• Tag Archives health care
  • Obamacare Is Dying. Let It

    Obamacare Is Dying. Let It

    The alleged failure of Republicans to repeal the misnamed Affordable Care Act (ACA) predictably has the conservative punditry up in arms. “Why Can’t Republicans Get Anything Done?” was one of many frustrated headlines lamenting the GOP’s lack of legislative success.

    One editorial asserted that Republican failure to ‘do something’ about the ACA “is one of the great political failures in recent U.S. history, and the damage will echo for years.” Really?

    Implicit in all the conservative ranting about the need to repeal, or worse, fix the ACA, is that health care was a wholly unfettered, dynamic source of free-market driven innovation before President Obama was elected. Let’s try to be serious for a moment.

    Letting Obamacare Fail

    Repeal of the ACA would have been an impressive headline, but the short and long-term politics of repeal for Republicans would have been worse than doing nothing. That is so because expectations about a looming nirvana would have been created, only for health care to, at best, return to its less-than-stellar-self that existed before passage of the ACA in 2010.

    Importantly, none of what’s been written so far should be construed as support for the ACA. It was foolish legislation, and evidence supporting the previous contention is that the ACA was already dying before our eyes. No surprise there. Legislation meant to give some Americans a lot for a little, with a lot taken from others in return for very little, was bound to fail.

    The ACA was plainly imploding as the constant rush of insurance companies out of ACA exchanges revealed in bright colors. Why abolish what the laws of economics were already abolishing?

    And that’s why the half-measures offered by Republican compromisers were plainly worse than simply doing nothing. Why legislate away one central plan in return for an allegedly improved central plan; essentially exchanging bad legislation for bad legislation on top of what already wasn’t working before 2010? The politics of repeal or partial repeal spoke to the horror of Washington doing anything to legislate a right to what was and is a market good like any other.

    Not discussed enough by either side is that it’s impossible to invent a right to a good or service of any kind to begin with. This is certainly true with regard to health care when we remember that it didn’t realistically exist until the 20th century. Lest we forget, in the 19th it was a death sentence if you were shot in the abdomen. If you broke your femur, you had 1 in 3 odds of dying. Broken hip? Dead. Cancer? Forget about it. You were going to die.

    Legislation didn’t reverse the previously mentioned odds as much as trial and error in the area of healing led to healing advances such that a market eventually formed. The shame here is that politicians discovered health care in the first place. Imagine how much more advanced we’d be had they left what was advancing alone.

    We Don’t Have a Crystal Ball

    All of the above has seemingly been ignored by Republicans ever eager to prove they’re as compassionate as their reliably hysterical opponents on the other side of the aisle. And there lies the problem.

    Much as health care didn’t broadly exist when the 20th century dawned, so were automobiles the microscopic exception to the horse rule. Imagine if politicians, sensing what few did about the car’s potential, had legislated broad access to what very few people owned. If so, it’s safe to say that the American automobile industry would never have taken shape, mainly because politicians can’t possibly divine what we want, let alone need. The car evolved into a common good thanks to relentless experimentation that occurred alongside a 99% percent failure rate for American car companies.

    Thinking about the computer, while few could get by without one today, as late as 1943, IBM Chairman Tom Watson confidently asserted that the market for computers wouldn’t expand beyond five total computers. Decades later, and billions of dollars worth of failed companies later, the computer is the can’t-live-without rule, including the supercomputers that increasingly line the pockets of rich and poor alike.

    At present, politicians in both major political parties are thinking about ways to spend trillions in tax dollars on enhanced roads, just as entrepreneurs like Jeff Bezos are aggressively thinking of ways to deliver us goods and services by air, care of drones. Yet conservatives are comfortable allowing Republicans to add more laws to an already over-controlled health care market?

    Despite the historical truth that the present rarely predicts the future of goods and services, politicians in both parties pretend that they know what the market for health care should look like. But how could they?

