51 replies to this topic

[thefirstimmortal]

If government forces insurance companies to accept applicants regardless of existing medical problems (called “guaranteed issue”), many people won’t bother to buy health insurance until they contract a chronic illness. They’ll have to pay a higher premium the first year, but the price will still seem small considering all the premium-free years that preceded it.

Many other people, who already have insurance, will no longer fear being without it, and will let their policies lapse (if they are smart), until they need them.

It’s as though you didn’t need to buy fire insurance on your house until you smelled smoke.

The insurance companies will be overwhelmed with claims from new customers, and will have to raise their rates dramatically.

When New York adopted such a plan in 1993, the dollar amount of the average claim doubled, as did the price of insurance for a healthy 25-year-old. So large numbers of young people dropped their insurance. Overall, the number of individuals with insurance declined 12% within nine months after the program began.

Washington State’s 1993 health-care plan forced insurance companies to accept all new applicants, regardless of pre-existing conditions, during a 3-month “amnesty” in 1994. Families with chronic medical problems, who hadn’t obtained insurance coverage before contracting their conditions, moved into the state, running up insurance prices for Washington residents. And 19 insurance companies moved out, leaving fewer choices for Washington consumers.

A study by the American Society of Actuaries found that claim costs have risen by an average of 38% wherever a guaranteed-issue rule has been imposed. Other studies have produced similar estimates.

The other “simple reforms” in the 1995 Senate proposal will beget other undesirable consequences. For example, one reform requires employers to cover all employees, even those with hefty claims, if any one employee is covered. Obviously, some employers will find this prohibitively expensive, and decide they can stay in business only by canceling insurance for all employees. Other employers may cancel their insurance because of the higher overall premiums created by the guaranteed-issue rule and other mandates.

Imagine the surprise when politicians discover that their plan to expand insurance coverage actually reduces it. Who would have
thought that human beings would pursue their own self-interest just as politicians pursue theirs? Of course you'll hear the politicians claim that "The free market fails again."

‘Of course, it isn’t the “free market” that will have failed the politicians. It will be human nature. Every such program assumes that individuals and companies will sacrifice their lives or well-being for the sake of the politicians’ grandstanding. But human beings don’t exist to please politicians.

[thefirstimmortal]

When insurance premiums go through the roof, government edicts won’t be blamed, any more than they are now. The politicians will accuse the insurance companies of price-gouging, declare another crisis, and “reluctantly” decide to impose price controls on insurance policies.

When insurance companies can uo longer charge adequate premiums, they will have to reduce benefits. This will lead to detailed regulations that dictate how every policy must work. It won’t be long until every insurance company either gets out of medical coverage or goes bankrupt.

And that will leave only one alternative: a health-insurance system run completely by the government. Many politicians will say that’s the last thing they want, but they’ll vote for it, because, once again, “the free market has failed.”

We will have arrived at Mangalas destination, a destination that became almost inevitable the day congress passed the original Medicare Act in 1965.

We will have a single-payer (meaning government) insurance system, just as the Canadians and British do.

And just like the Canadians, when a personal medical crisis hits, you may have to go south of the border to get immediate care.
Those Tijuana clinics are going to be very, very busy. Ahh, the Joys of a Government Program.

But that won’t be the end of the road.

The government insurance system will dictate how much it will pay for doctors’ services, hospital stays, and medicines. And those prices won’t be set by supply and demand. They’ll be set by what politicians and bureaucrats consider “fair.”
Cost containment will be the mantra for everyone working in the system. Medicines will be dispensed reluctantly, with cheaper, and not equivalent, substitutes being used in many cases. The flow of new drugs will dwindle. The fee schedule for doctors won’t recognize different levels of attention or care; one price will fit all. With below-market fees, doctors will have to skimp on service. Many doctors will quit altogether and become stockbrokers, land developers, or pro golfers. Young people who might have been good doctors will enter other fields instead. The reduced supply of doctors will lengthen the waiting lines.

Lower payments eventually will make hospitals unprofitable, and the federal government will be required to take over that business as well.

U.S. medical care will begin to resemble that of the Soviet Union.

And while you’re being wheeled into the operating room, your doctor may be on the phone pleading with the local health-care commissar to authorize the tests you need.

