A reader asks which group will be disadvantaged by Obamacare. It is horrifying to me that there is any literate person in America who can ask this question.

The voiceless group in America who will be squeezed out of health services will be the poor.

It is obvious that issuing insurance cards without increasing the number of doctors does not increase the amount or quality of care. Do this even need to be said? Seriously?

It is obvious that lowering the rate of reimbursement for medicaid means that more patients will see fewer doctors who therefore will see each patient for less time or not at all.

For a variety of reasons, the poor are on average sicker and sick longer than the rich. When the medical care is cut, it is not going to be “Robin Hood” style cut from the rich and given to the poor. It is going to be cut for everyone, because more demand is being put into the system, and less supply being supplied.

The number of doctors refusing to see medicare patients, on the ground that they government does not actually pay enough to pay for the service provided, surely must increase.

It is a rule of economics. You cannot keep your cake and eat it, too. There is no such thing as a free lunch. You cannot ration a good without producing a shortage of the good, because rationing forces the resources to seek a more economical use. Rationing produces waste, and waste creates an incentive for resources to move elsewhere, namely to a good or service or field where there is some return or reward for one’s efforts.

The other rule of economics is the Golden Rule: whoever has the gold makes the rules. In other words, the bureaucracy having control of the budget will economize according to its bureaucratic and political priorities, not the individual patient according to his.

Because the patients do not pay, the paymaster decides who gets treated and who does not. This means that, in order to economize (or ration) the health care, death panels will decide whose pain and suffering is worth the return on investment.

The old man needing a hip replacement will be told, since he is soon to die anyway, that his suffering can be tolerated by the bureaucracy, and euthanasia will be gently recommended to him; whereas the liposuction and plastic surgery of younger (and whiter) patients, whose family or faction has more political clout, will get a waiver and be allowed.

Or, if there is public furor over some case like this, then the opposite will take place, and some minorities, like Mexicans or Muslims, will get deferential treatment, whereas other minorities, like Muslim Women or Catholics, will be ignored or excoriated. Which factions get the power to decide where the death panels guillotine falls may change from administration to administration, or as different fads of medical philosophy sweep through the halls of power. One year, the medical system might pay only for aroma therapy or acupuncture, and the next year, it might pay only for homeopathic medicine.

If some technology of x-ray is superseded by a hand held MRI device, and the medical system pays for the old technology and not the new one, what reason will there be to remove the policy that subsides the older tech and hence disincentivizes innovation? I remind you that the Depression Era price supports for milk, which paid certain farmers a subsidy to destroy their milk supplies to create an artificial shortage to drive up the price, are still in place. Your government is diligently spending your tax dollars to fend off a problem which has not existed for seventy-three years.

If that possibility seems remote, what about the possibility of the government, in order to economize on the public costs of health care, demanding all citizens to buy and use contraceptives? The administration does not seem to think it outrageous to force all citizens to buy health insurance policies in the name of public health. What in their logic makes it outrageous to force all citizens to buy condoms in the name of public health? It is a sacrament to them.  The liberals have a fetish about putting a balloon on a man’s dick will stop the spread of AIDS, whereas abstinence from unnatural sexual acts will not.

We have already seen fads of education theory change the schools nationwide and change them again and yet again as the winds blow, and no local school board has the power to teach according to their own local needs and local wisdom. Why would this not happen with medical therapy fads?

What makes you think you can keep your doctor or get to decide how he will treat you?  IF SOMEONE ELSE IS PAYING FOR YOUR LUNCH, YOU DON’T GET TO SEE THE MENU!