Health Care Reform Without Obamacare Failure

We don't know what a free society might come up with for treating people's aches and pains given time to react to human needs, but Obamacare can be improved upon. A lot.

SyringeZaldyImg / Foter.com / CC BYAdvocates of free and spontaneous societies are at a bit of a disadvantage when asked by the opposition just what we propose as an alternative to some tottering example of the inadequacy of planned social order. After all, if we'd all spent the last few generations eating swill slapped in front of us at state-run cafeterias, who would feel comfortable describing a world of gourmet restaurants, fast-food drive-ins, greasy spoons, and ethnic food carts evolving all by itself if we just swept away the federal Department of Heartburn? Yet describe the alternatives, we must, when goggling at the current if-you-like-it-there-it-goes fiasco that doesn't even rate a description as the army-issue shit on a shingle of health care systems. We can't reliably describe what a free society would come up with for treating people's aches and pains given time to evolve and react to human needs, but Obamacare can be improved upon. A lot.

Aside from clearing away the spiderweb of mandates and regulations that have entrapped patients and providers in the United States, many health care experts have proposed less-coercive alternatives not just to President Obama's (not so) Affordable care Act, but to the system on which it's been grafted.

Job-based health insurance is an unintended artifact of World War II's wage and price controls. Employers offered benefits to hold or lure workers when they couldn't adjust paychecks. While the development made sense under the circumstances, it has since guaranteed that leaving a job also means changing health plans.

Such health coverage also means that consumers of health care—insured workers—have little incentive to comparison-shop for lower prices, since they don't pay out of pocket (this is a failing of any third-party-pays system). In a 2010 article for the Ludwig von Mises Institute, Vijay Boyapati described how elective LASIK procedures, which are usually paid out of pocket, declined in cost by 30 percent over a decade even as other covered medical procedures become more expensive. He also detailed his personal experience in shopping around for a dermatological procedure and finding prices ranging from $700 at a practice that accepted insurance down to $50 at a cash-pay clinic.

How to address these distortions?

Writing for the Cato Institute, Michael F. Cannon proposed that Americans gain more control over their pre-tax health dollars. Specifically, he suggested eliminating the tax preference for employer-sponsored health coverage in favor of very large, tax-free health savings accounts (HSAs) giving Americans direct control over their health expenditures.

Eliminating the tax preference for employer-sponsored insurance would therefore shift control over more than $532 billion each year, and $9.7 trillion over the next 10 years, from employers to workers. That effective $9.7 trillion tax cut would not increase the federal budget deficit, and it would more than swamp any small, explicit tax increases that altering the existing tax treatment of employer-sponsored insurance would impose on some insured workers.

Not incidentally, HSAs also put heath care consumers back in the position of paying with their own money, with an incentive to look at the price tag.

John C. Goodman and Peter Ferrara of the National Center for Public Policy Analysis have a similar idea. They propose giving people uniform tax credits to purchase health insurance. Once again, that approach would give individuals more control over their health expenditures, since they wouldn't be bound by employers' choice of insurers. It would also be more equitable, since current employer-based tax breaks vary widely depending on workers' income.

Goodman and Ferrara also want to "guarantee renewability" to address the problem of people being dropped by insurers. And they propose a safety net, funded up to the level of unclaimed tax credits, to cover the less-than-proactive segments of the population.

D. Eric Schansberg, a professor of economics at Indiana University Southeast, also likes tax credits, though within limits. He suggests they should be offered "only at a level to provide catastrophic insurance for substantial and unpredictable medical expenses. A variation on this theme would be to provide the subsidy on a means-tested basis, reducing it for those with higher incomes."

As with Goodman and Ferrara, Schansberg suggests health status insurance as a hedge against "the risk that one’s health status deteriorates in the current period—and thus, that future medical insurance premiums will increase."

Cannon and Schansberg both see a spiderweb of tight regulations on health insurers as limiting competition and driving increases in costs, which then squeezes many Americans out of the market for health care.

