Health-Care Truths and Consequences : The sales pitch from Washington will sound promising, but it won’t deliver.

The health-care debate is becoming ever more encrusted with lies. And, contrary to the Clinton Administration’s rhetoric, most of the lies aren’t coming from insurance-industry commercials.

Before the politicians undertake an overhaul of the health-care industry, they owe the American people the courtesy of telling us the truth. They can start with the following:

Truth No. 1: A “trigger” is a mandate. Meet Washington’s favorite lie: that doing something under threat of legal sanctions is doing it voluntarily. Thus, we get “voluntary” quotas on Japanese auto imports, “voluntary” labeling of music albums and TV programs and “voluntary” price controls. Now, instead of voting for explicit mandates, some congressional “moderates” want a mandatory system that will automatically take effect if 96% of the population doesn’t have insurance by 2000. It’s a buck-passing trick that seriously underestimates the public’s intelligence.

Truth No. 2: “Universal coverage” is a tax on youth. He may be our first MTV President, but Bill Clinton is no friend of Generation X. It is true, as he and the First Lady often remark, that uninsured young people who unexpectedly need expensive medical care may pass the cost of that care onto someone else. It is also true, in many cases, that the someone else is their family, not the general public. In forgoing insurance, young, healthy people are making a rational calculation; they are in fact very unlikely to need medical attention they can’t cover out of their paychecks.

Mandatory insurance may solve the free-rider problem but it also will impose a substantial tax on young people who aren’t earning much to begin with, who already pay huge Social Security and Medicare taxes and who haven’t had time to accumulate the assets that cushion even low-income older workers. An honest approach to mandatory insurance would match this new tax with a cut in Social Security and Medicare taxes on young workers. After all, if stamping out free riders is the goal, why are young people footing the medical bills for the over-65 crowd?

Truth No. 3: Expanding health insurance means expanding health-care spending. The President says giving everyone health insurance “goes to the heart of whether we can get our own economic house in order.” Clinton sees national health insurance as a way to cut the monstrous cost of Medicare and Medicaid. He is seriously deluded.

From 1971 to 1990, government health-care spending went up more than 2 1/2 times faster than private spending--and for good reason. When you tell people something is free, they demand more of it. A graph of U.S. health-care spending shows a huge jump when Medicare kicks in. We can expect a similar spike if “universal coverage” becomes law. Remember, in 1965 it was estimated that Medicare would cost $12 billion by 1990, allowing for inflation. It actually cost nearly 10 times that much.

Truth No. 4: Cutting costs and imposing controls means stopping technological progress. What we want, ultimately, is what might be called “Star Trek” medicine--the ability to look inside the body and mend problems without traumatic surgery. Medicine is moving in that direction. But government-controlled health-care systems tend to impose uniformity, stamping out innovation. And health economists generally agree that new technology is the biggest factor driving up costs. If we’re all footing the bill, the easiest decision is that newfangled ideas are too expensive. And if the American market goes, the whole world will suffer.

Truth No. 5: There’s no such thing as “universal coverage.” Every health-care system provides medical attention to some patients and denies it to others. A Clinton-style system would limit care not by the ability to pay (or to find someone else willing to foot the bill) but by a political judgment of the patient’s worthiness, including the urgency of the need, the expense of the treatment, the likelihood of a positive outcome and the effectiveness of the relevant lobbyists. When Oregon decrees that its Medicaid program won’t cover doctor’s-office visits for the common cold, it is making a rationally justifiable decision. But it is not offering “universal coverage.” There is no such thing as a free doctor visit. That’s one truth you won’t hear on Capitol Hill.