What you hear versus what you see.

• Position: Medicaid

The strongest advocate for expanding Medicaid--and the likely source of funding for the massive advertising campaign--is the hospital lobby, maintains G. Keith Smith, cofounder, medical director, and CEO of The Surgery Center of Oklahoma, Oklahoma City.

All we hear, points out Smith, is that hospitals are going broke; they cannot make ends meet; the uninsured are breaking the hospitals' backs from emergency room overutilization; hospitals will not survive unless Medicaid is expanded. (This is the most interesting claim, scoffs Smith, as hospitals simultaneously complain that underpayment by Medicaid justifies their cost-shifting to others.)

These are the obvious lies that primarily are responsible for bringing us ObamaCare--but, if we look around us, what do we see?, Smith asks. Hospitals are building everywhere. They sponsor sports franchises; purchase advertising in high-priced media outlets; ceaselessly are buying up physician practices--and acquiring rural hospitals they destroyed by having purchased all of the small-town physician practices and diverting their referrals. They are expanding their emergency rooms--and even building free-standing emergency rooms, so-called loss leaders for their institutions. They make multi-million dollar "logo" changes. Their administrative staffs are huge and extremely well paid.

Why are patients terrified of becoming uninsured and driven into bankruptcy by medical bills? It is not because of doctor bills. How many physicians have extracted such huge payments from patients as to cause them to lose their homes? It is hospitals that do that and they do it routinely, asserts Smith, who likens hospital administrators to drone operators--destroying people's lives in a remote, impersonal way, while they themselves remain safe in their office.

Economically, hospitals are not unlike utility companies in that they have high fixed costs. As Thomas DiLorenzo explains in Organized Crime: the Unvarnished Truth about Government, once the plant is built and the power lines are present, the cost of adding another utility customer approaches zero. Once the emergency room is built and staffed, the actual cost of an additional patient...