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.
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. (283,984)
So, how do you feel about trading goods and services in-kind? How do you feel about hand puppets? How do you feel about rap?
This video will help you answer all these questions. My presentation from Ignite Phoenix 5 : "Use What You Got To Get What You Want."
Rap text :
When I say "Sales Tax" you say "Auuugh!" Sales tax! [Auuugh!] Sales tax! [Auuugh!] When I say "Community," you say "Exchange!" Community! [Exchange!] Community! [Exchange!] Now clap with me... one, two, three, hit it!
Sales tax as a tax is regressive That means to the poor, it's oppressive Money has problems, that's what we say For local commerce, there's a better way! What is it that we propose to do? Let's trade things of real value!
Don't you know we're trading Hard hats for driveway surfaces Web pages for legal services Copywriting for photography Food for books, aiyyo, it's better than money!
Aiyyo I got some carrots! Yo I got some plums! Let's trade together So we both can have some!
Awwww yeah, that's the way that we do Trading goods and services in kind is not for fools! Hahahar! We got it made -- While I got a chance now, let me make this trade!
We're trading in kind, we hope you don't mind now Skills plus goods -- more value than money, hey all right! We get to better know each other When we trade in-kind with one another
Informal or organized, this trade is fly! Don't forget to file your 1099! Community exchange, it rocks the spot Use what you got to get what you want!
This is one I uploaded in 2004. I'd forgotten how excellent it was.
BOOK FORUM Tuesday, December 14, 2004 12:00 PM (Luncheon to Follow) Featuring Judge Andrew P. Napolitano, Senior Judicial Analyst, Fox News, and Author, Constitutional Chaos: What Happens When the Government Breaks Its Own Laws (Nelson Books, 2004); Gene Healy, Senior Editor, Cato Institute, and Editor, Go Directly to Jail: The Criminalization of Almost Everything (Cato Institute, 2004); and moderated by Tim Lynch, Director, Cato's Project on Criminal Justice The Cato Institute
In Constitutional Chaos, Judge Andrew Napolitano maintains that most Americans take their constitutional rights and liberties for granted and are largely ignorant of how the government breaks its own laws and gets away with it.
In Go Directly to Jail, Cato Institute senior editor Gene Healy shows how the government has been criminalizing more and more citizen conduct. With more than 4,000 federal offenses on the statute books and thousands more buried in the Code of Federal Regulations, Healy points out that there are good reasons to be alarmed by the government’s perfectly “legal” restrictions, investigations, and prosecutions.
About 6 months ago, while watching every video on the Ludwig Von Mises youtube channel, I stumbled across a meandering, rambling, unscripted, incendiary, merciless rant by some dude named Peter Schiff.
He is the CEO of Euro-Pacific Capital which, as the name suggests, makes investments anywhere but the USA (heavily in Canada though).
Schiff is born-and-bred libertarian, with his dad (Irwin Schiff) being so awesomely looney that he's actually been in and out of jail for the past 60 years for civil disobedience in the form of not paying federal income taxes. He recently was sent to jail once again, at age 84. He will be there until 2016.
Schiff is far more pragmatic than his father. He reluctantly bows to governmental and social pressures by following laws and recognizing social mores (like not being an aging jailbird struggling hopelessly to slay goliath using a couple books and the constitution).
The latter, in my opinion, is evidenced by him running as a Republican in the Connecticut senate race instead of the obvious and more applicable "Libertarian" moniker.
I. Euro-Pacific Capital
My current mutual fund has adopted a rather unorthodox strategy of measuring a prospective investments growth in terms of the size of the fire that could be stimulated by shoveling my money directly into it. I've decided, therefore, to shift the few dollars I have left to another company and possibly owning stocks directly. I've been following Schiff's public statements on Youtube for the past few months, and was highly entertained by his entrance into the Republican senatorial primary, so I looked up Euro-Pac and found there was a branch office nearby... "Well... why not?"
EPC is a smaller company, so I expected some moderate-rent digs, even though this was the 'rich' side of town.