[thefirstimmortal]

The sad state of American medical care will be a constant concern of the very Senators who caused it. They’ll hold hearings that lay the blame on heavy-handed bureaucrats, instead of the government system itself. No matter how bad it gets, the idea of ending the government system will seem as absurd to the politicians as getting rid of Medicare, Medicaid, or Social Security does now.

And why shouldn’t it seem absurd? After all, politicians will still get first-class treatment, no matter how the people in their
districts suffer.
They’ll get other benefits as well, because everything connected with medical care will become politicized:
Research facilities and hospitals will be built in the Congressional districts and states of committee chairmen.
Associations of doctors, nurses, pharmacists, chiropractors, radiologists, abortionists, paramedics, ambulance companies, Christian Science practitioners, and everyone else in the health-care business will fawn over Congressmen to maintain their positions in the pecking order when Congress conducts its annual check-up on the nation’s health-care system.

No incumbent Congressman will want for political contributions.
If you’re a major donor, your Congressman should be able to move you to the front of those long waiting lines. If you aren’t a major donor, don’t expect to get anything considered a "luxury"such as cosmetic surgery (even after an accident) or breast reconstruction after a mastectomy.

[thefirstimmortal]

As costs continue to escalate, it will become necessary to limit medical research, the types of patients who can be treated, and the procedures that will be covered. Research will take a back seat to immediate care, because neglected research doesn’t lead to exposes on television, the way people dying in a waiting room do.
But eventually it will no longer be either/or, since the scarce resources available for medical care will require rationing in every area. This means bureaucrats will decide, literally, who will get treatment and who won’t. In other words, who will live and who will die.

The first purge will end treatment for older people, who are the heaviest drain on the system, and who produce nothing to help
support it.

Then the retarded, the physically handicapped, and others whose "quality of life” is judged to be too low will be pushed to the
back of the line.

All this will be considered regrettable but, after all, someone will have to go without. Of course, before government took over, no one had to go without-even those who didn’t have health insurance.
The limited resources will severely curtail the variety of medical procedures available, and those still on the approved list will have long waiting lines, which will lead to bribes, as patients try to jump up the list for surgery or access to some overworked machine.

[thefirstimmortal]

If you think these projections are just scare stories, you should be aware that similar situations already exist in Veterans Administration Hospitals and in countries that have government health-care systems the reformers are trying to push on us. And they have their counterparts in the Post Office, the War on Drugs, the Defense Department, and virtually every government bureaucracy today. You may not realize it, but today the indigent receive better care in U.S. emergency rooms than many people in government-run systems in Europe.

And that is the Brave New World that awaits us. When we arrive there, will we remember how it all started? Will we recall those politicians who in 1995 urged a few simple reforms “we could all agree on” as the way to avoid the President’s bureaucratic nightmare? We probably won’t. But the most fanatical socialist couldn’t have done more than they did to assure such a Big-Brother future.

A little government involvement is just as dangerous as a lot, because the first leads inevitably to the second.

[thefirstimmortal]

Fortunately, that doesn’t have to be our future. There’s a second road-one that leads to better care than we get now, to lower prices, to freedom.

What should the government do to get us there?
Nothing, except to get out of the way.

The answer isn’t insurance “reforms,” employer mandates, the encouragement of managed care, means-testing Medicare or reducing its benefits, or tax increases.

Government can help the health-care system only by getting out of it. It has no more ability to make us well than it does to make us rich.

[thefirstimmortal]

Let people decide for themselves, with the help of their doctors and private testing agencies they choose for themselves, which medicines are safe enough for them. Let people decide for themselves what risks they’re willing to take. Let people with fatal illnesses choose any therapy they want in hope of beating the odds.

No one will be left on his own unless he wants to he. You and your doctor can use any testing and certification company you want-including one staffed by former employees of the FDA. Let drug manufacturers prove to you and your doctor the safety of their drugs. That way they won’t have to run up the cost of the medicine, as they do now to get the FDA to act.

Save Medicare by turning it over to private companies. Then, like any other service in the marketplace, it will be completely voluntary. Let seniors pick their own policies. Let them make as much money as they want without losing benefits. Get government out of the health insurance business.