    For Republicans and Democrats to legislate a right to medical services in the present is every bit as lame-brained as it would have been had they legislated access to specific kinds of cars, computers, and smartphones in 1900, 1950 and 2000. Whatever they would have dreamed up for all three would have been a fraction of what intrepid entrepreneurs divined through feverish trial and error.

    What Is and What Will Be

    Seemingly forgotten by Republicans is that legislation is the absolute worst way to solve any problem, real or imagined, particularly one involving goods and services created in the marketplace.

    Lawmaking by definition deals with what is while thriving markets are all about sleuthing out what will be. We’ll only arrive at what will be in the health care space insofar as individuals and businesses are free to experiment without limits, yet Republicans and Democrats in their infinite confusion are trying to create rights for people with what already is.

    Ok, but that’s cruel. It’s the hypothetical equivalent of politicians legislating access to the cars, computers, and smartphones of today at a time when all three were likely on the verge of rapid evolution. Health care is no different. If the goal is that everyone should have access to it, the only response from Congress should be that it will cease legislating access to what it can’t give, and more important, what it doesn’t understand. If so, watch health care markets evolve in amazing ways that redound to us all.

    Reprinted from Real Clear Markets.


    John Tamny

    John Tamny is a Forbes contributor, editor of RealClearMarkets, a senior fellow in economics at Reason, and a senior economic adviser to Toreador Research & Trading. He’s the author of the 2016 book Who Needs the Fed? (Encounter), along with Popular Economics (Regnery Publishing, 2015).

    This article was originally published on FEE.org. Read the original article.


  • Health Care Is a Mess… But Why?

    Health Care Is a Mess… But Why?

    You probably know a couple who both work full time to support their children, but even with their dual incomes, they’re finding it more and more difficult to afford health insurance.

    Everyday incidents like sports injuries, asthma, and blood pressure, combined with their anxiety over rising premiums, are turning their American dream into sleepless nights.

    Why can’t people catch a break? It wasn’t always this way!

    According to the Consumer Price Index and Medical-care price index from 1935 to 2009, the health care spending crisis didn’t start until the mid 1960s, around the same time when Medicare and Medicaid were signed into law, and at the same time that we began requiring doctors to go through all sorts of expensive licensing procedures beyond medical school.

    Since then, health care spending has doubled, even adjusted for inflation. Why? Well, there are a few reasons.

    Everyone wants health care, but there’s only so much to go around. And short supply leads to high prices. Normally what happens in a marketplace is that when prices are high, entrepreneurs try to profit by finding more affordable ways to provide goods and services.

    The more people become involved in providing these services, the less scarce they become and the lower the prices drop, so that over time, more and more people can afford them.

    This is what happened to televisions, microwaves, computers, cell phones, internet service, delivery services, food, shipping, transportation/air-travel, entertainment, home security, fitness, yoga, massages, and even all the medical technology, like LASIK, that isn’t as heavily regulated or controlled by government.

    Can’t government drive down the price of goods and services like the free market?


    Let’s look at what happened with Medicare and Medicaid as an example. In 1965, these two single payer health insurance programs were instituted in the US. These programs made the unfortunate less dependant on impartial private charities and more dependant on political institutions and pharmaceutical companies.

    On top of that, these programs constantly require tax increases, and because they function more to satisfy the health care industry than the worker, they continually lead to more expensive and wasteful ways of treating patients.

    As a result, prices shot up, making it even more difficult for people to afford health insurance. Not only that, but in 1965, government took over the training of new doctors, and in 1997 they limited the number of new doctors they would train at 110,000 per year – and the number hasn’t changed since!

    Even worse, our government won’t let migrant doctors from developed western countries practice in the US without undergoing this training. So, not only do experienced doctors from other countries not want to practice medicine here, but the ones who do are taking up 15% of those few 110,000 slots, limiting the supply of doctors even more.

    Won’t Obamacare solve these problems?