Pioneered by states seeking to satisfy every possible constituency with a heart-rending story to tell of illness and expense, mandated coverage of various ailments and treatments has inarguably elevated the cost of health coverage. While each individual mandate has a relatively small price tag, the Council for Affordable Health Insurance estimates that, in aggregate, "mandated benefits currently increase the cost of basic health coverage from slightly less than 10 percent to more than 50 percent, depending on the state, specific legislative language, and type of health insurance policy." The federal government, to much fanfare, now dictates "mental health parity," which raises costs by five to 10 percent, all by itself.

Those mandates have to go if we're to control costs, points out Cannon, and Schansberg agrees. Schansberg adds that insurers should be allowed to offer products across state lines to increase competition.

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  • OldMexican||

    Goodman and Ferrara also want to "guarantee renewability" to address the problem of people being dropped by insurers. And they propose a safety net, funded up to the level of unclaimed tax credits, to cover the less-than-proactive segments of the population.


    Even though I understand where Goodman and Ferrara are coming from and what the basic premise of their plant, it still an example of a plan that includes some sort of government internvention in the form of subsidies, which still are transfers of wealth from one group to another.

    The best approach to fix the problem of unmet demand is to increase supply, and in order to achieve this the government must take away all the impediments to supply - and I mean *all*, including insurance mandates, tax breaks and licensing laws. There is no other way.

    I understand that most people relent when told that one must let the market supply medical care and health insurance because, they believe, those unable to pay or to work will not receive the care that paying customers enjoy. But just how much can a poor person receive in healthcare if the distortions in the market throttle supply to the point that care suppliers become more expensive?

    You HAVE to allow care suppliers (doctors, nurses, hospitals and pharmaceuticals) multiply and prosper so people of smaller incomes can be catered to. Otherwise your nice thoughts become the nightmare of others.

  • Harvard||

    [I understand that most people relent ....]

    I have never thought of Tony as "relenting". Perhaps you meant "vent".

  • IDPNDNT||

    I agree with you on everything except licensing.

    I believe there should be some proven level of competence before someone is allowed to perform medical care.

    While I agree arbitrary scope restrictions should be lifted for certain people in the field. CNA's/Nurses/NP's etc. I just don't see how throwing licensing out the window will do much to address cost of care.

  • OldMexican||

    Re: IDPNDNT,

    I believe there should be some proven level of competence before someone is allowed to perform medical care.


    Who determines a person's level of competence for a license, if not his own and self-interested competitors? They don't call it "regulation capture" for nothing.

    Think about a kind of U/L certification except for doctors, lawyers or wedding planners and other dangerous professions. If the niche is there, they will come. You don't need government for that.

  • IDPNDNT||

    That's a fair point.

  • ||

    Yeah, your insurance provider is going to insist on your doctor being certified by the certification provider that greases their palms adheres to their high professional standards as well. There is literally no possibility that providers of medical care will not be held to standards of competence.

    People always act like doing away with public licensing would mean no standards of competence. Every industry has standards of competence: shitty performance results in firing. Beyond that, third party certification is almost always more sought after and more prestigious than government licensure anyway. Including in the medical field today. There's a reason why doctors hang their diploma on the wall and have their board certifications listed in their yellow pages ad. "Licensed physician" isn't a ringing endorsement. "Board certified osteopathic surgeon with degrees from Johns Hopkins and Harvard Medical School" means something.

  • Game of Gnomes||

    I read at a PA forum a comment from a progtard from Minnesota responding to someone complaining about Obamacare being terrible and the government should get out of medicine.

    The progtard was shocked and appalled at the prospect of the government not controlling drugs, licensing etc.

    The world and medicine worked quite well before the government came along.

  • wwhorton||

    I used to be a little leery of getting rid of gov't licensing and certs, too, until I realized that, even with them in place, we still have fairly routine incidents of malpractice, incompetence, etc. There are running stats kept by hospitals of how much stuff gets left in patients that come in for surgery.