[thefirstimmortal]

The answer to the Medicaid funding problems, the corruption, and the scandals is to end the program. Don’t string taxpayers along with more “reforms” that don’t reform anything. End federal grants and federal tax-collecting on behalf of states. Get the federal government out of it entirely. Let each state’s citizens decide for themselves whether they want a government program to provide health care to the needy, and, if so, what kind.

And let’s hope most states stay out of health care as well. State government programs are still government programs. Far fewer people will ask for help if they know it’s not available just for the asking. The small numbers who would actually need assistance would get it from private charities financed by the donations of people who care. I’m sure there will be many compassionate politicians among them.

[thefirstimmortal]

Solve the portability problem by making all medical expenses totally deductible from taxable income. Then employers won’t have to provide health insurance instead of pay raises. Employees will own their own policies. They can choose the policies that suit them, and they can take them wherever they want.

Let individuals decide for themselves how to use the money they’ve earned. Let them, not some omniscient politicians or bureaucrats, be responsible for their lives.

Better yet, get rid of the incospe tax entirely, so that tax advantages no longer influence any economic decision. But we’ll come back to that in another topic.

[thefirstimmortal]

Get state governments to stop imposing conditions on health insurance. Don’t require individuals to pay for benefits they don't want. Don’t force insurance companies to take customers they don’t want, a practice that prices healthy people out of the insurance market.

If a politician thinks an insurance company should accept everyone who applies, then he can start his own company and operate it that way. If it’s as easy as he thinks, he’ll make a fortune. Of course, no politician will do that, because it’s much easier to give orders than to cope with the real dilemmas of life.

Anyone who cares, really cares, about people who can’t get insurance because of pre-existing conditions can contribute to a private charity that would cover such people by providing either insurance or medical care or better yet, give that money to individuals directly.

[thefirstimmortal]

There is more that could be done to get government out of health care, but these steps would improve the system enormously.

These are real reforms, not more bureaucratic dictation. They will lead to better medical care at lower cost:
You will be able to select the insurance policy that’s most appropriate and most economical for your family.
You’ll be free to deal with the doctor of your choice.
You won’t be priced out of insurance because of government mandates.
Life-saving medicines will be on the market sooner. Prescription drugs will cost less.

And who knows what other benefits will flow? So much of what we put up with now results from government policies. With government out of health care, we will see benefits we can’t even imagine now.

Maybe, just maybe, doctors will start making house calls again.

[thefirstimmortal]

I can’t help but wonder what Thomas Jefferson would think of the current health-care debate. He and his colleagues fought a war to rid themselves of a king who made their decisions for them. They fought to establish the first nation whose guiding principle was freedom from government.

But today your ‘‘protectors’’ in Washington are busily scheming to take away your freedom to bargain with your employer or employees, the freedom to choose your own doctor, the freedom of doctors to set their own fees (just as politicians do), the freedom to obtain the kind of insurance you need, and the freedom to live your own life and be responsible for yourself.

I’m sure the politicians think Thomas Jefferson is looking down upon them with approval. After all, it was he who wrote the immortal words:

We hold these Truths to be self-evident, that all Men are created equal and endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and Health Insurance You Can Never Lose.

[thefirstimmortal]

Insurance is an efficient way to protect against bad luck. But it’s a clumsy way to pay for routine expenses. You don’t use car insurance to pay for oil changes or gasoline; you have it in case your car is stolen or badly damaged in a collision. You don’t use homeowners’ insurance to pay your electricity and water bills; you have it to cover a fire or other catastrophic loss.
Obviously, an insurance policy that covers every small, routine expense is going to be far more expensive than one that covers only extraordinary expenses. And the difficulty of administering a policy with frequent claims will run up the cost even more.

Tax incentives have led employers to offer broader and broader health-care coverage, and the same incentives have led employees to prefer such coverage over higher wages.

So medical coverage has become less like traditional insurance, and more like a total health-care service paying all your medical bills, big and small. To the employees, this seems like free health care, and so they use it much more than they would if they were paying for routine care out of their own pockets. This has put much greater demands on health-care providers, running up the price for everyone.

When we repeal the income tax, there no longer will be a tax incentive for employers to furnish health care, or for employees to prefer health benefits to higher wages. Incomes will go up. And you’ll be able to purchase relatively inexpensive insurance to cover extraordinary expenses, such as those connected with a bad accident or a life-threatening disease. Routine doctor visits will be much less expensive because people paying for what they use will be more sparing with their money.

