Libertarian Approaches to Health Care Reform

The health care situation in this country is getting sickening. Click here to see how low it can go:

http://news.yahoo.com/let-em-die-tea-party-short-leaders-let-215200152.html

The whole point of the Tea Party is that it's a grassroots movement. Anyone who wants smaller, more sensible government is in the Tea Party, regardless of previous party affiliation, or qualifications to have formed an opinion on any particular issue, or blood alcohol content. (There was more about the blood alcohol content issue at yesterday's Blaze.)

By supporting some Tea Party petitions, I've laid my e-mailbox open to all kinds of stuff from people who supported these petitions and are also pushing all kinds of other agendas. Politics makes strange bedfellows. Support for what you're doing may come from people who are doing other stuff that turns your stomach.

I'm as entitled to call myself a Tea Partier as anyone else is--but since the Tea Party is about opposing Obamacare rather than promoting any specific alternative, my recommendations for U.S. health care reform are my own, not those of the Tea Party. Some Tea Partiers will like these ideas; some won't.

I'm particularly dismayed by the way my Maryland correspondent reported Ron Paul as sounding so old. An answer to today's questions that's obviously unrehearsed and vaguely refers back to the 1960s, or even the 1980s, is unworthy of this candidate. Not as an expert, but as a writer and citizen, I've been following this debate for a few years now, so perhaps I can offer a few ideas that Team Paul can sharpen up into real talking points.

Anyway, here are some thoughts that are ethically acceptable to me, as consistent with the belief that it's wrong for me to impose my personal choices on others, no matter how good for others I think they'd be.

1. Penalize the insurance industry for its unconstitutional power grab. One reason why health care is expensive is that some treatments and medications really cost a lot of money. Another reason is that insurance paperwork eats up everyone's time and energy, and patients have to pay. The most important reason is that, when a patient has a valid claim on an insurance policy, both the patient and the doctor are spending other people's money...and a big faceless corporation that demands far too much of your time is an entity everyone wants to stick it to.

Even if a tube of Bactine is all the patient needs, when there's a chance to stick it to an insurance company, why not throw in the cost of a pricey antibiotic? We all know we need the cash more than the insurance company does. Of course, next year the company makes up its lost profits by charging customers more, and the whole spiral moves up to the next level. Consider the way the costs of simple dental and veterinary procedures have kept pace with inflation, but the costs of anything "medical," even Bactine or wheelchair rental fees, have skyrocketed since the 1980s, when a critical mass of Americans started depending on insurance to pay for these things. (Lots of details and numbers are supplied by Glenn Beck's research team in Arguing with Idiots.)

Recovering some control of health care cost is going to mean either regulating the insurance industry to the point at which it becomes impossible for insurance companies to make a profit, or simply weaning that critical mass of Americans off insurance altogether. Weaning ourselves off insurance would be much cheaper.

I'm uninsured and proud of it, and I recommend that all Americans become uninsured. Force health care providers to rediscover the simplicity of billing at realistic rates, rather than "spending the money of strangers we don't like much." If I break a leg, I'm willing to make payments on the actual cost of setting the bone and constructing the cast; I'm not willing to pay some guy in Hartford or Omaha to play the market.

2. Recognize more qualified health care providers. (This suggestion is discussed at length by Larry Elder in Showdown.) Health care providers at all levels have deliberately tried to keep prices high by keeping competitors out of practice. Often their strategies have targeted the most competent and ethical people in the field. As when Peter Breggin opposed the insurance companies' preference to pay for pills rather than counselling. Or as when the writer known as Priscilla King, then one of Washington's more respected private massage therapists with regular clients in the Clinton White House, persisted in treating massage as a spiritual matter first and a commercial matter second. But that's a different rant.

One of the most obvious strategies for fending off competition is to demand that all practitioners be trained at schools that charge outrageous tuition fees. In the interest of improving the quality of American health care, and also in the interest of getting a more balanced representation of underprivileged minority groups in the field, Larry Elder has proposed that financial barriers be lowered to allow more academically qualified, physically fit students to attend medical school. Since medical students are students who haven't lived long enough to earn money of their own, demanding that huge payments be made on their behalf shows neither common decency nor common sense. By all means, medical schools should insist on giving only the smartest and toughest students a chance to become doctors...but Daddy's ability to take out multiple mortgages has nothing to do with a potential doctor's qualifications.

3. Doctors should be as humanitarian as lawyers. Health care providers' associations should require, as the bar associations require, every practitioner to put in a certain amount of pro bono work for indigent patients. I said this on Associated Content, years ago, and got lots of flak from readers in the health care industry. I'll say it again. As a lowly masseuse who never charged more than $50 an hour, I was able to afford one pro bono day per week. If doctors don't feel able to afford that, I'll be happy to share some frugal living tips with them.

