As the numerous Democratic hopefuls for 2020 jockey for position on the far left, we are left to contemplate the consequences of their proposals. Be it free tuition, the Green New Deal, a living wage, or universal income, all are unworkable in their own way. The proposal that seems to be currently most popular with the Democrats in Washington, Medicare for All, remains ill-defined by its backers. Presidential hopeful Senator Kamala Harris has gone so far as to declare that we need to "move on" from private insurance. While the senator may believe government-run health insurance would be fairer, it is more likely to deliver coercion, corruption, and inequality.

Before discussing KamalaCare, we first need to review the effects that a government monopoly over health insurance would have on the delivery of care. Assuming that the senator's plan will operate like Medicare, it is safe to assume the program will be underfunded from inception. This means shortages and the need for the new agency to quickly find a means to ration what health care can be supplied.

Coercion

Given the federal government's obsession with paperless medical records, we can expect KamalaCare to ramp up the data collection by requiring extensive pre-insurance screening from each applicant. This would go beyond BMI calculations, blood pressure readings, and the taking of samples to a full genetic screening for preconditions. All results would be gathered into one's permanent electronic record to be used to determine premiums. These files would be widely shared throughout the system and constantly updated with new information. Every appointment, every trip to the emergency room and every interaction with a MedFed employee documented and costs assessed, for later premium recalculations.

But don't worry about the escalating cost of using your KamalaCare plan -- there will be plenty of opportunities to earn discounts and credits. Since prevention will be the guiding principle, clients will be incentivized to join a support group dedicated to improving their "health outcomes." If your file indicates that you could stand to lose a few pounds, stop smoking, eat less junk food or simply exercise more, there'll be a support group just for you. Simply strap on a permanent monitor and it will record your every move and report back to your certified health advisor. Your advisor will review your progress towards your goals and help guide you and your groupmates towards a healthier tomorrow. Even if the promised discounts for participation never seem to materialize, the intervention and forced discipline alone will make you forever praise a system that's there to help you avoid the doctor.

If you're more the persistent type and simply must see a medical professional about a particular health concern, be ready to endure a multi-layer screening process that'll take weeks to navigate. Those who live outside major congressional districts will be routed through a hub and spoke system of consolidated facilities before arriving at that final destination; a gigantic public hospital possibly hundreds of miles from home. Those actually admitted may wish they hadn't bothered when they discover their federal hospital to be nothing more than a patient warehouse staffed by overworked medical personal doing their best to provide care on an industrial scale.    

Corruption

As with any government-created shortage, individuals will find ways to re-impose market discipline. In KamalaCare, bureaucrats will be ready to smooth the way for those willing slip some money under the table to them. Don't want to pay for insurance you're not using? Then wait until you're really sick then grease the palm of an insider who can get you enrolled with a few quick taps of the keyboard. Need a surgeon or kidney dialysis? No problem, pay off the federal hospital employer who arranges appointments and you'll soon be at the head of the line.

Inequality

While fairness will be the stated intention of KamalaCare, the organization’s patient hierarchy will be nothing of the sort. The elites and their family members (administrators, members of Congress, celebrities, and anyone else deemed important to the well-being of the system) will have first access to the best care everyone else can buy. Residents of important voting districts will be next in line, followed by everyone else, who will end up making do with a pseudo nurse's assessment, a health counselor's encouragement, and a desperate hope that an alternative medical treatment works long enough until the sufferer can get in to see a real medical professional. 

Some few who can afford it will be allowed their own private hospital. Like an exclusive club, participation in these magnificent facilities will be by invitation only and admission by subscription. The highly regulated independents will end up serving as a dumping grounds for a federal system all too eager to shed its least profitable patients. The privates will be tempted to pay off their regulators (cash or treatment) in order to get back to practicing real medicine, even if they have to do so illegally. Ultimately, we'll end up with in a Prohibition-like world, where the wealthy and well-connected get the care they need while the rest overpay for what's left.

Is this an unrealistic vision of the future? Perhaps, but are you willing chance it?

Dr. Tar is the pseudonym of Barry Foltos, Ph.D. Dr. Tar is a regular contributor to iOTW Report and author of the speculative thriller FairPoint, based on the world described in this piece.