You will be able to handle routine costs out-of-pocket, just as you now pay for gasoline for your car or utility bills for your house. And most people will find that they are paying less than the wage increase they received in place of employer-provided medical insurance.

Until the income tax is repealed, all medical expenses should be fully deductible, whether you pay for them directly or through your employer. This will help to take the pressure off broad employer-provided coverage, and reduce the demand that is running up medical costs.

[thefirstimmortal]

Health insurance has become progressively more expensive and thus less accessible for many people.

Politicians love to posture as friends of particular groups, women, children, and people suffering from a particular disease, by insisting that health insurers must cover some medical procedure that is important to the target audience. But every time the government (state or federal) forces insurers to include another benefit in your policy, the company has to raise your premium.

Not surprisingly, the cost of health insurance has risen spectacularly over the past few decades.

Depending on the state you live in, your insurance company may be pricing your policy to allow for mandatory psychiatric coverage, chiropractors, acupuncture, naturopathy, marriage counseling, abortions, drug abuse, alcoholism, treatments to stop smoking, cosmetic surgery, weight loss, wigs and other hair-pieces, Christian Science practitioners, and dozens of other possibilities.

I have nothing against any of these treatments. But it makes no sense for the government to force you to pay for such coverage if you would prefer a cheaper policy.

For example, a Catholic nun buying health insurance may live in a state that requires every policy to cover abortions, and she must pay accordingly. You should be able to buy a policy that requires you to pay only for what you need and want not what the politicians think you need.

The alternative we have now keeps pushing up the cost of insurance. And as it becomes more expensive, every medical interest group suffers. So most of them go to Washington (or the state capitol) to lobby the politicians to provide relief by forcing insurers to include its favored treatment in all policies, pushing the price up further.

Expensive health insurance hurts young people in their 20s and 30s the most. Generally, they belong to no special interest group, and as insurance becomes progressively more expensive, more and more of them decide to risk going without insurance.

Just between 1990 and 1996, the number of insured people decreased by about one sixth. The largest block of uninsured is in the 18-35 age group.

Rising costs also have lead many employers to drop health coverage. In 1980 fully 97% of the companies with 100 or more employees provided medical coverage. By 1995, only 77% were doing so.

The growing number of uninsured people gives the politicians more ammunition for more programs to force more costs onto insurance companies, and to push the price of insurance still higher. More people will have medical insurance, and the insurance
will cost much less, if we get government out of the way.

[thefirstimmortal]

In 1999 politicians pushed for a “Patients’ Bill of Rights,” supposedly to give patients certain privileges in dealing with health maintenance organizations (HMOs).

No one was pushing for a “Bill of Rights” to protect patients against doctors, or against druggists, appliance stores, computer makers, or gardeners. So how did HMOs become so powerful and dictatorial that their customers need protection?

In 1973 Congress passed the HMO Act, which subsidized HMOs and forced any company providing employee health insurance to offer an HMO as an option. This requirement was finally repealed in 1995, but by that time the government’s favored treatment had made HMOs the centerpiece of employer-sponsored health programs.

Once again, the politicians are seizing the opportunity to rescue us from their own handiwork.

[thefirstimmortal]

Medical costs started moving up in earnest with the advent of Medicare and Medicaid in 1965.

By offering free or nearly free medical care, these programs increased the demand for medical services. Meanwhile, the supply of medical providers declined because the new programs overloaded doctors and hospitals with forms to fill out and bureaucratic regulations to obey. The result, not surprisingly, was dramatically higher prices for anyone who didn’t qualify for free service. Since the 1960s, health care costs have been rising generally at twice the rate of inflation.

Medicare is so complicated, no one person could possibly explain the complete system to you. The rules, guidelines, and instructions cover 111,000 pages. And whenever you hear that Congress has reformed the system to make it easier to deal with, to eliminate waste and corruption, or to provide more choice, you can be sure that it has become even more complicated. Medicare has overloaded doctors with regulations, forced them to undercharge for many services, and driven a large number of them out of the medical profession entirely.

Some doctors have remained at their posts but have resigned completely from the Medicare and Medicaid systems, refusing to perform any service that will be paid by Medicare or Medicaid. The savings to the doctors are so great that they now charge their patients only half or less of what they had to charge before. But it isn’t just doctors who have been hindered by Medicare.