    So, yeah, the idea of insuring an unqualified doctor would send chills down the spine of any malpractice insurance provider. They've got skin in the game, so if they start insuring Dr. Nick, they lose money on the payout AND they garner a bad rep. Much more motivation there to hold to high standards than even the most well-meaning government functionary.

  • Greig Krastev||

    This is based on the assumption that job performance standards of the employee in your scenario are necessarily equivalent with the minimal standards needed across an industry to limit outright harm to the society it serves? Ask anybody who's worked behind the closed doors of a kitchen or food retail: any employee who routinely throws food away when it's past expiration or dropped on the floor — rather than, as their floor supervisor would urge, taking an extremely liberal view of the 5-second-rule and expiration dates — will face termination from the floor supervisor because every tossed-away hunk of meat means lost revenues (regardless of filth or expiration). Trust me, if they think they can get away with some marginal or grey-area health concern, without causing an outright food-poisoning breakout which could be easily traced to their store, then they'll routinely do it. Likewise, I don't think that a completely unregulated cigarette industry would fire an employee for "shitty performance" when they were in fact very good at their job, if that job were to, let's say, blatantly advertise cigarettes to pre-teens.

  • Harun||

    I think technology could help there. Simply have video cameras run 24/7 of the kitchen with the feed ran directly into monitors in the restaurant waiting area. Problem solved.

    Also people do get sick from restaurants and then tell others. The owner has an incentive to avoid that.

    The problem is probably larger in chain restaurants where its all manager and metrics.

  • ||

    Yeah, restaurants have no incentive not to poison their customers. It's not like one outbreak of food poisoning at your restaurant is going to have wide-reaching consequences for your reputation with a good possibility of putting you out of business, or at least losing your liability insurance.

    Advertising cigarettes to pre-teens is an ethical question and a complete non-sequitur to the rest of your confused logic.

  • Sevo||

    Increasing supply will not solve the issue of elasticity in demand; new treatments tend to be extremely expensive and available only to those willing and able to pay.
    Assuming that society will pay for care for those truly unable to do so, society must still draw the line at some level. The claim that 'cost is no object' for medical care is not true at any level and becomes more difficult when the payer is a third party.
    I sure don't know the answer, but if we are to provide for those folks, we must find one.

  • OldMexican||

    Re: Sevo,

    Increasing supply will not solve the issue of elasticity in demand; new treatments tend to be extremely expensive and available only to those willing and able to pay.


    Most care only requires already-existing treatments (e.g. dressing wounds, setting broken bones, curing infections); getting rid of the FDA would open the market - once again - to new and better treatments in much less time and at much less cost. If a kid can come up with a cheap and simple test for finding lethal cancers, then the sky is the limit when it comes to new and affordable treatments.

    Assuming that society will pay for care for those truly unable to do so, society must still draw the line at some level.


    I find the assertion that the poor will always need to have their health services financed by others without merit. The market has been able to supply the poor with low-cost products that would have been considered magical (or the work of the devil) just three generations ago. I don't see why the same cannot be achieved for health care services and procedures.

  • optimusratiostultum||

    My favorite example of this is cell phones, you can buy a phone that was considered top of the line 15 years ago for 3-4 bucks on Amazon. capitalism did more for providing people with cell phones than the government ever did. (where do you think Obamaphones come from anyway?)

  • Greig Krastev||

    Ah, you mean that consumer technology that's based on a technology (i.e., radio) that originated with the (government) military? Many stages of whose precursors' development depended on government aid? Oh, THAT cell phone technology!

    In all seriousness though, 1.) medical technology is extremely advanced today compared with 15 or 30 years ago, owing largely I might add to government assistance to research funding, and 2.) you seem to be confusing digital technology (a constantly evolving field of PRODUCTS/GOODS technology) with medical insurance (a SERVICE industry built on unchanging elements such as premium payments, risk pool, deductibles, and whose overall quality service to society as a whole cannot be expected to show Moores Law-like improvement but instead can only be refined with high-level regulation).

