In the wake of the aborted launch of the U.S. health care overhaul, both the Congress and the usual array of Washington pundits have entangled themselves in a clash of idioms, scouring the trees while missing the forest.  News reports focus on party squabbles, phases of legislation, and items to include or omit while underplaying the visible damage wrought by Obamacare and totally ignoring the long-term consequences of health care by government fiat.

Government-run universal health care is the rule for almost all developed nations, with the U.S. the glaring exception until the shaky advent of Obamacare.  So how is the developed world performing for delivering health care to the public?   Answers remain fuzzy.  Most national health care systems contain large swaths of both satisfied and unsatisfied citizens, and any effort to compare the variety of universal health care systems across the globe has become a meaningless exercise.  Depending on whom you ask and what measures you employ, the United Kingdom is one of the best, but many can't get services, and the U.S. is one of the worst, but hordes of people flock to her shores for treatment.  It makes for an interesting paradox.

The paradox thickens when we set aside the mix of both valid and questionable health care parameters and investigate the foundation of all health care: biomedical research and development.  While the U.S. gets dissed by the international arbiters of what's good for you, the U.S. dramatically outdistances the rest of the world in R&D; about 40% of the world's R&D budget is spent in the U.S.  While the U.S. plays Atlas, supporting the infrastructure of world medicine on her shoulders, the notion that this Olympian effort fails to translate into quality practice strains credibility.

There is an abundance of conversation about the problems of government-run medicine in general and Obamacare in particular, but there is little mention of what would happen if the American Atlas shrugged off support of the medical world, leaving the lion's share of R&D tasks to others.  Half a dozen years of Obamacare has offered up significant clues, all of which revolve around a simple concept: incentive.  The practice of medicine is demanding, requiring four to ten years of rigorous training, depending upon specialty, and the courage to assume responsibility for the welfare, and very lives, of patients.  Personal and professional incentives to assume such challenges must be lofty.

Unfortunately, Obamacare has interfered with the doctor-patient relationship, meddled with compensation, and turned practitioners into data administrators.  Physicians have been running for the exits, retiring early or quitting medicine entirely; others have adapted to Obamacare's bizarre insurance scheme by refusing to accept any insurance at all.  The incentive to remain a physician has been sorely damaged.  What will become of the incentive to enter the field, especially since alternative opportunities in the business world continue to grow in appeal?

The R&D side of the medical equation likewise shows cracks in its foundation.  U.S. total R&D investment grew by 8.3% in 2014 but slowed to 4.6% in 2015.  Someone is tapping on the brakes.  The seismic shock to the system, however, was the medical device excise tax of 2013.  The global gasp from our sister nations was audible.  If the U.S. would handicap its device makers for a handful of beans, what other land mines in the path of progress were lurking in the legislative landscape?  Our sister states might not be able to match U.S. innovation, but when advances become available, they are ready and eager to apply them.  Without U.S. leadership, the world is a medically poorer place.

Our national conversation about government-run health care has serious consequences both at home and beyond our borders.  The pre-Obamacare years of U.S. health care may have been a distorted version of a free-market system, but critical advances in medical arts and sciences flourished.  The advent of the Obamacare version of government intervention has dragged medicine toward stall speed, with alarm bells clanging ominously.

Centralized control of health care mirrors central control of any part of a social economy.  For health care, the incentive for the best and brightest to practice medicine is diminished, and the incentive for collaborative scientists and investors to devote precious time and resources to medical R&D is, likewise, lessened.  Medical advances and their applications are bogged down to a slower pace.

It doesn't take an Einstein to run a simple thought experiment.  At mid-twentieth century – say, 1950-1960 – if the U.S. had joined the majority of the world and opted for government-run health care, how likely would it be that we would be living the gamut of blessing of 2017 medicine?  Slim or none.  Perhaps we would be living 1985-1990 medicine – good by historical standards, but lacking important progress in areas such as genomics and cancer research.

The crusade for equality through centralized authority always yields the same result, for pauper and prince alike.  Everyone gets less.