4. In lieu of accepting punitive damages, health care providers should accept a financial loss on treatments that don't work. If I break a leg and a doctor is kind enough to set the leg so that I can walk on it again in a few months, gratitude is going to motivate me to pay the doctor before I take any vacations. If I break a tooth and a greedhead dentist says "Oh, this is a surgical procedure, so you have to have a general anesthetic," without even bothering to find out that I'm Irish-American and may well have inherited a fatal intolerance to all general anesthetics, the least that dentist should be able to expect is to receive no payment for that day's work.

(Actually, for real-life friends who may be wondering, Dr. John Collins--why take my unsupported word, you can see his rating here--already knows that I'm Irish-American, Highly Sensitive to all kinds of substances, and adept at using deep breathing for pain control. I used the example of a hypothetical greedhead dentist in order to blur the identity of another health care practitioner.)

5. When medical disasters happen, communities should step in. In communities whose hospitals are affiliated with churches, the default assumption is that the church will help. When this possibility is discussed on the Internet, it always makes trolls sputter because they don't belong to the church and don't want to become a church's "outreach project." However, neighborliness is not confined to churches.

In my home town, one of the main forms of entertainment is a "benefit singing." This is a concert by one or more professional musicians who donate their time, for an audience who know that someone needs lots of money to cover medical expenses. People who are too frugal to go to movies, ball games, or the Carter Fold will donate a few hundred dollars toward a cause like "Eyes for Eileen." If the concert doesn't raise enough money, businesses will set out jars on their counters...and I see these jars filling up with cash.

In Washington, charity is the traditional excuse for parties, dances, and social networking. Yes, we all know that some of the more fashionable "charity balls" spend ten dollars on overpriced eats'n'drinks for every dollar they actually give to the cause...but it doesn't have to be that way. I've helped people plan and throw less publicized parties, the kind Zahara Heckscher has been known to call "friend-raisers," where the cost of the party was less than a tenth of the funds raised for the cause.

Social clubs have also helped many people with their medical bills. Shriners are famous for clowning to raise money for children's hospitals; smaller groups, like the House of Ruth, quietly dedicate a portion of their membership fees toward members' medical expenses.

Hospitals and the various "disease foundations" have been known to help patients meet their expenses. People may be asked to contribute to funds on behalf of a particular hospital, or on behalf of a particular disease.

Historically, when these were the only ways people raised money to cover medical expenses, they were not enough to take care of all the needy patients...and doctors. However, when the various voluntary-donation systems weren't meeting the needs of the community, the inadequacy was self-evident and generated additional funds as needed.

There is no getting around the fact that the twentieth century's Welfare State ideals have created a colossal debt. Paying is not going to be pleasant. My generation's retirement is not going to be as secure as our parents' and grandparents' retirement. Chances are that, within my lifetime, even the United States will cease to be a nation where our stereotype of "poor people" is fat, flabby people who own a couple of battered old cars and watch a lot of cable TV. But if we can just bite the bullet and accept that the government can't afford to keep "poor" Americans living like the kings of nineteenth-century Europe forever, maybe we can recover enough of our grandparents' sense of honor to understand that "let'em die" is not an option.

The vast majority of Americans' real health care needs, when not inflated by the practices of the insurance industry, have always been met by the patients themselves: when fit to go back to work, they went back to work and paid their medical bills. This should never have been allowed to change. In cases where the best-case outcome for a patient may not allow the patient to go back to work, or the only way to keep a patient alive actually costs more than the patient could pay, we need to rediscover the idea that filling in this gap for our neighbors is a point of honor for each of us.

Some may say, "If it's not institutionalized, it can't be guaranteed." Maybe not. Historically, when church and community funds were the default for filling in any gap between someone's survival need and ability to pay, there were times when those funds were depleted, and poor people died. There were disasters that impoverished whole communities together, and neighboring communities weren't always able or willing to bail them out. Maybe we don't need to discard the whole idea of federal rescue funds, but...

6. Government assistance programs can learn a lot from the Army. The Veterans Administration has developed a typical military-type system--not pleasant, but efficient--for meeting veterans' medical expenses. In an emergency, the veteran can always go to a V.A. hospital, but it's likely to be more convenient and less unpleasant if he (or she) has an ordinary patient/doctor/hospital relationship as the default option. The veteran is expected to pay as much up front as possible, and, if at all possible, pay the rest of the bill within a year. If there are enough unpaid expenses, or if the veteran has paid enough expenses, to make it worthwhile, at the end of the year the veteran can submit a claim for V.A. funds. The V.A. will then either pay the health care provider, or reimburse the veteran, as necessary. Of course, someone who has been fairly healthy, and whose doctor charges only $25 for a checkup, will probably opt to skip the hassle and absorb his or her own health care expenses.

I propose that, while weaning ourselves off the insurance gambling scheme and rediscovering the financial independence that all other cultures on Earth have considered an essential part of adulthood, we bring state and federal aid programs closer to the V.A. model. No encouragement to hypochondriacs, no enabling for addicts, no "marketing" of pills. If patients really want/need treatment, let them make every effort to pay for it for a year. Any public funding assistance will come after the patient has done what the patient can.