    Unfortunately, Obamacare suffers from similar problems. It eliminated the pricing structure by seriously restricting competition because all providers have to offer the same kinds of plans at the same price. And because that price isn’t really determined by the market, providers can charge the taxpayer way more than they could otherwise. It’s basically just a handout to big insurance companies.

    But it doesn’t have to be this way! If we get the government out of health care, more people like those you know will be able to get the care they need.


    Seamus Coughlin

    Seamus Coughlin is a comedy writer and animator with a deep interest in politics and morality. A good deal of his work can be found on the FreedomToons YouTube channel.

    This article was originally published on FEE.org. Read the original article.


  • Why the Swiss Health Care Model Will Never Work in America

    Why the Swiss Health Care Model Will Never Work in America

    If you’re wondering what in Hell is actually going on with U.S. health-care policy, the short version is this: Policymakers in both parties are trying to replicate Swiss policies in a country that isn’t Swiss.

    The Affordable Care Act was, as thinkers as different as Paul Krugman and Avik Roy both observed, an attempt to Swiss up the U.S. health-insurance and health-care markets. (Obligatory reiteration: Those are not the same thing.) The Swiss system, Santésuisse, achieves one big progressive goal — universal health-insurance coverage — while offering much to please conservatives: a private market for health insurance and health care, consumer choice, and relatively low government spending on health care.

    Obamacare vs. Santésuisse

    Santésuisse is, in its broadest strokes, a lot like the model established by the so-called Affordable Care Act — a model that is kept in large part by the Republicans’ “repeal-and-replace” proposal, which neither repeals nor replaces the Affordable Care Act, though it does make some substantial changes to it.

    Like Obamacare, Santésuisse mandates that all citizens purchase insurance from private insurance companies; establishes by law a minimum package of acceptable benefits to satisfy that mandate; subsidizes health-insurance premiums for lower-income people, with a goal of keeping their insurance premiums to less than 10 percent of their incomes; mandates coverage of preexisting conditions and imposes “community rating,” which means that low-risk insurance buyers pay higher premiums to allow for high-risk buyers to pay lower premiums, though the Swiss do make some adjustments for age and sex (!); it imposes controls on procedure costs and reimbursement for providers.

    The Swiss model also does a few things that ACA does not: It requires that insurance companies offer their minimal policies on a nonprofit basis; it is structured around relatively high out-of-pocket expenses (high copays and deductibles) in order to encourage consumers to spend soberly; and, perhaps most important, it does this in the context of a health-insurance market that is entirely individual: There are no employer-based health-insurance plans in Switzerland. Everybody buys his own health insurance, the same way people buy everything from tacos to mobile-phone service. Swiss regulations also mandate that prices be made public, which helps consumer markets to function.

    The Cost of Health Care

    In terms of government spending on health care, Switzerland isn’t terribly different from the United States. Indeed, with the exception of high-spending Norway, per-capita government spending on health care is pretty consistent across a selection of advanced countries with very different health-care systems: Switzerland, the United States, the Netherlands, Sweden, Germany, and Denmark all have similar per-capita outlays. Interestingly, none of those countries has a national single-payer system: Sweden and Denmark have largely public systems, but they are run mostly by local governments rather than by the national government.

    Among countries with single-payer systems, there is a fair amount of variability in per-capita spending: Australia, for example, has lower government spending than does the United Kingdom.

    In terms of total spending — government and private spending together — countries with quite different systems lead the pack: The United States spends the most, followed by Switzerland, Norway, the Netherlands, Germany, Sweden, Ireland, Austria, Denmark, Belgium, and Canada. (These are OCED statistics from 2014.) The lack of a robust relationship between health-care systems, health-care expenses, and health-care outcomes suggests that the most powerful determinants of these are exogenous to policy, things like national demographic characteristics and economic conditions: Older people with lots of disposable income will tend to spend more on medical services, the Swedes and Okinawans have been healthy and long-lived under a number of different health-care systems, etc.

