Now that Obamacare has gotten off to such an ignominious start, people are looking at tax increases. The economy is being hit hard. Companies are laying off workers or cutting back their hours to avoid the penalties for not providing a government-sanctioned insurance policy. Many people think these are small problems in comparison to all the good that the new legislation will bring about. After all, it is named the “Affordable Care Act.” Who could be against affordable care? Actually, a look into the history of health care in America shows that we can expect nothing but a worsening of our current problems as a result of this legislation.
If we want to fix the problems of high cost, long waiting times, and lack of customer-friendly service such as thorough care and house calls, then we have to identify what caused those problems to occur in the first place. If we just apply more of the same kind of pressures that have led to our current problems, then we will find our problems getting worse, not better. That is exactly what Obamacare is doing.
This book is not so much a dissection of Obamacare as it is an examination of the historical forces that have led us to this situation over many decades. It does discuss Obamacare, but that is actually a small part of the book. I will not be recommending a restructuring of government programs controlling healthcare. I will not be advocating some sort of “Obamacare-lite” alternative. I suggest removing the root causes of our problems, by reinstituting freedom in this country.
Freedom works. It has brought prosperity everywhere it has been tried. This has been proven time and time again. Freedom works in health care – this has also been proven. There are many examples of free market medical practices, including my own. These practices bring affordable health care to people of modest means, while providing thorough, personal service. Freedom means non-interference by outside forces in our transactions and pursuits. When it comes to bringing goods and services to ordinary people, freedom works.
I was board certified in family practice in 2003, after completing a Duke University family practice residency, following medical school. I have turned away from the typical modern medical practice model in which somebody besides the patient pays the majority of the bill. I practice as closely to free market principles as is possible in America today. My patients pay me in full at the time of service. This results in cutting fees and improving service drastically. I even offer housecalls.
I fully understand the way supporters of “universal coverage” think. I used to be one of them. I will now outline their views before I proceed to thoroughly debunk them.
Many people say we have to institute universal health care, or socialized medicine, in America, because it is the only way to help the less fortunate get the health care they need. Our technological advancement has outpaced our ability to pay for such care. We all need to contribute, for the greater good of society. These advocates of socialized medicine say that with government running things, our administrative costs will be much less, resulting in more of the money going to actual care. This is proven, they say, in countries like Canada, where a smaller percentage of their national income is spent on health care. Canadians spend less while they get more.
Here in America, as the story goes, the insured subsidize the care of the uninsured. People without insurance go to emergency departments for care. This ends up costing more than if they went to an outpatient clinic. They do not pay their bills, and the insured end up paying for these higher costs.
Everybody is said to have health care in the government-run systems, as opposed to the 40 to 50 million Americans without access to care. Longevity is better in the socialized systems. Infant mortality is better. The United States is the only country in the developed world that has not progressed to a government-run health care system. Enlightened people throughout the world have moved forward to these systems, while Americans are still trying to hold onto free markets. This is an obsolete way of thinking Americans have.
According to this philosophy, free market capitalism has been given its chance, right here in America, and it has been shown to be a failure. We have no system. We just have a patchwork of different government programs and capitalist players, leaving many holes in the pattern for people to slip through. We are spending way too much and getting too little for our money.
It is widely proclaimed that everybody has a right to health care. It is one of the fundamental rights of human existence. As a society, we have an ethical responsibility to ensure that right to all members of society, no matter what their material situation. With government-run medicine, access will be guaranteed to all Americans. There will be no haves and have-nots, like there are now.
I used to think that way too, when I began medical school. I even argued for socialized medicine while I was applying to medical school, during an interview with the school president, who was a staunch supporter of free markets. I wanted to finish my training and go to work for a state-subsidized indigent care clinic.
Most of the academic leaders teach these same philosophies. In medical school, we even had a one-hour lecture given by a member of some socialized medicine advocacy group, entirely devoted to pushing the cause. I was completely in agreement. We never had even a portion of a lecture devoted to the merits of free market principles in health care.
I soon came to realize the arguments for socialized medicine simply do not hold up to reality. I saw the results of our government programs, and what they did to the people whom they were supposed to be helping. This experience caused a profound change in my viewpoint. By the time I finished my training, I had evolved from a big-government socialist into a pro-constitution supporter of freedom.
There are points on which agreement can be reached between a supporter of government control and a supporter of free markets. Our goals are often the same, but we would use entirely different methods to achieve these goals. We often see the problems as being the same, for example, unaffordability and poor service.
We need to examine the causes of these problems, however, if we are to find solutions that will work. We need to figure out what incentives apply to different people. Doctors, patients, hospital administrators, insurance company executives, medical equipment producers, and pharmaceutical manufacturers all respond to incentives much more than they respond to the intentions of policy makers, no matter how good the stated intentions might be.