So I walked into this beautiful, lavish office building with this ultra-hot receptionist at the front desk (and an idle secondary receptionist just adjacent to the primary one, in case one surpassed thermal tolerances and needed to be swapped out). They called the representative down to meet me and as he escorted me through the labyrinth of people and cubicles, I finally asked, "is this all Europac?" "No," he replied "just this part up here." He gestured towards this bundle of much smaller, windowless closet-esque offices ahead of us. I'm down with minimalism, but it was ironic given the lobby with the fembots and whatnot
What first jumped out at me were the items on the desk which were obviously permanent fixtures: calendar, plant, computer, and a copy of Peter Schiff's new book. In fact, though there were not many 'personal items' in the office, among the few were FIVE different books by Peter Schiff, including two duplicate copies. There were no other books on the shelves of the office, as if to say no other book authored by man or ape need be read.
In fact, the first words out of the guy's mouth were "So, where did you hear about Peter?" My reply was "Wait, why would you guess I heard about this place through him?" We kind of chuckled and he responded with "Well that's kind of 'our thing'." ... or something to that effect.
I knew Schiff was a walking advertisement for his own company, but I didn't actually realize his company was his company. It's almost like being a EPC client is like being granted membership into the Peter Schiff Fan Club or maybe even the Cult of Peter.
At several points in the discussion when poking around for different investment ideas, the broker introduced a stock by saying "This is what Peter likes" or "Peter's real big into..."
It was a little aggravating, as you can imagine. Is Peter handling my account personally? Will he call me every month with suggestions and updates? Will he blow me if he accidentally co-mingles my money with his Thai Hooker fund?
Schiff's employees bear striking resemblance to the Oompa Loompas, who practically worshiped the eccentric Willy Wonka and labored as slaves, catering to his every whim... Okay maybe it's not that bad, but if his reps all had orange skin and green hair I think I'd be morally obligated to give him all my money.
All that said, their rates seemed very reasonable apart from their first-ever mutual fund which was hatched about 2 months ago. Said fund is exclusively Chinese stocks, so their excuse was naturally something along the lines of "there are a bunch of fees and exchange difficulties yadda yadda It's freakin China--literally". I suppose that's reasonable explanation, but the fund would have to yield roughly 6% just to overcome the fees.
I have some real trepidations about China. I mean, it's freakin China. I don't know anything about China, and I'm willing to bet a lot of white investors don't either. For the time being I'll wait until it actually has a past-performance to look at.
Euro-Pac does specialize in a lot of strategies I'm leaning towards. They're able to purchase currencies, stocks in essential goods and services, commodities and do it all in foreign denominations immune to American inflation. They don't just do Asia, either; they're big into Australia, New Zealand, Europe, and Canada. The MERK hard currency fund (symbol MERKX) can be accessed through there and it does extremely well.
Even though I have some misgivings, this firm is still my top candidate for my next investment firm. I mean, even if Schiff takes his antics to their logical conclusion and he and his company go all Heaven's Gate on me, I'll still own the stocks so it won't leave me broke.
Update: Apparently Fidelity has some really good international common stock mutual funds as well.
II. Irwin Schiff
I was going to start off trying to persuade you to respect this True American Patriot™ (forgive the hackneyed language, but I use this term sparingly). However, that's really not the way I feel about Irwin Schiff.
Here's the deal as I see it: If you don't think Irwin Schiff is a terrific bad-ass, you're an idiot.
There's really no way around it. This guy recognized that the income tax violates a HANDFUL of the amendments known as "The Bill of Rights." He then devoted his whole life proving not only that to be true, but also that even in the weighty tome that is the personal income tax code, there exists no line that says you actually have to pay it.
Of course, as a practical matter, since everyone believes this to be true, the government doesn't even have to be right.
In one of the many cases against Irwin Schiff, the prosecution and even the judge (carefully selected by the government to see this case) told the jury essentially that even if no particular statute could be found, Irwin Schiff could still be held in violation of it. And they won with that. Because that's how it works.
So to sum up: You may think Irwin is a cooky libertarian nut who has a fetish for prison. However, he's been in and out of jail for DECADES defending the Bill of Rights (albeit futilely). He sacrificed greatly for something he believes in, and that's something that will almost certainly never be said about any of us. By anyone. Ever.