After reading over 1000 pages of reports, rules, guidlines, and instructions (less than 1 percent of the total) I have this to say.
If you’re a senior citizen locked into Medicare, you have my sympathy.

Medicare routinely turns down roughly 20% of all the procedures physicians decide are needed. The skyrocketing costs of “free” medical care have already led to rationing of various kinds. Many treatments that might relieve your discomfort or even save your life are rejected to save money.

If Medicare refuses your request for a particular test or treatment, even one your doctor thinks is essential, you can’t pay your doctor for it out of your own pocket. If the doctor were to accept your money, he would not be allowed to treat any other Medicare patients for two years thereafter. To get the treatment you need, you would have to find a doctor who refuses all Medicare and Medicaid patients, and you might have to travel several hundred miles to find him.

If Medicare denies your hospital claim, your appeal can take as long as a year to be processed. Hardly the freedom I envision in my dreams.

Because Medicare regulations are so complicated, ignorance of the law could easily get you or your doctor in legal trouble. Penalties for mistakes include fines and imprisonment.

You most likely pay out of your own pocket at least twice as much for health care as seniors did before Medicare began, even after allowing for Medicare’s contribution and after adjusting for inflation.

You will be much healthier and spend less money on health care if we replace Medicare and all other federal programs with the kind of health care that was available before the politicians decided to become doctors.

You’ll be able to get private insurance that is tailored to your specific needs, without paying for government mandates. Government programs will no longer run up the price of medical care. And your doctor will be free to treat whatever ails you.

[thefirstimmortal]

Medicaid is a federal subsidy for state government programs that provide free health care to people below a specified income level and to nursing homes for the elderly.

Each state designs and names its own program. However, 50-75% of the money comes through the federal government, which doles it out according to formulas set by Congress.

With most of the cost paid by the federal government, the states have an incentive to spend as much on Medicaid as federal rules will allow. This generates still more upward price pressure on medical care.

Like so many federal-aid programs, Medicaid is an invitation to waste and corruption. State programs are continually under fire for exceeding their budgets. In 1994, for example, Oregon instituted strict rationing of health-care services in order to bring medical costs under control. And in Tennessee in 1999, the Republican governor cited out-of-control Medicaid costs as his excuse for breaking his word and proposing the state’s first income tax.

Before the government stepped in, poor people found solace with charity hospitals, free clinics, and doctors who knew and cared for their patients. One way or another, there was always medical care for those who needed it urgently. But some people didn’t like that system. So instead we now have a health-care system that even fewer people can afford.

[thefirstimmortal]

Medicare and Medicaid don’t just fleece you with the taxes they extract from you.

Most doctors, clinics, and hospitals are able to bill the government for only a percentage of what they would normally charge, sometimes as little as 25% to 50% of a normal bill. In order to stay in business, they have to make up the difference by overcharging their paying customers, including some of you. And that’s just the beginning of your extra costs. The federal and state governments have imposed all sorts of regulations on doctors, hospitals, insurance companies, managed-care providers, and others in the health-care industry.

Hospitals are forced to admit anyone who shows up at the door, with or without the price of admission. And hospitals and doctors fill out endless forms to comply with federal regulations, to justify Medicare and Medicaid bills, and to prove that they aren’t discriminating. Who pays for all the free services and for the time involved in complying with federal regulations? You do, of course; it’s in the bill you receive from your doctor, hospital, or insurance company.

The “Medicare + Choice” bill in 1997 included demands that managed-care providers add more services for free. This pushed so many providers into a loss position that over a hundred of them chose to leave the Medicare system entirely, making over 400,000 senior citizens search for new plans. The result has been less choice for the elderly, and everyone else, not more.

The supply of doctors has been diminishing as well. Almost every health-care law passed by Congress includes provisions that make it easier to sue doctors and other health-care providers. As a result, the cost of malpractice insurance has sky-rocketed. Some doctors see roughly half their income going to pay insurance premiums, necessarily adding to the cost of your bill. Even worse, this prompts more and more doctors to throw in the towel and leave the profession.

As the supply of health-care providers continues to shrink and the political demands on the providers continues to grow, health-care costs continue to escalate.

