Cuckoo Medicine

Robert E. Freer

10/17/2012 12:01:00 AM - Robert E. Freer

“In a humane health care system, as much of the rest of the world has, no one would have to know the arcane minutiae of how to apply for a high risk pool. Everyone would have (coverage) that qualifies you for health care when and where you need it.” — Liz Jacobs, a health care advocate and spokeswoman for the group National Nurses United

Far from Ms. Jacobs’ ideal, much of the rest of the world does not have a health care system at all, humane or not. To most of the world, “a high risk pool” is a large body of water.

Medical care and insurance are commodities, not rights. In the U.S., the privately funded portion of our competitive system is in constant flux as new medicines, new procedures, new cures are found and delivered to the American people. The public portion of this delivery system is over managed, yet chaotic, detached from the everyday realities of medicine on the front lines.

Commodities cost money. The reality is that all parts of the system have costs, and private enterprise is better situated to find those efficiencies that will lead to the lowest cost through competition. A publicly financed system professing responsibility for all runs up against Margaret Thatcher’s truth that ultimately you run out of other people’s money and must stop.

The inevitable accomplishment of such a system is to force a declining quality of care on the public by removing the competitive dynamism that characterizes our mixed system. Left to the forces of the free market, consumers have choices regarding commodities that they purchase. With government interference, and most especially an attempt by government to manage/control an entire industry constituting more than one sixth of the economy, the consumer will be pushed out of the market and left with fewer choices.

Because the risks of failure are universally personal and life altering, medical care, however, is not just another commodity, that is why doctors are required to complete so much medical education, internships, and residency service. That is also why the prime directive of medical practice is: “First, do no harm.”

Medical insurance abuses that fueled the legislative thrust that created a Progressive “cure” is worse than the ailment. We do need improvements in insurance coverage options, but one thing worse than insurance companies dictating treatment is government-controlled insurance companies dictating treatment. The balanced relationship between producer and consumer is rudely interrupted by government bureaucracy. In the case of mandated medical insurance, the patient-doctor relationship is interrupted by the insurance company and the government bureaucracy. No longer is the best treatment for the patient privately agreed to between patient and doctor, but instead is to be dictated by a bureaucratic technocrat and the insurance company that is controlled by the government.

In a free market, if a patient does not receive proper service from an insurance company or the doctor, the patient has other choices. In government-controlled medical and insurance industries, choice is removed. We have just one government enforcing a one-size-fits-all national standard. In effect, quality declines, choices decrease, costs increase, and the entire economy is saddled by astronomical and rapidly increasing debt.

As substantiated by Forbes and National Review, data compiled by the Organization for Economic Co-operation and Development (OECD) confirms that per-capita public-health expenditures of the United States were the third-highest in the world in 2007. For the past thirty years, medical care dollars has increased two percentage points faster than the economy, and it is currently 18% of G.D.P. (Gross Domestic Product). One third of medical costs do nothing to improve patients' health. The government is complicit in this waste, and the American people are accomplices, because they benefit in the short-term from the wasteful system. However, the American consumer is disadvantaged in the long run, because a system as large as a national system is wasteful.

As the Cato Institute puts it, "Government is largely incapable of eliminating wasteful health care spending, because nobody spends other people's money as carefully as they spend their own. Government tax and entitlement policy denies patients ownership of their health care dollars, and strips them of any incentive to control costs." Our profligate national spending on health care is without a reasonably expected result from such Federal intrusion into a private system that works well. Could it be that such federal largesse is in itself a major inflating cause of our cost escalator?

The Obama administration and the Progressive solution is to control costs through rationing, and we know how poorly that works. Using a 15-member Independent Payment Advisory Board, beginning in 2015, the IPAB will determine what treatments and services are covered. Patients and doctors will be stripped of their personal and professional power to decide from among all options for their patients

Disturbingly, the IPAB is empowered to circumvent Congress. Congress chooses 12 of the 15 members and the president chooses the remaining three. Members are confirmed by the Senate. Once the members are seated, their power is secured in six-year terms. The board’s regulations become law after seven months if Congress doesn't officially veto the policies. Ergo, Congress passed a law, Obamacare, that would prohibit them from exercising their Constitutional power to change the law in the future. How many members of Congress are aware of that? That power in the hands of these fifteen is ultimately the power of life or death for patients.

Under a free market system, consumers will benefit from lower costs, because their choices in medical care plans and insurance companies will whittle down costs to meet their needs and financial abilities. The free market filters out wasteful spending, because consumers will ration their own medical care and reap the rewards through healthier minds, bodies, and bank accounts.