Come for the Politics, Stay for the Pathologies

Sunday, August 2, 2009


If you start with an incorrect premise, I will guarantee that you arrive at an incorrect solution.

For example, health care. Obama started with the premise that our health care system is broken. And no one bothered to question that hypothesis. When in fact, if they had, they would have discovered the obvious: we have the best health care on the planet. Period. Nonpareil.  And it’s not a “system.” There’s no one administrative body that dictates how health care works in this country. That’s what Obama wants to give us. What we have are thousands of individual providers, doctors, nurses, hospitals and insurance companies that charge a fee for their services.

But following the rule that if you say something often enough it will make it true, team Obama (which includes his MSM PR Department) has continued to repeat the lie that our health care system is broken.

It is a lie. From the number of people they claim are without insurance to the implication that they are not insured simply because they can’t afford it, to the contention that millions are denied health care, it’s simply a lie. The truth is that of 307 million Americans, nearly 10 million (conservative estimate) are illegal, another 19 million make over $50k per year and choose not to buy insurance (9 million of them make over $75k), and 14 million are on Medicaid or Medicare. That leaves about 5 million legal, uncovered citizens, or about 2% of the population. That’s a much smaller group than 47 million. And even they are not denied health care. They get in in the local ER, unless they're the victim of a patient dumping scheme.

So why does the President want to blow up our entire health care “system” for 2% of the population? Are you telling me that the geniuses in the Administration can’t figure out a better, more cost effective way to deal with 2% of the population than to undermine everything about our health care that works, and works quite well?

There’s no one who believes that their health care will remain unchanged no matter how many times the anointed one tells us otherwise. Nor does anyone believe that private health insurance and Medicare – that 91% of Americans have, 84% are happy with and 76% want no changes in – will continue unchanged once a “public option” is available and Medicare is gutted for “cost savings.” Apparently ordinary Americans understand economics far better than the White House geniuses. They know that eventually a not-for-profit system will make it impossible for a free market, for-profit health insurance system to maintain itself.

Nor does anyone believe that Medicare benefits aren’t going to be cut. When you start talking about doing seniors a favor by giving them free counseling for “end of life” decisions, only leftist ideologues miss the message that the government doesn’t want to keep spending money on someone who’s old, and going to die anyway.

And positively no one believes that the cost of this huge government takeover of  18% of our economy is going to be “cost neutral.” Please. I know we’re not all Harvard lawyers, thank God, but we know a thing or two about government programs. Beginning with “they’re never cost neutral.”

Yes, there are problems with the delivery of health care. How about we address them specifically, instead of just telling us we have an insurmountable problem that only the government can solve. For one thing, unless it’s an enemy attack that requires our military force, there is no “insurmountable" problem where a government solution would be either my first, second or third choice. Vilify free markets, competition and profit motive all you want, you’re unlikely to find government listed as ‘innovator of the year’ in anyone’s survey.

Yet Obama wants government to give us an omnibus solution to what he considers an intractable problem. All I can say is, how’s that War on Poverty working out for you? Forty five years and counting, and it’s worse than ever. (You doubt me? Please come visit Detroit.)

We don’t need an omnibus plan. We need to identify the individual problems with the health care delivery and insurance and address them one by one. Here’s my list, although I’d be hesitant to turn Congress loose on anything that requires them to read more than a 2 page Cliff note summary before casting their uninformed vote.

  1. Fraud. The Medicare system, run by our esteemed government bureaucracy, is riddled with fraud and has been every year since its inception. This is not as tough as the war on drugs. A few forensic accountants on staff at each medical center might be good start. Good for the economy too. Or possibly just a claims system that would be able to identify doctors who’ve performed 4 colonoscopies on the same patient in the same month. Or that red flags HIV transfusion centers run out of a local pizza parlor. I bet you could find someone in private  industry that could design an anti-fraud system that might work, oh, I don’t know, 150% better than the one in place now.
  2. Tort Reform.  I know the Democrats are going to channel a conniption fit over this. Not based on any legal principles, but because the tort lawyer association is among the largest lobby groups in the country, and they know which side their bread is buttered on. But until you take the Wheel of Fortune and the Lottery Jackpot out of medical malpractice the cost of medical care will continue to escalate with each judgment. As a bonus, if we can figure out how to deal with medical malpractice we can apply it to the rest of the frivolous lawsuits that clog up the courts and line tort lawyers pockets.
  3. Prescription Drugs. Why are they cheaper in Canada and Europe? Because they have omnibus government healthcare there, and the government establishes what they will pay for a medication. Therefore, in order to recoup the costs of development – which are astronomical due to any number of reasons with litigation being one of them – drug companies, both domestic and international, charge much more for drugs in the US where there aren’t price controls. This is not free market, this is not level playing field. Outside the US it’s price collusion, inside the US it’s gouging. It ought to be illegal and Congress should have addressed this years ago.
  4. Insurance. State insurance regulations need to be revised. Groups and individuals should be able to form inter-state risk pools and shop across state lines for insurance coverage which they can’t do now. Pre-existing conditions should not exclude you from buying insurance, albeit at a higher rate in recognition of a realized risk. Or if the government really wants to help, they could subsidize the additional premium. With the exception of Medicare and Medicaid, private medical providers should not be allowed to charge one rate for patients covered by insurance and another, higher rate for patients that have no coverage. And health care insurance portability needs to be made available at a rate comparable to what the employer was paying.
  5. Electronic Records. Team Obama is right about this one. Archaic record systems are not only cumbersome and more costly to maintain, but they are can also be impediments to obtaining proper care. But please, don’t let the public sector handle this.
  6. Tax deductions. Review the structure and carryover of medical reimbursement accounts as well as additional tax deductibility of all medical expenses.
  7. Illegals. Illegals don’t go without health care. They get it in emergency rooms and local hospitals. We don’t deny  critical care to anyone. As long as we allow illegals to use the health care services of our country for free, everyone else’s costs will go up. We need to solve the illegal immigration problem for any number of reasons, but 10 million additional people in the healthcare system is one of them.

In other words, keep the socialized medicine out of my back yard. You can bet Great Britain wishes they had.