by Audrey Pietrucha
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 email@example.com.