  • Sevo||

    Ah, you mean post hoc ergo propter hoc?

  • DarrenM||

    Ah, you mean that consumer technology that's based on a technology (i.e., radio) that originated with the (government) military?

    Yes, there was no technological research, discovery, innovation, or invention apart from the dictates of a group of people for whom these things were not a huge consideration.

    http://en.wikipedia.org/wiki/Invention_of_radio

  • ||

    ARPANET! HURRRR DURRRRR

    Fuck off, troll.

  • LynchPin1477||

    Someone on here (I forget who) had a good point about this. Yes, the poor may be able to get some level of medical care at prices they can afford, but the really top quality care is always going to be more expensive. That may be OK if we are talking stitches, but let's just pretend that someone finds an alternative to chemo that, at least at first, is really expensive. A lot of people are NOT going to be OK with a rich person getting through cancer treatment fairly easily while a poor person suffers through the hell of chemo. And the people who have a problem with that probably won't think twice about demanding higher taxes or some such thing to finance a safety net that provides more equal care. So any proposal has to be able to deal with that.

  • ||

    That people refuse to tolerate the realities of a market in the health care industry does nothing to undermine the arguments in favor for it. Even from a utilitarian standpoint, is it better for everyone to have equal access to a stagnated, low standard of care than for levels of care to be stratified by income such that the poor get a low standard of care, but the wealthier get a higher standard of care based on their ability to pay? A higher standard of care that will, of course, become more universal after the early adopters have invested the premium to bring it to scale, the same way that they do in EVERY other industry in the market? Fuck those people, I say. They are heartless. Dividing up a shit sandwich into equal parts that still leave everyone starving so that the bottom 10% won't have to endure the indignity of watching the top 10% eat caviar is sick and immoral.

  • Richard Jones||

    Is it wrong that a rich person is able to afford a private chef to cook healthy meals while the poor eat McDonald's and potato chips? Or hire a personal trainer? Drive an expensive yet safe car instead of a dangerous clunker? Fly first class instead of risking a cross-country drive or bus ride? The poor deal with these inequalities every day, and equality of outcome cannot be legislated or subsidized, not matter how much your heart bleeds.

    But the bright side is that eventually those next-gen expensive cancer treatments will come down in price to be within the reach of the poor, and so their children will reap the benefits.

  • DarrenM||

    A lot of people are NOT going to be OK with a rich person getting through cancer treatment fairly easily while a poor person suffers through the hell of chemo.

    It's better that no one has access to this kind of medical advance than that only a few who happen to be rich can access it (thereby eventually bringing down the price so more people have access ala HD TV, cell phones, computers, etc.).

  • Brian||

    After all, if we'd all spent the last few generations eating swill slapped in front of us at state-run cafeterias, who would feel comfortable describing a world of gourmet restaurants, fast-food drive-ins, greasy spoons, and ethnic food carts evolving all by itself if we just swept away the federal Department of Heartburn?

    Oh, don't talk to me about your utopian free market fantasies. As if there'd be a wide variety of food, available at a wide variety of prices. If there was, it would only be to the extent that it was subsidized or provided with some kind of food "stamp" or something.

    /progtard

  • Sevo||

    I despised the service and got my butt out as quickly as I could. But to this day, I find SOS to be just fine; a 'comfort food'.

  • James Taggart||

    How many foreign doctors would move to the US if they were given visas? More doctors = more supply = lower prices. You say a graduate of the Botswana School of Medicine is not as qualified as one from Johns Hopkins? So what if you are going to see him for some stitches or a sore throat?

    Of course, the AMA would go postal but their real motivation is to limit the number of doctors in order to keep doctors' fees high.

