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Best Of Latewire The Healthcare Disaster and Why Obamacare Will Make It Worse

Daniel Roe
Poster: Daniel Roe @ Wed Dec 23, 2009 10:11 am

As I've stated before, I'm a libertarian and a medical student currently seeing patients in the field. As such, I'm uniquely annoyed by all the goings-on in DC lately. I'm sure most people reading this think it's all over--that the socialists/corporatists in power have "won" and that there's no use even talking about it anymore. Of course if we've learned anything from these systems of central planning, we know that eventually, they all fall down. If the current health bill passes, it's likely to actually make our unsustainable system even worse for all the same reasons it's currently failing (which this article is about). The debate is not over, it's just been put on hold for a few years--until the government's new plans to screw up their mess even further can come into fruition.

I propose a different approach: not more government, but less government. Then there's the obligatory argument about the number of uninsured being "too high." I posit that the best way to reduce that number is to make healthcare less expensive and more accessible rather than just accept the huge costs and setup government programs to cover it. The easiest and most effective way to reduce prices is the free market.

84% of Americans already have some form of health insurance. If the free market were allowed to reduce costs by say, 30%, how would that "84%" figure grow?

Our system fits the classic Harry Browne line, "Government is good at one thing: It knows how to break your legs, hand you a crutch, and say, 'See, if it weren't for the government, you wouldn't be able to walk.'" The Government is responsible for the high cost of healthcare and therefore the high number of uninsured, and the only way to fix their mess is to get them to stop doing what they're doing.

I know many people reading this will say "but we already have a free market, and clearly it's expensive and ineffective!" Of course, those same people really don't know what a "free market" is--that is, a market where the government does not regulate, subsidize, or fix prices. Our medical system, though not outright socialist or fascist, is about as close to capitalism as the Titanic is from docking in New York.

Most people don't understand how cheaply healthcare could be done if we allowed the industry to evolve like other industries. Many of the things we as doctors do require equipment and drugs that are either cheaper than dirt or have alternatives that are. The high cost of doctors' time could be supplanted in most cases by trained nurses or even the injured/sick individual themselves. The folly of those who don't see this is a failure of imagination. Rest assured, however, Medicine is no different from other industries (eg Unlicensed individuals service their own cars all the time, and most medical procedures are far less dangerous or could at least be made that way by the demand to do so). Given the opportunity to evolve, quality care would be as ubiquitous as color televisions

I imagine a country where an uninsured person living in poverty will be diagnosed with cancer, and even the most bleeding-heart socialist will unsympathetically say "Well why the hell didn't you buy health insurance? It's cheaper than your smoking habit. Here's $10, go get some chemotherapy"

Indirect Health Care Subsidies - Tax Incentives

59% of Americans with health care receive it through their employer. The reason the employer does this is because the government taxes cash reimbursement (wages) not only through the Federal Income Tax (Median ~20%), but also Unemployment (6%), Medicare (6%), and Social Security taxes (12%). Paying for employee healthcare incurs none of these taxes. Therefore, the government is effectively partially paying for employee healthcare by so heavily taxing other forms of compensation.

This is an indirect subsidy which, again raises prices universally. In addition, like the direct subsidy, recipients of this care will use much more of it because they are not responsible for paying the premiums. (* See explanation below)

The way to end this is more complicated than ending a direct subsidy--if we continue taxing wages**, we must then start to tax all forms of employee compensation, including health care. This would start to push people towards paying their premiums directly instead of getting insurance through their employer. Sounds like a bad thing, but theoretically you could reduce the federal income tax (and other wage taxes) to match the massive influx of revenue generated by this tax.

Also, remember that "15% of Americans are uninsured" statistic? Well 1/3 to 1/2 of all people currently uninsured are uninsured because they're in between jobs that provided them with insurance. If they paid for their insurance themselves, they'd have it now. Therefore, we could eliminate the number of uninsured by 33-50% almost immediately by simply transferring the employer's policy to the employee. Eliminating the tax incentive to do otherwise would certainly fix the problem.

** Optimally, we would tax neither wages nor other forms of compensation, but that's even more of a pipe dream than any of the other things I've mentioned.

Direct Health Care Subsidies - Medicare & Medicaid

28% of Americans with health insurance have it totally paid for by the government. This is an obvious subsidy and leads to higher prices for those who do not enjoy this subsidy. Moreover, recipients of this care will use much more of it because they are not responsible for paying the premiums. (* See explanation below)

Indirect Governmentally Managed Care - Tort

This argument you've surely heard before: Health Care Providers change their care to accommodate an altered risk/benefit ratio strictly because they're afraid of getting sued. It's unknown how much this actually contributes to costs, but there are a few studies that show it being greater than 25%. That's not including the change in the culture of medicine, which may actually bring quality down in the end.