Unless the next recession occurs before the Republican primary, He's F$cked.
I'm not saying it's impossible. I'm saying (again, forgive the cliche) the paradigm has not shifted... yet.
Some are still confused as to whether or not we're out of the woods economically speaking. The economy is THE ONLY issue Schiff could be potentially popular on. When (or if) it becomes well known that we are actually in the middle of a depression, Schiff's record will be a tremendous boon and could propel him to the front.
The problem is time: We had this first recession and the next one is sure to follow. However, will it be deep and alarming enough for people to actually drastically reconsider their political approach? Will it be in time for Schiff to win the Primary? Who knows?
On a happier note, I'm going to talk about prostate cancer.
Prostate cancer is one of many cancers that is actually fairly preventable through changes in lifestyle and such.
Who do you think are least likely to get prostate cancer (other than women, smartass)?
Prostate cancer survivors.
After years of tear-jerking pleas from doctors, cheeseburger binges, and pretending to be an obese couch-ornament, they all at once change their ways. Men who survive prostate cancer tend to change their whole lifestyle after their little 'brush with death', now realizing the full consequences of their actions.
I believe this depression--this 'brush with death'--may actually purge the notions of keynesianism and monetarism from the minds of short-sighted, self-indulgent, opportunistic politicians (and the people that elect them). After decades of printing and borrowing trillions to support decadence and irresponsible non-investments, America will "go on a diet." Either that or we'll meet a horrible f$ckin end; how should I know? Someone call that soothsayer Schiff. (143,234)
You hear people like Ron Paul constantly moaning about the good ol' days when we had a gold standard. The reason for this is not that gold is pretty or magical or any better than counterfeit-resistant pieces of paper; the reason is simply that no matter how much they may want to, government cannot create any more gold.
Of course, if we could trust our government, there would be no need to rely on the finite nature of atoms to keep the purchasing power of our currency constant.
Though the United States had been shying away from the gold standard since the early 1900's, it wasn't until 1971 that Nixon took us completely off it. This basically meant the government was now given free reign over the purchasing power of our currency. Let's take a look at the result of that experiment:
In the 1980's, Ronald Reagan eliminated federally-funded asylums for the insane in the United States. Before that, most of the patients in these facilities didn't develop their condition from some genetic predisposition or unfortunate roll of the dice. Most of the occupants of these asylums actually acquired their condition from drinking too much alcohol.
Obviously we're not talking about some weekend benders here, we're talking men and women who drank far more than they ate for several years or even decades.
Apart from the obvious, the biggest problem with this particular lifestyle choice is not just that the person is deprived of nutrients, it's that alcohol actively destroys several important vitamins. Such vitamins include folic acid, vitamin C, B2 (riboflavin), B6 (pyridoxine), and most important in this case: vitamin B1 (thiamin).
When a person with a history of alcohol abuse enters the ER, one of the first things given is an injection of B1. Thiamin, among other things, is necessary for proper metabolism. Your body has energy, but it can't use it because one of the many linchpins of the complicated chemical pathway is missing. In some cases, a man in a near comatose state will be miraculously revived only a few minutes after repletion of thiamin.
Thiamin does many other things as well. Scarily, many of them have to do with the brain. When that alcoholic woke up on the table in the ER, he woke up with a few less marbles than he had before.
Memory is what separates animal from insect. When a person's memory centers of the brain melt away, so with it goes their humanity. Thiamin, for reasons we don't understand, is essential to those parts of the brain. Having deficiency for any length of time will permanently cripple the capacity to form new memories. Old memories are polluted and cannot be recalled properly. Fantastic but meaningless gibberish replaces what used to be a human's mental voice. This is called Korsakoff syndrome, and unfortunately it is common.
All this is well known. What is not well known is why it is that alcohol manufacturers don't fortify their beverages with thiamin. It would not affect flavor, and the cost would be miniscule. As with any obvious idea, someone's already thought of it. In this case, it was the alcohol manufacturers.
