March 9, 2017 2 Comments
Dan Mitchel wrote back in 2010
The only way to fix healthcare is to restore the free market. That means going back to a system where people pay out-of-pocket for most healthcare and use insurance to protect against genuine risk and catastrophic expenses. The time has come to reduce the size and scope of government. …Change Medicare into a system based on personal health accounts and shift all means-tested spending to the states. …the flat tax is ideal from a healthcare perspective since it gets rid of the healthcare exclusion in the tax code as part of a shift to a tax system with low rates and no double taxation.
This video, narrated by Julie Borowski for the Center for Freedom and Prosperity, looks at the Obamacare/third-party payer issue.
Yep, and for that matter, back in 2013, I wrote this,
Understand this, 404Care isn’t healthcare, it’s a chance to buy insurance, executed properly, in some alternate universe it might even have been useful. But here, where the sky is blue, it’s not. Why? Because with the limited number of plans available and the narrowness of providers, you’re screwed. You’re screwed, even if your identity doesn’t get stolen, which is likely as well.
Why? Because healthcare is properly defined as having a doctor and/or hospital take care of you when you are sick or injured. Depending on your choices, insurance is a valid way of paying for that (which is required, since Obamacare, before that doctors and hospitals were required to provide minimal, lifesaving care, free, if necessary.) 80 years ago, chickens and/or eggs worked, cash nearly always works, nearly anywhere. The way this is written, since I’m from Nebraska, if I go see Mt. Rushmore, and get food poisoning (because I’m too stupid to refrigerate my potato salad, say) I’d better be tough, cause I ain’t going to see a doctor in South Dakota, unless I have cash, of course.
What all the noise then and now is about is how to pay for it. Medical care in this country is very expensive. Mostly that is so because of bureaucracy, of the government, of the insurance companies, and of the healthcare industry (although to be fair, much of the industry’s bureaucracy is driven by the other two).
In 2010, John Goodman wrote,
Almost everyone believes there is an enormous amount of waste and inefficiency in health care. But why is that? In a normal market, wherever there is waste, entrepreneurs are likely to be in hot pursuit – figuring out ways to profit from its elimination by cost-reducing, quality-enhancing innovations. Why isn’t this happening in health care?
As it turns out, there is a lot of innovation here. But all too often, it’s the wrong kind.
There has been an enormous amount of innovation in the medical marketplace regarding the organization and financing of care. And wherever health insurers are paying the bills (almost 90 percent of the market) it has been of two forms: (1) helping the supply side of the market maximize against third-party reimbursement formulas, or (2) helping the third-party payers minimize what they pay out. Of course, these developments have only a tangential relationship to the quality of care patients receive or its efficient delivery.
The tiny sliver of the market (less than 10 percent) where patients pay out of pocket has also been teeming with entrepreneurial activity. In this area, however, the entrepreneurs have been lowering cost and raising quality – what most of us wish would happen everywhere else. For example:
- There are more than 1,000 walk-in clinics spread across the country today – posting transparent prices and delivering high-quality, low-cost services;
- Whole businesses have been created to provide people with telephone and e-mail consultations because third-party payers wouldn’t pay for them;
- Mail-order pharmaceuticals are a huge and growing market – one which emerged to offer price competition to consumers who buy their drugs out-of-pocket;
- Wal-Mart didn’t introduce the $4-a-month package price for generic drugs in order to do a favor for Blue Cross. It is catering to customers who pay their own way;
- Concierge doctors are also providing patients with innovative services – services that health insurers don’t cover.
Nothing has changed. Except that the GOP has taken ownership of Obamacare, well it might accidently be a little better, but not much. David Harsanyi says this.
First of all, the preferred free-market plan for health care policy should be no plan whatsoever. The idea that we need a federal, top-down strategy to manage a huge chunk of the economy is at the very heart of the problem. We don’t need a federal “plan” for health care any more than we need a federal plan for food or clothing. Yet, Republicans have allowed liberals to frame the entire health insurance debate in these anti-market terms.
So the American Health Care Act is obviously weak tea, falling far short of a promised free-market solution, much less a full “repeal” of Obamacare. It’s a half-measure that endeavors to fix Obamacare with small doses of deregulation while failing to repeal its core. It’s almost as if Republicans were trying to mollify their constituents and save Obamacare at the same time.
Donald Trump tweeted out something about a three-phase rollout, but the specifics of the other two parts have yet to be confirmed as of this writing. Perhaps the full proposal will reflect better on Republicans, although considering the noise moderate senators have been making and Trump’s own views on entitlement programs, it’s unlikely to meet conservative expectations. So what can be done?
In a piece highly critical of the plan, The Washington Examiner’s Philip Klein, who’s done some of the most insightful writing on Obamacare, states: “the GOP will either be passing legislation that rests on the same philosophical premise as Obamacare, or will pass nothing at all, and thus keep Obamacare itself in place.” What if this is the choice?
We know the Democratic Party’s plan for health care: constrain markets to create monopolies that can be controlled by a federal regulatory regime (this is why liberals oppose markets expanding across state lines); and rather than worrying about access, choice, or cost, continue to incentivize the growth of the welfare state. When this situation becomes untenable, pass single-payer. What Democrats understand, but Republicans often don’t, is that you can reach your goals incrementally.
He asks this: “is something better than nothing?”
Perhaps, at the margins, but the basic problem is that the government has been driving healthcare fiscal policy since World War II, and the market distortions are continually getting worse. Swampcare isn’t going to help much, if at all