Republicans in Congress are doing their usual job of chickening out from taking effective action, preferring half-assed deck-chair-arranging and cost-can-kicking instead of risking the chance someone might call them names. Fixing this mess requires understanding how we got into it.
Before the Great Depression, doctors charged what the patient could afford, overcharging some to give free care to others. Hospitals charged the patient directly. In the Roaring 20’s, people could afford good medical care.
During the Great Depression, people couldn’t afford doctors so they substituted nurses and midwives or went without care. Private hospitals ran short of money. FDR spent federal money on medical care as a stop-gap measure. Hospitals associated with charities or religions provided reduced-fee medical care.
When World War II loomed, FDR worried that federal contractors would gouge the government so the Office of Price Administration set wage and price controls. When men rushed to enlist after Pearl Harbor, employers scrambled to fill positions on the now-booming assembly line but were unable to offer higher wages to entice employees. Employers offered free health insurance to pad the offer and deducted the cost as a business expense.
After the war, employers couldn’t drop insurance because it would be seen as a pay cut. But as Baby Boomers aged and needed more expensive care and the economy slumped reducing profits, employers were forced to drop coverage. The clamor for free health insurance turned to government, resulting in Obamacare.
The health insurance problem is just like rent control in New York – it was a temporary war-time something-for-nothing measure that was continued too long and now the addicts are screaming because they won’t get their special war-time subsidies. They shouldn’t. The war is over.
The first step is to end the deduction for employer-paid health care so that more employers drop coverage, and prohibit units of government and unions from paying for health insurance, which will level the playing field as everybody becomes a health insurance consumer, same way everybody is a car insurance consumer.
The second step is to let states decide what insurance policies are allowed to be sold. Minnesota coverage will cost a bundle because the legislature will require every policy to cover everything. That decision will cost us jobs as employees leave to get lower premiums elsewhere. The laboratory of democracy eventually will find its balance.
The third step is to means-test Social Security and Medicare. Seniors who can afford to pay, must pay, or the system goes broke.
The fourth step is to limit the use of welfare medical care. People who buy health insurance have deductibles and caps so they don’t run to the doctor for every sniffle. People who don’t buy insurance should have similar incentives to conserve resources. Yes, this means some children will suffer and die. If the entire system collapses, all the children will suffer and die. We’re trying prevent that.
The fifth step is to deregulate medicine. Allow more drugs to be sold without prescription. Allow non-doctors to prescribe medicine. Allow medical providers flexibility in meeting standards. The country doctor who had his office in the front room of his house could handle most of what came in the door, he didn’t need admitting privileges at a Level 1 trauma hospital. That policy might also mean recruiting more health care professionals from other countries – we’d rather have them than have unskilled laborers climbing The Wall.
The sixth step is to limit medical malpractice lawsuits to reduce malpractice insurance premiums so doctors can afford to charge patients less. Doctors make diagnoses by using statistics to play the odds, there always will be mistakes, not every mistake is a lottery ticket.
I know: Democrats will howl. The media will howl. College kids will howl. Seniors will howl. Everybody who wants Free Stuff will howl that they’re not getting enough Free Stuff, fast enough. Doesn’t matter, clean up the mess anyway because (a) it’s the right thing to do and (b) if we don’t, the system will collapse and the howling will be even worse. Time for Republicans to man up and do the right thing, for a change.
No, I’m not holding my breath.
Nor should you. The cult of the government savior is ascendant.