At one point, many alcohol makers were actually considering adding thiamin to their products. This would have a benign effect on sales and costs, but could save tens of thousands from debilitating illness. What they decided--or rather what was decided for them--is that they couldn't afford to do so.
It was posited that adding thiamin to alcoholic beverages could potentially lead to alcohol being taken out from under the umbrella of the relatively impotent Alcohol & Tobacco Tax and Trade Bureau and it being placed under the jurisdiction of the FDA. This would mean alcohol would have to be treated and regulated as if it were a food (or worse: a drug), which carries with it expensive and pointless changes to facilities, licensing, marketing, and retail sales.
There is a small island of unregulated anarchy the alcohol industry lives on, and they can't afford to swim away to better land for fear of the sharks.
It's sick and wrong, but nonetheless it is less discomforting to know that a man is dying based on the path he has chosen for himself rather than the cards he's been dealt. However, when his pain and suffering (and that of his family) could have been averted so easily, it still makes sense to want to find out why it wasn't. (112,628)
This is a draft I posted to reddit that seemed to go over pretty well, so I decided to post it here. ----------------------- I am a 3rd year medical student seeing patients about 50 hours a week. I am also a libertarian. The news these days, as you can imagine, has been a bit of a distraction.
Back to Reality
With health care, the first thing you have to accept is that there is literally not enough wealth on the planet to give everyone the best and most convenient healthcare possible. There is medical technology out there so advanced and on the bleeding edge it makes NASA look like a 7th grade science class.
Even if we had the money, there are other things we'd much rather be spending our money on than our health. It ends up the case that health care can never be cheap enough, fast enough, or good enough.
Think of it this way--The following is what I want from my health care:
* Fast * Effective * Cheap
Now pick two.
What We Get For Our Money
People look at this system and say that it's way too expensive--that it's bleeding money from every orifice and needs to be patched up by government.
People use life expectancy as evidence for this. Since we're not number 1 (or even number 10), surely this means that our system's results are inferior.
However, using life-span as a measurement of health care is wrong.
Americans, as we all know, are fat. Only about 1/3 of Americans are not fat. Moreover, 1/3 of Americans are not only fat but obese. This fact alone has some huge effects on health care costs, but when you factor in the general lack of health in America due to lack of diet moderation, exercise, and weight control, that's when things get a little heavy (pun intended. deal).
Complications from weight excess, bad diet, and exercise deficiency dwarf even tobacco in morbidity and mortality by several fold. Heart disease is the number 1 cause of death, 8% of Americans have diabetes (+90% of which is type 2), CVA and stroke are up there too. Not to mention the fact that nearly all cancers have increased morbidity and mortality in the obese. This lack of self-maintenance of health has cascading effects on nearly every biological process in the body.
Death is cheap. If people would simply just up-and-die from every heart attack or diabetes exacerbation, it'd save the system a lot of money. However, as our life-expectancy indicates, people don't die from these diseases much in our country. Only a few years of life span is shaved off our average. This is an amazing feat: to actually bolster our abysmal lifespan with the might of our economy.
When people point out that 15% of our GDP is spent on healthcare, I'm actually surprised at how little that is.
Nothing would make me happier than to tell you that just removing profit from the insurance companies would make things cheap. I'm a libertarian, but I'd support it if it were just that simple a sacrifice. The problem is, that's totally wrong.
You would be hard-pressed to find a medical insurer in the US that makes more than 7% net income. Up until the past few years, 5% was an astronomical profit and insurers were hovering at cost.
People like to blame insurance companies for the high cost of care. Would cutting 7% off your medical bills be all that earth-shattering?
In a recent interview with Bill Moyers, one former executive at Cigna stated the hideous practice of trying to disqualify high-cost beneficiaries by technical flaws in their paperwork. Indeed they did do that, but it doesn't actually happen that often.
People decrying our system seem to think that nobody with an expensive and potentially deadly disease gets healthcare. If that were true, my health insurance as a fit, healthy young student with no prior conditions wouldn't be $2,000 a year. More than enough people dying of horrific diseases in this country are covered. I know, some of them are my patients and family members.
