What if the idea of a national healthcare program is flawed because we can’t afford it under current economic conditions? Setting aside the twenty trillion dollars of government debt for a moment, consider just the question of a patient’s payments. What if there’s (1) no way to tax the people (over there) in the shrinking middle class living with less money every year to (2) pay for the poorest people (over here) who can’t afford to pay for the inflated price of healthcare in order to (3) make a huge profit for insurance companies everywhere and (4) make a huge profit for pharmaceuticals and (5) create inflation in the economy that disguises poor GDP performance?
What if that government sponsored healthcare model can no longer be sustained and that’s why Obamacare is failing and why it must fail? Of course, it may also be failing just because it was a bad product that served as (1) a vehicle to inflate healthcare costs while (2) offering less care, and (3) less healthcare security and (4) virtually no privacy or information security. One example of healthcare inflation is the cost of Novolog insulin. It has gone up in price over the last five years by 248% (see note below)! No one in the pharmaceutical industry can explain why this product should cost diabetics ever more money in our shrinking economy. Why does it cost so much?
Part of our problems with healthcare begin with regulatory politics. When you look at the regulations that came about during the modern liberal era from 1861-1944, there were a lot of regulations designed to prevent harms. For example, regulations in the Food and Drug Administration established in 1906. When a business failed to respect regulations designed to keep the public safe, it could be sued in civil court for monetary compensation. A contrast can be seen by comparing the modern liberal and classical liberal period. During the classical liberal era, which happened from 1776-1861, instead of trying to prevent harms through the growth of the regulatory state, courts allowed parties who were harmed to seek damage claims in criminal court and sometimes the court would revoke the operating licenses of businesses that caused harms. During the neoliberal period from 1944-the present, damages have been pursued in civil court and large sums have sometimes been awarded. In healthcare, that has increased costs by adding fees that doctors now pay for malpractice insurance. And also now, doctors are ordering unnecessary testing just to avoid a malpractice claim under standards of care that create more billable tests. That increases costs, too.
What if the Trump Administration isn’t able to revamp and reinstall the government’s involvement in healthcare? Because it doesn’t work. Healthcare inflation was always expected as a side effect of government healthcare programs. And now we see that healthcare inflation has gone cost-crazy. What if the government stopped guaranteed payment of pharmaceuticals at a constantly inflating price? Wouldn’t the price come down? What if the insurance middleman went away? Wouldn’t that reduce costs? What if people acted as their own agent in paying for healthcare and choosing their doctor? What if this allowed them to re-energize their patient doctor relationship? Instead of being at the mercy of insurance providers and doctors that don’t care about patients anymore? Wouldn’t that decrease costs by increasing competition among doctors for patients? What if the number of billable tests went down instead of increasing? Wouldn’t that decrease costs? What if bad doctors were removed from practice and the need for malpractice insurance went down? Wouldn’t that decrease costs? What if the government’s involvement in healthcare has been a terrible economic mistake that is now destroying the healthcare marketplace? What if?
I realize that our media keeps banging the drum for “replacement” and not just for “repeal.” In fact the very idea that fundamental changes are needed in healthcare is strictly avoided by the media which proposes that the U.S. government should continue to interfere with American healthcare, despite the obvious failure of Obamacare. Media outlets that say we need to “replace” Obamacare are really saying, “we need government sponsored healthcare.” Even though most Americans didn’t sign up for the healthcare exchanges. Because they didn’t want Obamacare. And I think that many Americans who have wanted Republicans to repeal the Affordable Care Act didn’t want to replace it. They saw that the government’s involvement in American healthcare was bad. It invades privacy because it allows government encroachment into people’s private health concerns. It also invades privacy because computers are vulnerable to computer espionage. Because we are mortal, government healthcare makes us vulnerable to healthcare denial and inflation. Ouch! Those are two harms we want to avoid. Perhaps instead of replacing the ACA, it should just be allowed to die the death that it deserves.
Note: It may be hard to imagine a 248% increase but that means that if a vial of insulin cost $113.59 five years ago, it now costs $281.72! (A diabetic uses many vials per year.) The same runaway inflation is happening in other medicines too. Insurance companies, pharmacy companies and the subsidized and protected medical profession needs Obamacare and medical insurance programs in order to ramp up medical costs this dramatically. Co-pays hide the real costs. A real market wouldn’t hide these price increases and the public wouldn’t tolerate them.
For source material on date, see: US Food and Drug Administration, https://www.fda.gov/AboutFDA/WhatWeDo/History/, accessed 13 Mar 2017.
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