Audrey Pietrucha
 |
| It already does |
Providing health care to a
population doesn’t have to be complicated, but we have made it so. We added third
parties in the form of either private of government-provided insurance payment.
We added exchanges and multi-level plan choices. We added tax credits and
subsidies, navigators and multiple government and quasi-governmental agencies
to the picture. What could have been a simple line drawing has turned into a
Where’s Waldo book.
Perhaps I should use the
pronoun “they” rather than “we” because we, the people, did not really have
much say in this. The Affordable Care Act was forced on us at the federal level
just as Green Mountain Care is being forced on Vermonters. We, the people, have
been taken out of this equation entirely. Those of us who were happy with our
health care plans, the vast majority of Americans, are losing them. The State
has decided it is better able to determine our needs and has taken away our
choices. Our governments, which were originally instituted to protect our
liberties, now take them from us.
The chaos that has
resulted from the roll-out of the ACA, or Obamacare, as it is popularly known,
would be comical if it weren’t so frightening. Billions of dollars – 600,000,000
and counting – have been spent on the exchange website alone and the result has
been disastrous. No need to go into the stories here – they are many,
widespread and well-known. And this is just the beginning, the individual
plans. When employer-based plans join the mix next year the confusion and chaos
will likely grow exponentially. Suffice it to say a private company would never
allow such a shoddy product on the market. If they did you can bet Congress
would be hauling their executives in for investigative hearings faster than you
could say “Big insurance.”
We haven’t even gotten to
the substance of how this legislation will work (or not). Once we do, more
nasty surprises assuredly await. Patient records and payment forms will create
a labyrinth of unmanageable paperwork. Privacy will become a thing of the past
as government bureaucrats from multiple agencies, not excepting the IRS, will
have access to our personal health and financial information. As for choosing
or keeping our healthcare professionals – that remains to be seen but, based on
what has happened so far, is by no means guaranteed.
There was a time when
medical care was regarded as the consumer good it is. A doctor, a midwife or a
well-trained nurse provided care and in return was given reasonable payment,
something mutually agreed on by provider and recipient. Sometimes that payment
was in the form of eggs or firewood but usually it was in the form of cash, an
affordable one-time payment or an amount that could be paid over time. The
system worked well until outside parties began intervening a hundred years ago,
beginning with the regulation of medical schools (hint: the main beneficiaries
of these regulations were not patients but doctors seeking to stifle
competition). The proliferation of health insurance benefits during World War
II as an end-run around government-imposed wage controls greatly expanded the
third-party payment system. Today third-parties pay the vast majority of our
doctor bills and having someone else pay for one’s medical services has somehow
evolved into a right.
The practice of medicine
has undergone incredible changes over the past century and modern practices
must be accommodated. That being acknowledged, there is every reason to believe
that, with a few updates, a market-based system could work again. One of the
first might be re-introducing actual risk-based insurance. What we have now is
actually a payment service. A free-market system would eliminate insurance for
all but catastrophic care. Patients would pay for routine visits and would have
access to price information. Providers would compete for patients by offering
either lower fees or superior service. Insurance would be detached from
employment and all plans would be individual or family plans. Under such a
system new ideas such as subscription services might become popular or former
arrangements such as mutual aid groups formed by churches, community
organizations, etc. might be revisited. Civil society’s ability to creatively solve
problems knows no bounds.
Except when it is
inhibited by the bureaucratic power structure that has become our government. The
health care schemes we are faced with actually move away from individual
freedom of choice and toward government’s unimaginative and immoral fallback
position, the use of force. Neither President
Obama nor Governor Shumlin gravitated toward free-market solutions; rather they
are engaged in behavior more befitting dictators than public servants. Mandates
should not be part of the conversation but they are, in fact, the bulk of it. Free
people should not be compelled to purchase something they do not want and will
not use, yet that is exactly what it happening. If nothing else, Obamacare and
its evil twin, Green Mountain care, have lay to rest any notion that Americans
in general and Vermonters in particular are free.
Yet the ACA may prove
useful. It has provided the best American illustration to date of the folly of
central planning. A successful system of exchange requires the input of the millions
of people of which it is composed. A few people at the top, no matter how
educated or experienced they are, can never anticipate every need and every
action that spontaneously work together to create an effective arrangement. Maybe
this debacle is the wake-up call we need. The horrific implementation of this
latest one-size-fits-all government scheme might be a blessing in disguise if
Americans once again discover freedom, with all its warts, still provides the
fairest and most satisfying framework to society.
Audrey Pietrucha is on the executive board of
Vermonters for Liberty. She can be reached at vermontliberty@gmail.com.
