Government intervention almost always starts with a good idea. It’s a good idea to have clean water. It’s a good idea to have paved roads to get us from place to place. It’s a good idea to pool our resources so that our children can get a quality education. It’s even a good idea if sick people get health care services they need to get well, maintain their health, or live longer lives.
Health care is a complex issue. It would be a good idea if people had access to the services they need in order to stay healthy. It would be good if these services were available to the poor and elderly, with as much access and quality as are available to the rich and young. It would be good if medical interventions were based on established best practices, if necessary treatment information was shared seamlessly between service providers, and if the consumer was given as much information as possible.
Government intervention, by the time it has made it through the legislative and regulatory processes and is brought to bear on the actual problem, is inevitably the most complicated and expensive solution imaginable. In spite of the complexity and expense, the original problem is most often only tangentially addressed. Thomas Sowell put it this way, “It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer ‘universal health care.'”
Many of us have turned to the insurance industry for help. We pay a little per month, and if something terrible happens, they foot the bill. Sounds good in theory, but in practice these are for-profit corporations. They make money if you pay but don’t get sick. They make more money if you pay a higher premium, and they make more money if they pay out fewer claims. They make money by betting that you won’t get sick, and they don’t like losing money by betting on folks who are sick already. Of course it has become more complex than that, but the fundamentals are fairly evident.
Some where along the line, folks in government got the idea that the best way to provide health care services is to make sure that everyone has access to insurance. Medicare and Medicaid have adopted this approach. Obamacare was the government’s latest solution to the problem of healthcare access, but by mixing up the interests of sick people with the interests of the for-profit insurance companies, and by throwing in plenty of government money, the system had immediate problems.
Supply and demand and the “free market” are supposed to control pricing, to some extent. When the demand for health care is increasing due to an aging population, chronic diseases, and poor lifestyle choices, one might expect that the prices would rise. This is in fact the explanation given by the insurance companies, such as Blue Cross Blue Shield. However, when the government props up the industry with guaranteed money, this in turn continues to prop up rising prices. When profits are protected by Uncle Sam, there are no consequences to an insurance company when they keep on cranking up the rates. Another factor behind the overall increase in costs is the high cost of new and specialty medications. This link provides a nice analysis of the costs of treatment for Hepatitis C, for example, and explains that the cost is paid by insurance companies and government services. Again, when profits are protected by access to Uncle Sam’s money, there’s no reason not to increase the prices. Are the pharmaceutical companies entitled to recover costs to develop their product, and to ultimately make a profit? Of course, that’s basic capitalism. On the other hand, a substantial portion of the development cost involves maneuvering through the FDA drug approval process. The cost of the drug is increased because of government intervention (in the name of keeping us safe), and is maintained at a high level because of government funding (in the name of keeping us healthy). In the end are we better off? That’s highly debatable, but it appears to me that the good ideas of safety and health have been hijacked by the government with the result that we end up paying higher prices.
Government has also restricted the supply of medical providers, by requiring licensing for various levels of care. Do you need to be a MD to use a decision tree to get yourself some antibiotics? Must you be a nurse practitioner to get your family something beyond Tylenol? Do you need to be a gastroenterologist to answer a medical question about a colon? The government says you do. By restricting people from accessing medical care themselves, even if that means potentially more risk taken by individuals, the supply of providers remains restricted. Restricted supply means higher prices, every time. We are forced to trade independence and personal responsibility for assurances that the state is “only letting qualified people provide care.”
Consider also the case of a person who is insulin dependent from an early age. Do they need insurance? They’re 100% guaranteed to need insulin, but insurance isn’t supposed to be for things that happen 100% of the time. Would car insurance cover an oil change? No, it is only for unexpected major expenses. Our current system puts access to expected health maintenance under the umbrella of “insurance.” An “annual wellness checkup” is covered. Strep throat treatment, or influenza? Covered, even though these kinds of things may be readily expected. In the diabetic case, not only is routine insulin covered, the patient is considered as having a “pre-existing condition.” He doesn’t need insurance for diabetes, only reliable access to his medication and insurance against catastrophe.
This week saw another Republican effort to repeal and replace Obamacare, as the house passed a bill they’re calling the “American Health Care Act.” Each interest group has gains and losses within the bill, which addresses several of the conservative’s complaints regarding Obamacare. Certain taxes are reduced or eliminated, as is the “individual mandate” requirement that every American must purchase insurance or face a penalty. And what has been the reaction to these changes? Almost everyone is dissatisfied, from industry groups, medical providers, and individual consumer advocacy groups.
Day one of science class starts with the scientific method, and step one has always been “define the problem.” It is to this point that we need to return with regard to health care. Sure, the issue is complex. Granted, there are many divergent interests at stake. But when it comes to the bottom line, the issue has been poorly defined.
“How can we pool our resources to get people access to health care?” is the fundamental question. Such access should be affordable, and I’ve made the case that the rising cost is due primarily to the for-profit nature of the insurance companies we pay for this so-called “service”, due to the availability of guaranteed payments from Uncle Sam, and due to restrictions on providing medical care to ourselves. The true problem won’t be solved until we get the government out of the health care business in all but the extreme cases. If the poorest and sickest need government assisted health care, that seems reasonable. What we need isn’t a “repeal and replace”, what we need is a “retire and rebuild.” Scrap it all, every single word, and start with the problem of health care access. Craft a solution with as little government involvement as possible. Craft a solution where access to a doctor is fundamental, not access to insurance. Craft a solution with less regulatory burden, less licensing, less documentation requirements, where patients can get medications they need without going through the insurance system.
Rebuilding is hard. People will lose services, people may die waiting for a doctor, and people will go broke waiting for a solution. It’s naïve to assume that there’s an easy way out of this mess, but it is also idealistic to assume that the best solutions have already been presented. The government-in-bed-with-insurance solution has been in play for a while now, with the primary result of increased costs. It’s time to try something different, even if the effort is painful in the short term.
When we finally get our opportunity as Texans to separate and rebuild, we will have an opportunity to address the issues of health care as well. Texit, health care reform, tort reform, infrastructure funding, and a host of other issues will be difficult on the re-boot, but progress is always difficult. As the words of Hebrews 12:11-12 remind us, “No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it. Therefore, strengthen your feeble arms and weak knees.” The people of Texas can solve their healthcare and other problems, if we hold to discipline, and if we stop looking to Washington for answers.