Reason TV's health-care coverage has always viewed the Affordable Care Act in its properly Sisyphean context: Obamacare is a government fix for problems created by an earlier government fix for problems created by an earlier government fix. How best to fix the U.S. health care system? Undo all the earlier fixes.
So our videos have highlighted the ugly mess U.S health care was before Obamacare and how Obamacare made something terrible even worse. Medicaid has done a poor job of serving America's poor, so Obamacare expanded the program. State laws allowed large hospitals to block new competitors, so Obamacare made it even harder for new health care facilities to open. Because of a quirk in U.S. tax policy, insurance policies cover even routine medical costs, which leads to general price inflation. And so Obamacare piled on new rules and mandates that cover yet more procedures.
Reason TV has profiled health care entrepreneurs who've found innovative ways around all the government rules to actually lower prices and improve patient care, offering a glimpse at what medicine would look like if only the government would get out of the way and let markets function.
Here's a quick tour of highlights from our past coverage.
"Can Medical Tourism Save Us From Obamacare?," Reason TV, January 29, 2013.
About 50,000 Canadians go abroad every year for treatment at a foreign hospital, escaping a single-payer system that makes patients wait on average four months for non-emergency procedures. As the U.S. health care system becomes more like Canada's, medical tourism may become just as vital in this U.S.
Medical facilities abroad show what happens when patients cover their own health care bills, and doctors and hospitals have to fight for their business. In India, heart-valve surgery costs one-tenth the U.S. price; in South Korea, gastric bypass surgery costs about half what American hospitals charge. Thailand's renowned Bumrungrad International Hospital, which serves 400,000 foreigners a year, is home to some of the world's best clinicians. Medical travelers aren't confined to windowless rooms and fed tater tots and jello cups—foreign health care facilities treat their patients like guests at a resort, offering a holistic approach to wellness and healing.
"Oklahoma Doctors vs. Obamacare?," Reason TV, November 15, 2012.
Dr. Keith Smith, managing partner of the Surgery Center of Oklahoma, did something that would only be considered radical in the health care industry: He posted his all-inclusive prices, often a small fraction of what traditional hospitals charge, on his website. Patients started showing up from around the world.
Smith can maintain unusually low prices because he's figured out a way to solve many of the coordination problems typical at U.S. hospitals. Surgeons and patients don't have to wait around while support staffers struggles with the basic logistics of moving patients from preoperative care into the operating room. The Surgery Center's impeccable operations explain why many of Oklahoma's top doctors favor the facility as a place to perform their procedures.
Oklahoma City's largest traditional hospital Integris pays its top 18 administrators average salaries of more than $400,000; Smith, himself part of the Surgery Center's team of anesthesiologist, has no dedicated administrative employees. "One reason our prices are so low," says Smith, "is that we don't have administrators running around in their four or five thousand dollar suits."
"Treat Me Like a Dog: What Human Health Care Can Learn from Pet Care," Reason TV, February 25, 2010.
Why does Oklahoma City have an unusually consumer-friendly health care sector that's made it possible for people like Keith Smith to do business? Twenty-five years ago, the state rolled back its Certificate of Need (CON) laws. As
Ted Balaker reported for Reason TV back in 2010, CON laws, which are still in effect in 35 states, explain in part why dogs and cats often get better medical treatment than people.
CON laws, which differ slightly state-to-state, generally empower local planning boards to block new medical facilities from opening on the grounds that they're providing new supply that could drive down prices. "The existing hospitals go in front of these government agencies and say, 'we don't need any competitors, we're taking fine care of the people,'" Reason's Ron Bailey told Balaker.
Entrepreneurial vets, on the other hand, face no artificial barriers to entry. Dr. Peter Weinstein, executive director of the Southern California Veterinary Medical Association, opened his doors in about 12 weeks. "In veterinary medicine," says Weinstein, "we could have two practices right next to each other and then it's the consumer deciding to whom they want to go."
"How Medicaid & Obamacare Hurt the Poor—and How to Fix Them," Reason TV, April 25, 2013.
If the U.S. were to move to a market-driven health care system in which most patients paid their own routine medical bills out of pocket, many Americans would still require assistance.
Medicaid, the safety net program we have, is a disaster. The program often pays doctors so little that it's difficult for recipients to get an appointment, which is why they show up at emergency rooms at nearly double the rate of the privately insured. The challenges Medicaid recipients face in getting basic care explains why they're more likely than even the uninsured to have late stage cancer at first diagnosis, and they're about twice as likely as the privately insured to die in the hospital after surgery.
What would a better safety-net program look like? Dr. Alieta and Dr. John Eck, primary-care physicians based in Piscataway, New Jersey, who run a free health care clinic in Somerset, New Jersey, have an idea.
"Obamacare vs. Samaritan Health-Care Ministry: A Case Study," Reason TV, October 1, 2013.
Before there were large government programs like Medicaid, many Americans turned to "mutual aid societies" to help pay their medical bills. In 1910, an estimated one-third of American men belonged to one of these organizations in which members pitched in to help each other during times of need.
"Health care sharing ministries," which are some of the last mutual aid societies still around, highlight what's wrong with our insurance-driven health care system—and the unintended consequences of Obamacare's health care exchanges.
"Would Hayek Have Approved Obamacare," Reason TV, February 14, 2013.
Would the great patron saint of contemporary libertarianism and champion of pricing as a system for conveying knowledge have supported the Affordable Care Act?
In an interview with Reason's Nick Gillespie, George Mason University philosopher Erik Angner talks about his 2012 Politico op-ed in which he argued that Hayek may have liked certain aspects of Obamacare, such as the individual mandate and some sort of redistribution to the poor. At the same time, Angner says that Hayek would have staunchly opposed any policies that hobble the functioning of a price system. The bottome line: It's possible to provide for the poor without beating market incentives out of the entire health-care industry.