Several states have started implementing tort reform and not surprisingly it's been a complete success.

Direct Governmentally Managed Care - Health Care Regulations

Americans are universally turned off by managed care, yet they are inexplicably in favor of Government managing their care through regulations.

Health Care is one of the most regulated industries in the United States. From compulsory licensing of physicians to the drug approval process, the market is mired in government ineptitude, sloth, and corruption. Nearly every step of patient care is delivered exactly according to government edicts.

Giving people a choice between licensed and unlicensed physicians (for instance, allowing a nurse to write prescriptions and perform simple procedures without a doctor) would drastically reduce costs and therefore insurance premiums.

In addition, giving people a chance to buy drugs that haven't been through the FDA's 12-year process would save thousands of lives and allow the market to find better and faster ways of ensuring drug safety. Meanwhile, the actual FDA could be privatized and run by Ralph Nader (or some other ostensibly incorruptible person) and its approval being available for people who are untrusting of drug companies.

* 3rd Party Payer - The Bugbear of Subsidy

73% of all Americans (87% of the insured) not only receive a government subsidy for care (directly or indirectly) but are also not responsible for paying their own premiums. This is the biggest reason prices are rising both through the indifference and profligacy of the recipients (nobody "shops around" for care before they get it) as well as recipients actually taking worse care of themselves as they are not responsible for the bills that come of it.

For instance, if a private insurance company were to give breaks for people who ate right and exercised, this would start a trend that may even fix America's obesity problem. It sounds far-fetched, but that's only because you have no idea how much the actuarial tables would change for a healthy population as opposed to ours (with 1/3 of Americans being overweight and another 1/3 obese). The premiums for these "fit" people, especially in their later years, would be halved.

The current incentive structure encourages the opposite--if you're not fat, you're not getting your money's worth for healthcare. After all, by taxation or reduction in cash wages, you are paying the premiums to be fat whether you want/need to or not. It could be that our "good" healthcare is what's killing us.

The Current Healthcare Bill (Dec 23, '09) Is More of the Same

The current healthcare bill will expand all of the problems with American healthcare--direct subsidy, indirect subsidy, direct regulation, and indirect regulation:

  • Direct Subsidy - This bill mandates that everyone pay a private corporation for healthcare. In addition, it increases Medicaid and pays for private health insurance for people who 'can't afford it'. I thought they called this Fascism. It'll be interesting to see how they determine who gets paid and who doesn't--who draws the line between 'fully paid' and 'forced into poverty by paying obscene premiums'.

  • Indirect Subsidy - This bill gives money to [small?] businesses who can't afford to provide healthcare to their employees. Government giving money to private corporations... I couldn't fathom how corruption could ensue!

  • Direct Regulation - This bill adds at least a thousand pages of healthcare regulation, especially on insurance companies. Insurance companies make a tiny profit margin as it is. Take it away, you don't increase competition, you bankrupt competition. Many think this new bill will be a boon to insurance companies because of the compulsory addition of 30+million new customers. I'd advise those who believe this to look at the remaining 1,000+ pages of the bill and see if that makes you want to start an insurance company.

  • Indirect Regulation - This bill will serve to undo some of what little tort reform there's been on the state level. It does this by penalizing states with liability caps. It shouldn't surprise anyone that this is the exact opposite of what we were promised. It looks like the #1 contributor to the Democratic party got their money's worth.

Trial and Error

Milton Friedman was always railing against 'central planning' for its inherent immorality. However, he also said that we were lucky in that these systems had the added detriment of inevitable failure. Our healthcare system is like Frankenstein--sewn together from all manner of dead and dysfunctional parts, then artificially reanimated and left to run amok. Eventually, the people will grow wary of its rampage and destroy it. The question is: how many people will die in the interim.

Keywords: Healthcare  Medicare  Medicaid  Obamacare  Libertarian  Snakes  Socialism  Fascism  Obama 
Comments: 3  •  Post Comment  •  Share Share Top
Hank Wed Dec 23, 2009 6:37 pm
I was mauled by a bugbear and my face transplant was paid for by Medicaid
Hank Wed Dec 23, 2009 6:38 pm
Ever notice how "Medicaid" almost has th' word "AIDS" in it?
Daniel Roe Thu Dec 24, 2009 11:08 pm
Few people realize that the original goal of medicaid was actually to infect poor people with AIDS.

They figured they could kill far more the other way.
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Bio: Daniel Roe
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Daniel is Medical Resident from the southwest US. Prior to medicine, he worked in IT as a consultant, programmer, web designer/developer, and technician.

Health, music, economics, libertarianism, computers

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