Insurance companies pay 97% of all claims. (by the way: Many of those claims are made with the health care practitioner knowing full well that they wont be reimbursed, but do so anyway)
HMO Vs PPO
If you saw Michael Moore's Sicko, you know about HMOs. One of the not-so-subtle implications of Mr Moore's movie is that insurance companies to this day still manage care. He even took footage from 10-year-old congressional committee meetings that made a convincing case against managed care.
The problem with this is: we don't have managed care anymore, and we haven't for some time now.
You can look up the "HMO Act" yourself, but basically this act of congress under Nixon made HMOs the standard of American care until it expired in the mid 1990's. HMOs fell by the wayside and PPOs took over. That, combined with a decline in healthy lifestyle, is why health care costs skyrocketed.
HMOs (AKA Managed Care) basically tells doctors straight away which procedures are allowed to be used for each set of symptoms. If you have a cough, you may be able to get a chest x-ray, but you can't get a kidney function test (even though you can have kidney ailments that are involved with cough, they're just rare).
If you had a devastating illness, HMOs did an okay job of covering you most of the time. It's by no means perfect, but remember: it was cheap!
The HMO tells you which doctor you can see (the doctor had to agree to work under the plan), and tells the doctor what they're permitted to do.
In contrast, if you come to a doctor's office with a PPO backing you, it's basically a free-for-all.
One thing I will say for HMOs is that they were cheap, and they provided most of what you want out of a health care plan.
Since the advent of PPOs, it has become very hard to even find a company willing to sell you a HMO plan. When you find a plan, you have to jump through several hoops to qualify. However, even now, HMO's usually cost 30-40% less.
Because HMO's so tightly managed care, they became vehemently opposed by Americans. When the HMO Act came up for renewal, it was voted down by congress and lead to the extinction of the practice.
HMOs Vs Single Payer
Single payer systems are managed care, by definition.
The single payer manages what physicians can do for their patients, puts conditions on care (eg "Quit smoking if you want your arteries fixed"), and sets prices.
When countries allow the single payer to compete with private insurers, some patients and doctors choose not to participate in the single payer program at all. This is why many systems do not allow private competition.
Latest Health Care Plan By Obama Et Al
As far as I can tell, the new health care bill on the table now is going to make it illegal to not have healthcare.
Even if I weren't a libertarian, I'd probably still say that forcing people to buy health insurance is about the most fascist thing this government has done in a long time.
More Health Care = Less Personal Responsibility ?
It's no coincidence that the people who put the least amount of effort into maintaining their health are usually those who have the best healthcare.
I know libertarians are up in arms over medicare, but the fact remains that these patients get superb care. There's a reason why the medicare program is on a rocket-sled to bankruptcy, and it's not that they pay out too little. Medicare pays more per capita than any socialist system in the world. They get everything they want from motorized chairs to unnecessary joint replacements. No private or public managed care system hold a candle to Medicare.
It's true that there's a lot of red tape and that doctors routinely get paid less (or are unexpectedly denied payment)--a lot more than a PPO. However, recipients still live like kings on the plan.
It's no wonder, therefore, that the obesity rate in the elderly is higher than any other demographic, with a close second being the poor (who get coverage under Medicaid).
Yes, it's harder to take care of yourself when you're old, but it's a mistake to think that these people are incapable of diet and even a modicum of exercise. Proof of this is simply by comparing our elderly obesity rates to those of other countries.
It really doesn't matter who pays for it, having a lot of health care makes you lazy about your health. The government directly subsidizes the poor and the elderly, but employer-provided health care is also indirectly subsidized. Basically, government made it more lucrative to both sides to give more reimbursement in the form of health insurance than wages. Just like with wages, employee health care reduces profit, which reduces corporate tax. In addition, it is currently untaxed by the labor tax (aka the personal income tax), nor is it taxed by FICA or Social Security. In fact, employers didn't start providing employee care until government started heavily taxing other forms of employee reimbursement (wages).
As a libertarian, I'm mortified by the prospect of government manipulating care. However, as a future physician, I can't shake the feeling that maybe having managed care will bring back personal responsibility for health in the US.
It's very conflicting, but in the end, you just can't argue in favor of slavery, even if it will make people safer from themselves. (152,684)