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BLOG: Another point of view
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In my last blog, “Backdoor health care reform,” some of my readers thought I might have revealed a political bias. I like to keep politics and health care separate, but there are occasions where the two subjects end up on a collision course.
In fairness, I have turned to one of my good friends who may have more right-wing bias in his writings on health care issues.
I introduce Dr. Charles Mund to voice his thoughts on the subject. I will share my thoughts on his piece in the comment section of this post. I invite you to weigh in, as well, and perhaps we can generate a healthy discussion:
Charles R. Mund, OD: The insinuation of de minimis, or “backdoor,” health care reform (ie, the reduction of the individual mandate penalty to zero) into the Trump tax reform bill was not the plenary remedy that is needed to address the aliments that plague the American health care system. But neither was the Affordable Care Act, which turned out to be patently unaffordable for millions.
Of course, the Republicans will tell us that Rome wasn’t built in a day and that the 2018 elections will emancipate them from the John McCain “veto” that forced their backdoor approach. Likewise, when the microphones are off, the Democrats will confess that Obamacare was merely a “transitional form” designed to deconstruct the private health care market in order to ultimately supplant it with a socialistic single-payer system.
This begs the larger ideological question: What kind of health care reform will serve us best? A top-down, one-size-fits-all, command-and-control model under the aegis of the same government that administers the VA? Or a bottom-up, market-based model that encourages and empowers patients to become informed health care consumers, a model overseen by a minimally intrusive amount of government regulation, but with a safety net for those who for one reason or another have difficulty accessing the care they need — including the 13 million who will putatively lose their care by 2027?
The significant problems with the socialized Canadian (Fraser Institute) and UK (Bandler) systems and the malpractice recently unearthed at the VA argue that the latter is the better choice. A free market-based health care system, properly constructed, can offer better and accessible care and at a more affordable cost if the right incentives are in place.
What gave rise to the premium and deductible crisis that Obamacare attempted (in vain) to address was the increasing dissociation of the patient from the real cost of health care — a problem rooted in the tethering of employment to health insurance during the Second World War as a means of circumventing government-imposed wage and price controls. And like all government meddling into the private sector economy, there were unintended consequences and costly distortions.
To wit: In addition to the inhibitory effect of an employer-funded health care system on the fluidity of the labor force (ie, “I can’t switch jobs for fear I might lose my coverage.”), as employers footed more and more of the premium bill and negotiated increasingly lower deductibles and co-pays, overutilization — by both patients and practitioners — was inevitable.
“After all, Mrs. Jones, your insurance is paying for this $1,000 MRI, so let’s just go ahead and get it done, to be sure that this headache you’re complaining about isn’t more than the sinus infection I’m 99% certain it represents.”
As optometric practitioners, we have probably at one time or another been presented with splashy and beguiling spreadsheets by ophthalmic salespersons detailing just how many procedures we would need to rack up in order to cover the monthly payment for that expensive piece of technology they want us to buy.
In contrast to the socialistic model, an effective market-based system would need to include the following features:
--The removal of interstate restrictions on the purchase of health insurance. The object of intense political lobbying by the insurance companies, these restrictions erect a floor under their premiums, thereby obviating the need for meaningful competition amongst insurers.
--Prominently posted prices. Requiring all providers and health care venues (doctor’s offices, hospitals, outpatient clinics, etc) to post their prices in full public view would remove the opacity that now separates patients from the actual costs of their care and inform more rational health care spending decisions.
--Cradle-to-grave tax-exempt health savings accounts. An informed patient in control of his or her health care dollars is the prerequisite for a cost-cognizant health care consumer.
--Tort reform. The ambulance-chasing legal lobby that now has the politicians in its back pocket needs to be brought to heel in order to reduce exploitative litigation, prohibitively priced malpractice insurance and wasteful defensive medicine that adds billions to the cost of care.
--The restoration of customized plans, such as high-deductible catastrophic policies, etc, to meet the varying needs of a heterogeneous population. The choice concerning one’s health care is one of the most intimate and significant decisions a person can make. To surrender it to the impersonal will of nanny state elitists is inimical to what it means to live in a free society.
In summary, when insurance companies and providers are forced to compete, when pricing data is made readily available to the public and when people are given control over their health care dollars via expanded health savings accounts, patients will morph into consumers and make more rational, cost-efficient spending decisions. The exquisite free market mechanism of price-discovery will redound to drive costs down and quality up, as providers are suddenly more directly accountable to their patients (clients).
Market-based health care reform will produce a system that is more personal, more affordable and, therefore, more accessible. Enough with the smoke-and-mirrors pricing, the bureaucratic arms-length administrators who decide the particulars of our care (often to our chagrin) and the quid pro quos between the politicians and their various cronies within the health care matrix. All have contributed to the debacle that now besets us. We want transparent “front-door” health care reform that maximizes the purchasing power of our hard-earned dollars, protects our freedom of choice and provides us with the kind of personalized care we really want but will unlikely get from a “socialist” model.
References:
Bandler A. Seven things you need to know about Britain’s failing nationalized health system. Dailywire. https://www.dailywire.com/news/14470/7-things-you-need-know-about-britains-failing-aaron-bandler#exit-modal. Posted March 16, 2017. Accessed January 16, 2018.
Fraser Institute. Leaving Canada for Medical Care, 2016. https://www.fraserinstitute.org/sites/default/files/leaving-canada-for-medical-care-2016-post.pdf. Posted October 2016. Accessed January 16, 2018.
For more information:
Charles R. Mund, OD , practices at Eye Associates LLP in Columbia, Md. He can be reached at:
Disclosure: Mund reported no relevant financial disclosures.