    Which is to say, one of the reasons the Swiss and the Americans spend relatively large sums on health care may be the structure of the insurance markets; it might simply be that they are rich countries in which consumers choose to consume more health care, which would explain why Sweden and Canada are in the club of relatively big spenders. And low medical spending is not necessarily a sign of health: They don’t spend very much on health care in Cameroon.

    Cultural Differences Matter

    As Avik Roy and others have pointed out, trying to build Swiss health-care architecture on American foundations is a project by no means guaranteed to succeed. Switzerland, for example, has enjoyed very strong compliance with its national health-insurance mandate. Part of that is cultural (the Swiss are rule-following people), and part of it is that Swiss government: If you fail to comply with the mandate, the Swiss government will garnishee your wages and charge you a penalty equivalent to the cost of the premiums plus up to 50 percent, and, if you persist, the government will sign you up for an insurance policy and allow the provider to sue you for back premiums covering the period during which you were uninsured.

    The American version is a little less robust, to say the least: The ACA mandate is “enforced” with a very small penalty that in most cases is nowhere near as expensive as signing up for insurance. That is, the Swiss have a system under which compliance makes economic sense, and we have a system under which non-compliance makes economic sense.

    The Affordable Care Act was designed in a dishonest way, front-loading the revenue and backing in the expenses in order to get a nice budget score from the Congressional Budget Office. The CBO rolled its institutional eyes at this, and its report suggested very strongly that its analysts did not believe a word of what they were writing, inasmuch as the most popular parts of ACA were likely to be enforced while the unpopular bits — like the “Cadillac tax” — would be put off or softened, resulting in a program that in reality cost much more and produced less revenue than it did in the model version that CBO scored.

    Sure enough, Hillary Rodham Clinton and Bernie Sanders both campaigned against the Cadillac tax (it hits their union foot soldiers first and hardest) while the House and Senate Republican plans would keep in, in theory, but put off collecting it until 2025 — at which point the smart money would be on its being put off again.

    If you want a Swiss health-care system, then you have to be willing to accept ruthlessly efficient Swiss enforcement and an unsentimental Swiss bottom-line view of the program. Neither party is interested in that: The new Republican health-care plan would formally do away with the individual mandate while keeping a form of the preexisting-coverage rule, which is, the protestations of the bill’s drafters notwithstanding, probably going to be unworkable.

    As long as you have a mandate that insurance companies cover preexisting conditions (i.e., that they place bets against events that already have happened) then you really have to have the mandate that people buy insurance, too; otherwise you create incentives to forgo buying insurance until you are actually sick, creating insurance markets composed mostly of sick people, a model that is not economically sustainable. If you want to cover preexisting conditions, then you have to have a mandate and enforce it strongly — Switzerland’s compliance rate is about 99.5 percent.

    For comparison, the United States mandates that drivers carry automotive insurance, and about one in five drivers fails to comply with that mandate. And while the enforcement is tougher, the subsidies are less generous. Two-thirds of the Swiss receive no health-insurance subsidies at all, and the subsidies that are received tend to be relatively small except for the very poor.

    But what is most critical may be that the Swiss model is free of one big problem that most Americans do not see as a problem at all: employer-based health-insurance programs. The Swiss market is an individual market, but most insured Americans get their insurance from their employers. Doing away with that would provide real benefits, but it would also bring a great deal of stress to risk-averse Americans who are, in large part, satisfied with their employer-based insurance plans. A Swiss system in the United States might — might — be a good idea, or at least better than the status quo ante of 2009.

    A Swiss system with no real enforcement, sloppy economic thinking, and no dynamic, consumer-driven insurance market? A Swiss system that replaces Swiss efficiency with American sentimentality? It didn’t work when it was called Obamacare. It won’t work when it’s called Trumpcare or Ryancare or McConnellcare, either.

    Reprinted from National Review. 


    Kevin D. Williamson

    Kevin D. Williamson is roving correspondent for National Review.

     

    This article was originally published on FEE.org. Read the original article.