All this is so unnecessary America had the best medical system in the world before the politicians started playing doctor.

Dr. Jane Orient of the Association of American Physicians and Surgeons has pointed out: When medical care was mostly paid for by patients, the hospital bill for an appendectomy was the equivalent of 10 days’ wages for a common laborer ($149 in 1960). Now it’s at least a couple months of take-home pay for a middle-income person (about $3,000). They still do the procedure the same way, and the patient is generally home faster.

Few doctors in America ever walked away from a patient in urgent need, no matter how poor the patient. But good works aren’t good enough for politicians. And so we have today’s bureaucratic, inefficient system instead.

[thefirstimmortal]

Both parties campaign on the health-care issue. Each claims to have your interests at heart, and each wants to write out a prescription for you.

[thefirstimmortal]

The Democrats much like Mangala keep pushing for “universal health care.” But such a system is an impossibility.

There aren’t enough resources in the world, or in the solar system, to meet every health-care wish of every citizen. Choices always have to be made, and it is far better when you make your own choices based on cost than when politicians make choices for you on the basis of political pressure.

There’s a reason so many Canadians cross the border into America to get operations or other treatment. It’s because Canada has “universal health care” with “free” medical care and “free” can mean a dangerously long wait for what you need.

When patients don’t have to consider the cost of anything, they deny themselves nothing that might conceivably improve their health. So in Canada waiting lines are long, very long. And an emergency doesn’t necessarily put you at the head of a line. Even people needing open-heart surgery can be left waiting a very long time.

In Toronto, hospital emergency rooms have turned away ambulances because there wasn’t enough staff or space to handle the patients. Throughout Canada, hospital hallways are crowded with patients on beds or stretchers waiting for a scarce room. A vice-president at Vancouver General Hospital estimated that 20% of heart-attack patients who should have treatment within 15 minutes now wait at least an hour.

Consequently, doctors and hospitals routinely refer patients to the U.S. for treatment. Canadian-type systems aren’t unusual. They’re common-place in Europe, as are the waiting lines. But unfortunately for Europeans, there are no American facilities nearby. The contrast between government-run and private health-care systems is stark. In Canada, for example, dentistry and veterinary care still are privately run. So you can get treatment for a cavity faster than for cancer, and your dog gets better medical care than you do. This is what the Democrats hold up as the model enjoyed in more “enlightened” countries, the future they have in store for you and every American. In other words, the cure for our deteriorating health-care system is to replace it with one that’s even worse.

[thefirstimmortal]

The Republicans take a different approach. They claim credit for having stopped Hillary Clinton’s 1994 attempt to impose universal health care in one giant step, and they pose as the defenders of private health care. But the two parties differ only in the speed at which they would take us to Hell on a hospital gurney.

Republican politicians claim our system doesn’t need a massive overhaul, only a few small changes, such as making health insurance portable (so that you can take it with you to a new job), or covering people with pre-existing conditions. Of course, they are talking about remedies that wouldn’t be necessary if government weren’t involved so deeply in the health-care system.

In recent years these “needs” have led to the Kennedy-Kassenbaum bill, the Hatch-Kennedy bill, and the “Medicare + Choice” act. These and other bills have burrowed government more deeply into your health, your insurance, and your medical treatment. The Republicans have imposed more and more mandates on insurers, hurrying the eventual destruction of the private insurance industry.

The Republicans have helped make health care so expensive and hard to get that people are eager to try anything else, even a proven failure such as government-run universal heath care. Once again, the politicians created a problem that provided a new excuse for politicians to impose a new solution.

[thefirstimmortal]

So what is the difference between the positions of the two parties? One party runs a little faster, but they’re both headed in the same direction.

It may seem prudent to support the one that’s taking us to Hell a little more slowly. But continuing to support either party assures that our health-care system will never be fixed. America had the best medical care possible until the 1960s, when the federal government moved in. Libertarians are the only political party working to restore the system that worked, so you and your family can have low-cost health insurance, a doctor whose waiting room doesn’t resemble Grand Central Station, and, whenever needed, a hospital stay that doesn’t cost a year’s pay.

Libertarians would get government completely out of health care, while freeing you from the income tax. Given the advances in computers and medical technology of the past two decades, America would have a health-care system that goes beyond even the politicians’ imagination.