    And, we can call people who oppose this plan racists. That's probably the best part.

  • OldMexican||

    Re: James Taggart,

    How many foreign doctors would move to the US if they were given visas? More doctors = more supply = lower prices.


    I would seriously consider changing careers from administration to medicine if the government finds itself in such a serious bind that it would consider importing medical doctors and caregivers.

    Maybe an on-line course in homeopathy or oriental medicine... Hmm.

  • bassjoe||

    I don't think there's anything inherently wrong with insurance exchanges. Also, the employer-based health insurance system we have now is a piece of crap -- a holdover in the Tax Code originally meant to provide highly-paid individuals with compensation exempt from the 95% tax rate -- which screws people who are self-employed, underemployed or unemployed and in the so-called individual market.

  • reardensteel||

    I've been saying to everyone who's willing to listen for the last couple years that employer-sponsored health plans are the biggest part of the problem.
    WRT the high cost of drugs, I think the FDA isn't so bad in concept, but as is always the case, gov't gatekeepers turn into corruption hubs, rewarding their friends and taking no responsibility for anything. For that reason, I can see a lot of value in limiting the power of the FDA.
    However, there is one practice of which I think some simple regulation would helpful: direct-to-consumer marketing of prescription drugs. In most cases I am not for regulating consumer marketing, as long as it's kept honest. But in this case, consumers are not able to get the product on their own anyway; they need a prescription. So drug companies put huge amounts of money into something that does little more than motivate patients to demand specific drugs from their doctors. Yes, I know it's the FDA who established doctors as the gatekeeper in the first place. Yes, I know the doctor can always refuse to prescribe. And yes, I know this marketing obviously makes more money than it costs, or else drug makers wouldn't do it. But I guess I would just rather have them spend that capital persuading doctors to prescribe their drugs.
    Anyway, it's just one idea and wouldn't solve the many other problems.

  • ||

    Yes, I know it's the FDA who established doctors as the gatekeeper in the first place. Yes, I know the doctor can always refuse to prescribe.

    If you know all that, then why are you proposing for the government to apply further regulatory remedy to a problem caused in whole by government regulation in the first place?

  • reardensteel||

    Probably just b/c I can't stand drug commercials and I think they're so pointless.
    Which... is not a very good reason to regulate.

  • JidaKida||

    Sometimes man you jsut have to roll with it.

    www.Privacy-Web.tk

  • LynchPin1477||

    The problem I have with tax credits and subsidies is that they will inevitably be restricted to use with approved plans, procedures, etc. It is just another avenue for regulatory capture that would end up hurting the poor the most, since they would be the ones having their choices restricted.

  • dan'o||

    I get my healthcare in Mexico. Only narcotics and (recently) antibiotics require a script. Dr visits are 25$, and my doc is a UCLAmed grad, who gives out her personal cell $. To cover my ass here I want an HSA and ridiculously high deductible (low premium) plan to hedge against cancer and other highly unlikely shit for my age group.

  • ||

    Can you improve upon a steaming, maggot infested pile of horse-dung?

    Yes, yes you can.

  • 11bravo||

    The GOP has 3 different plans. All reporters, even this one knows this. Why doesn't he give us the details of those plans?

    We are ready to repeal and replace anytime! Just say the word. I personally do not like any of those plans, but they a far more market oriented.

    Obamacare is basically socialism - as if you guys didn't already know that.

  • Vendula Jackson||

    wow its great method to made wine i never thought before but here i read some interesting point. Plate Forming

  • blist14ant||

    As libertarians we need to speak on healthcare philosophically

  • thorax232||

    Modern(L)iberatarians, replacing statism with statism and calling it "freedom". This is how I imagine abolitionists creating arguments for prohibition.

  • sheila124||

    my best friend's ex-wife makes $74 an hour on the laptop. She has been out of work for five months but last month her pay was $21054 just working on the laptop for a few hours. explanation..........................

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