In a comment on “Bash,” “Blonde” asked the question, “What sort of healthcare do you think is desirable for the United States? Certainly not what we have now?”
I was strongly tempted to write, “Everyone should be taxed in order to pay for all the health care I want,” and then use the ensuing discussion to point out the problems with that statement and, by extension, with socialized health insurance. However, that approach relies on people actually reading this, so I’d best be a little more direct.
I think the government should have as little as possible to do with health care beyond enforcing contracts, property rights, truth-in-advertising, and anti-fraud legislation—in short, treat it no differently than any other sector of the economy. I might make an exception for epidemic control, but I’m not sure the government’s especially good at handling that.
That said, here’s a short list of what I think the feds and the states should do regarding health insurance:
Step One: Allow interstate commerce in health insurance. For decades, you could only buy health insurance from companies in your own state, which weakened competition within the industry and put upward pressure on prices. The ability to buy health insurance from anywhere in America would make the industry more competitive and put downward pressure on prices.
Step One has an additional advantage. If health insurance companies could set up shop in any state, then they’d likely flock to the states that have the fewest rules and regulations about what health insurance plans must cover. That may not sound like an advantage, but there are a lot of people out there who have to buy plans that offer coverage they don’t need or want. Step One gives them a greater opportunity to find health insurance plans that cater to their needs.
True story: earlier this week, I had lunch my friend “Lego” and the discussion turned to “ObamaCare” and the need for national health insurance, or for government involvement in healthcare. Lego, a supporter of ObamaCare, lamented that a few years ago he was between jobs and he needed health insurance for himself, his wife, and their newborn son. His best insurance option was a plan with X, Y, and Z for $800 (if I remember correctly) a month. He didn’t need or want Y or Z, and wished he could have bought a plan that only covered X for, say, $300 or $400 a month. I cut him off and told him that state mandates forbade him from doing that. It was an object lesson in irony; I wish more people had seen it happen.
Step Two: Give individuals the same tax incentives to buy health insurance that companies already have. It would have made Lego’s life a lot easier a few years back. Plus, many people would prefer to have their employers pay them the extra wages or salary instead of giving them the company’s health care plan, and then go out and find a plan more suitable to their needs and wants.
Step Three: Eliminate all federal laws and regulations that specifically affect the health care industry. That includes doctors, nurses, insurance companies, pharmaceuticals, designers of medical equipment, emergency responders, etc. It shouldn’t be regulated any more or less heavily than any other industry.
Step Four: Establish a legal distinction between “health insurance” and “health transfer payments.” Why? Because forcing insurance companies to pay for pre-existing conditions is not insurance. It’s a form of “health welfare”; it’s forcing them to give you money from a risk pool that you haven’t paid into. It’s akin to buying fire insurance after your house burns down and then demanding that the company cover your losses. If we recognize and emphasize the difference between the two, if we can separate the two issues, the people can focus more clearly on how to manage them.
Step Five: Phase out Medicaid and/or Medicare. Ultimately they are promises that cannot be kept. Medicaid threatens the long-term fiscal stability of the government more than Medicare does, but neither is sustainable.
Step Six: (This will sound crazy. It isn’t.) States should lower the qualifications to be doctors, allow construction of more medical schools, and review (with an eye towards reduction) the legal distinctions between nurses, nurse practitioners, doctors, and other medical professionals. Why? Simple: it will make more doctors available and put downward pressure on prices. “But the extra doctors won’t be as good!” True, but as with all other products, there are people who prefer to sacrifice quality for price. Furthermore, people would be more likely to visit the “extra” doctors for relatively simple matters, freeing up the more qualified doctors for more complicated matters. There’s greater room for specialization, which is generally positive. Regarding the legal distinctions, consider: How much time, money, effort and life is wasted waiting for an answer or procedure from a doctor when you could get the same answer or procedure from a nurse?
Right about now, an astute reader would note that I didn’t actually offer any solutions. That was deliberate. I believe in Dr. Sowell’s maxim that “There are no solutions, only trade-offs.”
In response to this non-solution, some might ask, “But what about people who face bankruptcy because of high medical bills?” “But what about people with pre-existing conditions?” “But what about people who don’t know how to take care of themselves?”
These are good questions. Here’s my response:
I can’t design and enforce a healthcare program for 310 million Americans that would be more efficient and effective than letting those 310 million Americans—individuals, families, employers, religious groups, private charities, health insurers, doctors, hospitals, etc.—buy, sell, and manage their own healthcare. Neither can Obama, or Pelosi, or Reid, or the staffers who wrote the legislation, or any team of experts. Heck, Romney and his experts couldn’t do it for just 6.5 million people in Massachusetts. Show me socialized healthcare, and I’ll show you inefficiency that brings the entire government closer and closer to bankruptcy.
We didn’t have anything even remotely like national health insurance until 1965—and yet every single statistical indicator of health had been improving throughout our history. It’s only since the advent of Medicaid, Medicare, and greater government involvement in healthcare that the fiscal health of our government, and by extension the entire country, has been threatened. We’ve gotten the same improvements we had before, but at several times the cost.
In short, I think free markets in health care are most desirable for the United States and for any other country. Fire away.