Tuesday, July 8, 2014

Health-care realities vs. free-market fantasies

  Black helicopter watch can get lonely, even if there's one always just over the horizon.

  Any day now, for instance, President Obama will assemble the death panels of his health-care designs, appointing the extraterrestrials we suspected he would, to a thousand cable-televised told-you-sos.

  So much that was evil, we were told, would dawn with the Affordable Care Act. Most assuredly it wouldn't include 30 million newly insured Americans not even one year on.

  One loses track of all the things by the ACA's most ardent foes assured us would happen. On this occasion, however, it's worth looking at one claim uttered over and over, and which will be uttered over again.

   The claim: that the ACA used Medicare as "its piggybank" – that it took, stole, confiscated, filched, pilfered, over $700 billion from what was set aside to care for your grandparents and mine and to assure the future of the Medicare trust fund.

   That claim not only is fallacious but doubly so. Most of the money in question is calculated savings on hospital reimbursements under Medicare, a crash diet, if you will, regarding overcharges that have been a national scandal. Not only do these savings mean less of an obligation for taxpayers, but as Factcheck.org explains, they significantly "prolong the life of the Medicare trust fund."

   That's a good thing. So is this: With tighter Medicare criteria setting the standard, increasing numbers of hospitals are reining in costs, saving themselves and their patients money in the process.

    Kaiser Health News recently focused a report on hospitals in Utah which had established a data base to track the cost and quality of services to all their patients. So doing, instead of the typical cost run-up, Utah hospitals actually spent less – $2.5 million less – in the last year, without sacrificing quality.

   One big factor in this: constructive pressure from the Medicare system to do things differently.

   Yeah, we know – government ruins everything. Well, when Time magazine's Stephen Brill spent a year studying why hospital bills were so insanely out of proportion, he found a hero and a model for getting us out of this mess: Medicare. Every hospital bill abomination was cast in stark contrast to Medicare's clear-eyed price-setting mechanism.

   Where these comments are headed is this: Some readers don't want to hear it, but the answer to what long has ailed health care is, yes, more government.

   Health care is something the free market cannot do by itself.

   It cannot care for people scraping along in the ranks of the poor and the elderly. It cannot care for people with pre-existing conditions, or those who have no employer-based health coverage and can afford no alternative.

   The free market cannot regulate prices fairly in health care, largely because actual competition is alien to the industry, whether it be making drugs or removing tonsils. The consumer is captive to virtual-to-absolute monopolies.

   And anyway, hospitals are no more private enterprises than is the Pentagon. They are inextricably linked to government and public policy. That is never going to change. So, let's get real and get the most out of what government can do to make health care fairer and more equitable.

   What an odd statement it was when the Supreme Court ruled that a business owner could apply religious tests to what kind of health coverage employees could have. But welcome to the odd coupling of private and public interests inherent in ACA's employer mandate.

  And that says nothing about the role of private insurers who can, and did, drop policy holders on a moment's notice.

   Don't want the government telling employers what they should do? Support a single-payer approach. Get real. To meet the needs of the uninsured and to hold down health-care costs, free-market fantasies don't work. They never have. They never will. 

   Longtime Texas newspaperman John Young lives in Colorado. Email:jyoungcolumn@gmail.com.


Marianne Hoynes said...

I am so glad you understand that the only way we can possibly have health care justice in this country, is via a single payer, improved medicare for all system, and that the government must run it as efficiently and as well funded as is Medicare. That is to say, the government should not be looting medicare, any more than the government should loot a fully funded single payer system, with our tax money. It is a shame you save that conclusion for the end of the article, though- I would like to hear more correlations in the meat of the article, about the failings of the ACA, and what being tied to Big Insurance actually means for the US population. For example, it sounds in the beginning like you are defending the ACA, talking about the types of criticism the current obamacare program has come under, or has been accused of. you write, "Most assuredly it wouldn't include 30 million newly insured Americans not even one year on". Let me say that it is the official White House stance, that the ACA was never meant to cover 30 million Americans. Here is a link from the Congressional Budget Office on just that:


Thus far, the solution for the poor is to be dumped into Medicaid, a program for the poor that doctors are not even required to respect. Doctors do not have to take medicaid patients, and virtually no specialist will take a medicaid patient. If some kind of specialized care is needed for the health of the poor person, and is available in another state but not in their state of residency, tht person would be declared UN-insured if by some miracle they were able to go for that care in another state, as medicaid only covers the person in their state of residence. Some great examples are hospitals like the Cleveland Clinic, Johns Hopkins or the Mayo Clinic- specialized places that are among the only ones in the country who deal with rare heart issues, autoimmune diseases and neurological diseases. They treat people from all over the country and the world, for rare condiditions or those in need of ground breaking procedures, like a face transplant. This ENSURES that the poor will be underserved, a problem that the US Government knows about fully, yet has done nothing to correct, as our jobs are shipped overseas, and unemployment rates are at their highest. The only solution is a single payer system, and the American people are given no choice. We are now tied to a completely unregulated health insurance industry, that has been the very reason why Americans are made to feel so desperate for health care to begin with. We are tied to an industry, where our needs are a loss to their bottom line, and THIS seems to be the BEST that the Democrats have to offer. Nationalized Romneycare.

Bert Loftman said...

We do not have a free market in medical care because tax incentivised-employer owned health care is not a free market. it is corporate socialized medicine. After watching the federal government run the VAH, I am disinclined to let them run the health care system.

Charlie G said...

Unfortunately, just as other libs, you conveniently leave out "realities" of the ACA. Why didn't ACA allow inter-state sale of policies to address your statement about free market competition? You must include the "reality" of the numerous exclusions/delays of various ACA regulations to make citizens think the law isn't as terrible as it really is....also, remember the "if you like your Dr. you can keep your Dr."? What you libs really want is a single-payer system...there is way too much government in our lives already!!!