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« Opinion
‘Free’ health care was a bad idea from the start
‘Free’ health care was a bad idea from the start
EDITOR:
Thanks for Last Sunday’s article on health benefits, both those for government and private sector employees.
The reality of tax-exempt commercial health insurance is that it was bad product from the moment it was cooked up by 1920s do-gooders. Imagine a benefit that instantly creates three-tier costs of labor, which commercial health insurance does, and that’s just for starters. Strapping a “truncated universal” like Medicare onto commercial health insurance risk pools, which is what Lyndon Johnson and the 89th Congress did, made as much sense as hitching a Ferrari to the Budweiser Clydesdales to get more horsepower.
Trust me, though. No amount of arguing or rhetorical gimmickry will persuade even the best-intended and brightest among our medically insureds there’s something profoundly wrongheaded about the benefits they enjoy at what they mistakenly take to be very little cost to themselves.
On Capitol Hill, the current tortured debate over health care reform makes me think of the course that slavery took from the signing of the Constitution through its abolition by Civil War and subsequent Constitutional amendment.
There was opposition by sentiment, formal arguments in opposition, direct action by such means as the Underground Railroad, Constitutional delimitation of the slave trade, political wrangling and compromise over slavery’s expansion, melioration of the conditions of those held in bondage, the example of England’s emancipation of its slaves, and the manumission by many Americans of their own slaves. Yet, for all the good they did, these incremental measures allowed slavery to become ever more entrenched with cotton agriculture and the Southern patrician lifestyle.
Don’t our senators see something similar with health care? Two-thirds the nation is allowed approximate medical purchasing parity, all of it assisted by massive government intervention, such as enormous direct purchasing and huge tax preferences. Another third is completely ignored, except for the ritual bleating about the medically uninsured, or is corralled into politically vulnerable risk pools such as SCHIP and Medicaid. Is getting health care for sick people a good thing, or not?
How much longer is this expected to go on?
JACK LABUSCH
Niles
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Comments
The current system of government- regulated health care (so-called "private" insurance) coupled with government-run medicine (Medicare, Medicaid, SCHIP, VA, etc.) has created a coverage-driven decision model. "Sure, why not get the MRI, it's covered!"
If instead, we had a free market health care system, decisions would be based on necessity, or a cost-benefit analysis, "I'll get the MRI only if I really need it, and I'll shop around for the radiology center with the best rate!"
A free market health care system would reduce costs by reducing the medical bureacracy (insurance forms, "coders", etc.).
One would pay for non-catastrophic medical care the way you pay for other necessities of life such as food or shelter. Catastrophic medical care (hospitalizations, major surgeries) could be covered by insurance. The premium for the catastrophic coverage would be at a reduced rate because it covers less. Therefore, more people would likely be covered because it would be more affordable.
The flight of providers out of primary care would reverse, as the paperwork would be greatly reduced and their incomes would be controlled by market forces, and not the government.
Of course, there is a Democrat-Socialist fiat that wants to add your health care to the growing list of government owned entities. We must draw the line now before they deny breast cancer treatment for you or your family (ala the NHS).
Nonsocialist,
I think that reducing the pay of primary care doctors through ending insurance in your scenario would do nothing to encourage a physician to enter the field.
I can't understand why doctors bemoan their lack of numbers, yet make sure that thousands of qualified students are turned away from American medical schools every year. This is, frankly, not meant to assure quality, but instead to reduce competition by restricting medical licenses. (Somehow doctors' children always manage to make the cut.)
This policy then forces hospitals to recruit doctors from foreign medical schools, although most patients would prefer a native speaker of English when trying to explain symptoms.
When insurance only covers catastrophic illness, a greater number of patients will skip visits to the doctor's office until a small problem that could have been easily cured becomes catastrophic.
Most of us know people without insurance who have done this. The cases include a mother of one of my students, who died leaving 5 children under the age of 12 with her husband, a man incapable of the task of mothering.
She resisted spending money on abdominal pain, hoping it would go away, and even changed her mind once while waiting in the emergency room. When her husband finally did take her in, she had only hours to live because of an overwhelming abdominal infection.
Education Voter,
I appreciate the feedback.
There is no perfect system. No system can cover all things at little or no cost to the consumer. Just ask the NHS (bankrupt in 2 years) or the US government (CMS bankrupt in 2019). We can only hope for the best system. No matter the system, people will get sick, suffer pain, and die.
Medical schools, like other graduate and undergraduate schools, cannot accept all applicants. I believe that system encourages aspiring clinicians to study harder in order to make the cut. Foreign medical graduates (FMGs) are more prevelant mostly because less US graduates are pursuing primary care because of the paperwork and income so low that paying back medical school loans is difficult.
In a free market health care system, the primary care provider could set their own rates. If they are too high, they'll lose their market share. If they are too low, they'll have difficulty meeting their overhead. In short, it reduces bureacracy and increases patient and provider freedoms alike.
