bureaucrat. (The 46 million Americans who have no health insurance don’t have to worry about this.)

The survey also found that the cost of medical treatment mattered.


Even among those with high incomes ($80,000 a year or more), one in eight had postponed needed care or gone without a prescribed medication.

*A copy of the report is here.