This book will bring these incentives into the light of day, in a way that is easy for anybody to understand. It is thoroughly documented, from reliable sources, most of which can be easily verified by anybody with Internet access. As we will see, we do not have a free market in American medicine. We have not had one for many decades. We have government interventions into every aspect of health care. These interventions completely distort the free market, with incentives that directly cause the problems we see today.
While increasing technology drives cost down and satisfaction up in other sectors of the economy, in health care, technology drives prices up, because somebody besides the patient is paying the bill. Cost is disconnected from the consumer, more than it is in most developed countries, even in the ones that are usually considered to have socialized medicine.
In free markets, business leaders bend over backwards to please the customer. They constantly work to achieve low prices, high quality, and good service. They do this to keep the customers coming. They know if they do not, their customers will go elsewhere. In health care, the patient is not the customer. The customer of the doctor is usually the insurance company. The customer of the insurance company is usually the employer. There is little reason for anybody involved to bend over backwards to please the patient.
What we have in America is not a free market economy in health care, but a semi-socialized system. It is a system of third party payment, caused by tax incentives. It is a heavily regulated, centrally controlled economy. It is controlled through the Medicare and Medicaid programs, and the regulations that they have initiated which have then spread throughout the insurance industry.
It is a system wherein government permission is needed to buy medications, to sell medications, or to practice a trade in health care. Physician supply is controlled. The types of insurance policies that can be sold are heavily regulated by the state. A doctor needs government permission to perform simple laboratory tests. There are many more types of regulations that strangle the efficiency of health care delivery.
Litigation has become a plague on every doctor, and indeed on everybody who produces and contributes to American society. This is the result of a deliberate effort on the part of legal theorists for the past several decades. Our system of civil law has changed from one in which blameworthy conduct was punished, into one in which losses are redistributed as a matter of social justice. Practicing a trade with extreme diligence and care, to avoid mistakes, does not protect one from lawsuits. This pushes costs up and drives doctors away from the practice of medicine.
Privacy of medical records has been abolished by recent legislation from Washington. Fraud has become a problem when a distant third party is paying the bill, and the effort to detect fraud is perhaps even more costly than the fraud itself.
The economic impact of these problems extends far beyond just health care. Its contribution to our national debt is enormous. Our long-term national debt has reached staggering proportions. It has already gotten beyond our ability to pay, and Medicare comprises the majority of that debt. It is mathematically certain that if we continue on our current course, health care will bankrupt our country.
High fees, difficulty finding thorough care when and where we need it, and high cost of medications are all problems that have resulted from a lack of free markets in American medical care. Many people simply cannot afford the health care they need.
Other, more heavily socialized nations, face an even more dire economic future. Shortages that would shock the sensibilities of ordinary Americans are just a part of life in those countries. Government-run medicine is causing drastic hardship in Canada, Great Britain, and every other nation where it has been tried. People in the lower economic classes are harmed the most, because they do not have the resources to flee their countries to find care.
The solutions to our problems have to be based on correcting the causes that led to those problems. If we just apply more of the same incentives that led to the problems, we can only expect the problems to get worse. Removing the incentives will correct the problems. We can have the same kind of prosperity in health care that we have in other areas of our economy. We just need to see why those areas are prosperous, and apply the same principles to health care.
Obamacare is an attempt to fix the problems that have been directly caused by government interference in free markets, by increasing government interference even more. It is like trying to treat a patient in congestive heart failure with fluid overload by giving a large bolus of IV fluid. This can only make our situation worse. The only possible results are worsening waiting times, higher costs, and loss of personal control over our health decisions.
I offer a perspective that is not often heard in this critical debate. After changing my philosophy during my training, I decided to put these principles to work. I now run a solo family practice that operates as closely to free market concepts as possible. I do not work with Medicare or Medicaid, and do not have contracts with insurance companies. People pay me directly. Most of my patients are uninsured. Some are on Medicare, paying me out of pocket without reimbursement. Some have traditional insurance, but see me even though I am not on their networks. My fees are typically just a fraction of what most doctors charge, with the kind of service that was expected in the days of Marcus Welby, including house calls.
My practice is one example of what can be done in health care when free market principles are applied. There are many others that will be discussed, some in the United States, some in other parts of the world. There are examples in family practice, and also in complex surgical care, with surprisingly reasonable fees.
America has led the world in freedom. We can stand apart from the more socialized nations in health care, as we have stood apart in so many other ways, if we remove government controls and establish free markets. Specific ways of doing this will be discussed later in this book. If we generate the political will to make these changes, we can have affordable health care with high levels of service once again. Our economy can be saved from the disaster that now threatens us. We can become the envy of the world, and show other countries the way to fixing their broken systems.
If you are opposed to a government-run system of health care, then read this book. It will confirm your suspicions about socialized medicine, and give you intellectual ammunition to argue your case in a logical and thorough way. If you are undecided, then read this book. It will explain the workings of our health care economy in a way that you probably have not heard before. If you are dedicated to socialized medicine, then read this book. If you want to elevate the condition of the lower classes, which socialists say they want to do, then you need to use capitalism to accomplish that goal.