Regarding catastrophic-only coverage, a hospitalization for an overwhelming abdominal infection would be a "catastrophe" and be covered. Since routine outpatient visits for cholesterol checks, etc., wouldn't be covered, the insurance premiums would be lower. How many people are not being covered for catastrophes because their premiums are ~$700/mo. Isn't it better to have hospitalization coverage for say ~$200/mo., and pay for outpatient visits and meds out of pocket? For those out-of pocket expenses, you could find one of the many $4/month prescription plans. If a person is truly indigent, than there are free outpatient clinics available. I hope these clinics survive President Obama's repeal of charitable deductions.
The current system is broken. Dropping a socialist atomic bomb on it sure won't fix anything.
I agree that consumers should pay more of the cost of an office visit out of pocket -- and most are, or are paying higher premiums.
Yes, in the example I gave, my student's mother was covered in her death throes. My point was that she wouldn't have died if she had seen a doctor earlier.
I'm not convinced that the current system of medical school acceptance is based on merit. It also often requires a political effort (more on the part of the parent than the student). Especially in our Ohio medical schools, colleges need funding, legislators can provide that, legislators need campaign contributions, parents can provide that. Of course, some brilliant students will be accepted regardless, but in a choice between equally gifted students one with connections or wealth, one without, who do you think wins? The sad thing is that there would be plenty of work for both.
I do not think that all patients are good at picking the best doctor for the best reasons. So I think insurance companies checking into doctors, and controlling costs gives us some guidance.
By the way, the best care I have had is at the Cleveland Clinic, where doctors are employees, rather than pursuing a profitable private practice.
I will give you this, the age of insurance changed medical practice from a respectable calling to the best paid of businesses. We got a lot of conspicuous consumption from docs and their families, and lost guys who made house calls.
"Sure why not? It's covered!"...you hit the nail on the head with that statement, Nonsocialist. I have been asked multiple times why I don't "just have xyz" done because my family happens to have excellent private health insurance. Why not? Because I don't abuse the system. Going to a doctor, or especially a hospital, is my absolute last resort. I believe that people need to be active participants in their own well-being. Take care of yourself, learn some basic home remedies, and stop expecting your doctor to fix every little twinge or ache. My kids don't see the pediatrician for every little runny nose or fever. It drives me nuts when people show up at emergency rooms with a common cold or flu. Unless they are old and frail, they need to just stay home and deal with it the way people used to-have some tea, go to bed, and wait until it passes. The hospital cannot do anything or give you any drugs to get rid of the flu. Yet these kinds of patients are flooding our emergency rooms, making it hard for people with REAL emergencies to be seen on time, and raising healthcare costs for everyone as well. But like you said, this is the attitude that "free" health care has created.
I think part of this has to do with your background. I'll bet you have a northern European family culture like mine, where you are expected not to whine, and kind of retreat to your own space until you come out better (or die).
My husband, from an Italian background, goes to the doctor for the flu, regardless of having to pay, and even pays for the after-hours places. I think other Mediterranean cultures (Jewish, Spanish) are equally concerned about illness.
Now, I've got to tell you, sometimes he has been right with this attitude, and I should have gone to a doctor, like when a stomach ache is really an ulcer.
Old Fashioned Mama,
I agree with you entirely. The stories are extreme. In Minnesota, people on medical asistance take the "cabulance" to the ER for sinus infections. It's not paid for by the patient, but by the government (ie, us). MA covers all prescriptions fully except for a $1 (yes, that's right) co-pay. I've heard that they often complain about this and ask the ER staff for the $1.
A free market health care system would reward responsible lifestyle choices. If you stay away from the smokes, exercise regularly, and limit the booze, you'd save a ton of money on health care. I know "personal responsiblity" has become synonmous with racist conservatism, but I'm "old fashioned" too, and I too believe in the power of the people.
To underscore the deficits of socialized medicaine further:
www.foxnews.com/search-results/.../healt...
How does it make sense to adopt a universally failed model?
Education Voter-
You guessed it right. My heritage is German and Romanian. We aren't entirely sure where or when my dad's side (the German side) came to America, but I do know that my mom's side (Romanian) came through Ellis Island and their name is on the monument there. My own experience has been a balanced mix of modern and traditional medicine. My mother is an RN and very much believes in the modern healthcare model, and is the one giving me weird looks whenever one of the kids gets a scrape outside and sees me ripping up plantain leaves and rubbing them into their skin. However, my dad and stepmom are the complete opposite and use mainly traditional herbal medicines that they make at home. I have followed more in their path. I grow and gather many native medicinal plants in my own yard and make salves and teas from them. I know, however, when to let the "experts" step in, and I know what illnesses I can and cannot handle at home. My 2 year old had a persistent 105 degree fever for three days this winter. That was a situation out of my control, so we went to the hospital where they could safely deal with it.
I can't imagine anyone complaining about a $1 co-pay. I got a little shock the last time I went to the pharmacy. One of my prescriptions that used to have a $5 co-pay had suddenly jumped to $27. (Thanks for sending me a notice!)