Well, the latest Republican turn at the jousting tournament that is the debate in Washington concerning healthcare in the United States has passed. Oh Trump, you did try your best to get this one through didn’t you? Defunding Planned Parenthood sure was a bold move; too bad you had to couple it with a reduction in Medicaid expansion, repeal of tax breaks for smaller businesses, and repealing the Individual Mandate and the Employer Mandate (oh wait, or was it just the fee, same effective outcome but technicalities are technicalities after all) while STILL RETAINING the provision in Obamacare that denies insurance companies the ability to deny applicants based on preexisting conditions (the two are mutually inclusive: If you have the mandate on either the individual or employer to buy insurance you need to guarantee people can avoid the penalty by buying insurance and not be denied for preexisting conditions, if you deny the ability of insurance companies to deny coverage based on preexisting conditions then you need the mandate to make sure people are either covered before their sick or at least pay a fee to make up for the costs).
But then again, is there any chance that the outcome would have been different? Was it truly a surprise that a bill that didn’t embrace a single point of free-market insurance reform, would leave more Americans uninsured, and failed to address the central unconstitutional nature of the Mandate (sure the fee’s gone, but we’re still technically required to buy health insurance for ourselves/employees), could ever build an alliance between the Tea-Party born Freedom Caucus Republicans yearning for a restoration of individual and local/state government autonomy in the healthcare system or the Bernie-style progressive Democrats who won’t stand for anything less than single-payer “Medicare-for-all”. Republicans had a chance to unite behind a solid healthcare bill that kept costs low, ensured everyone was covered for basic, emergency, medical care, and fostered the most amount of choice and individual autonomy in all medical decisions not related to basic, emergency, medical care. Instead what did we get: An assortment of nose-thumbing to the poor on Medicaid, encroachments on the market through tax hikes on small businesses, and the worst way to deal with the problem of the mandate that violates the constitution and doesn’t even have the benefit of getting people to buy insurance BEFORE they need it.
Congratulations Trump! Not only did you not succeed in getting the ACA repealed AND replaced with anything decent enough to ensure the goals of coverage and choice were met, now the Bernie Dems are clamoring for a bill to extend Medicare coverage to every American citizen – making us have to submit to the same single-payer fanaticism that dominates the Anglosphere (particularly in the UK where the NHS resembles the VA more than Medicare). Then again, would that be so bad, anyway? As leftists are very fond of saying, all these various countries pay less per capita and yet do better with almost every indicator of the quality of the healthcare system, including longer on average lifespan, lower infant mortality rate, and, of course, no one goes bankrupt to receive medical treatment (paid for by millionaires and billionaires)! Still though, I remain skeptical (must…resist…tipping fedora) of the idea that having the public pay the bill for every individual’s decisions regarding health and safety doesn’t seem very just when the very same people, liberals that is, would defend the right of people to engage in any activity harmful to themselves and their body but not to anyone else (but no mega-gulps, that makes are universal healthcare model look bad). Plus, not everyone has the same preference for healthcare in the long run, some are rugged individualists who want just the minimal amount of coverage in case something truly horrific happens while some are border-line hypochondriacs, most meeting somewhere near the middle. With single-payer, the government utilizes tax revenue to give everyone the same standardized medical procedures for the same diagnosis, if you want anything more, you’ll have to go into the private market – assuming the government even allows it to exist.
So, single payer isn’t the panacea to our healthcare woes that socialists want it to be, what about universal healthcare in general, there’s plenty of ways to skin that cat. Well, I’ll admit this point: Society is necessarily better off when more people are taken care of for basic medical needs, which does not include any experimental or elective procedures. I don’t want to move on to a point about ethics, I’m just going to assume that any proper healthcare model should at least attempt to guarantee all basic, emergency care should be paid for by a public entity. If someone shows up to an emergency room, no matter what the condition might be, it just makes sense to insure all costs for providing immediate care are provided for. Perhaps this point about ethics and universal health coverage is worth expanding on in a later piece, for now let’s focus on the politics of this stance. The American people have decided, pretty firmly too, that anyone who shows up at the emergency room should be taken care of, hence Ronald Reagan (yes, the Republican candidate, Trump!) signed the EMTALA in 1986 to promise that very thing. Unfortunately, it did not ensure that such hospitals were compensated for those services, and while the American people may not love the ideas of having to pay for other people’s emergency care, it would be harder to sell the idea that it is better to do so with higher premiums from private insurance companies recouping their costs of paying higher medical bills that rise due to the fact that those in poverty are receiving the most expensive care and not paying for it. This is why the first round of healthcare reform should extend Medicare to cover all basic, emergency care, which I will define as any care you receive when you call 911 and then an ambulance drives you in (like panic attacks from Trump winning the presidency). The good thing about emergency care is that there is virtually no room for choice: Once you show up on the operating table, your fate’s in the hands of the man right above you. So were Medicare to cover all emergency costs, there would be a very rigid fashion established on centuries of medical wisdom that would dictate what procedures follow what problem, and the public nature of Medicare gives it superior leveraging over private hospitals, thus lowering the cost per procedure.
Oh boy, the socialism sure is strong today, let’s actually get some pro-freedom rhetoric here. Now that we’ve given basic, emergency care over to single-payer, what do we do with the rest of the medical world that falls outside of it. Choice is more of a factor to consider in this area, as well as competition between healthcare providers to deliver low-cost, high-quality plans. The only way to properly do this is through radical liberalization of the healthcare marketplace. While many policies exist to do this, I will keep this piece short by focusing on the three main principles of free-market reform:
1. Allow insurance companies to compete across state lines and eliminate all basic requirements and lifetime caps
2. Loosen the standards placed by the AMA on medical licensing
3. Repeal the IP laws related to medicine – particularly with concern to pharmaceutical drugs
These policies all fixate on one respective, particular form of the market, and utilizes market forces to increase options and keep costs low. The first fixates on the insurance market and forces private insurance to compete against each other nationwide and allows consumers to opt out of unnecessary coverage, a la men paying for OB-GYN care cause “what about the wimenz”. Sorry ladies, but single men have their own health problems to deal with, it’s not as if Viagra™ is covered as an “essential benefit” in the ACA. This will drive down cost as the risk of insuring someone will be massively reduced for each individual. As will lowering the standards to go into the healthcare professions, as it will increase the supply of medical staff, thus lowering overall wages, one of the primary reasons for why healthcare is so expensive in the first place. Finally, completely repeal the intellectual property laws that allow pharmaceuticals to charge monopolistic prices on medicine. Single-payer advocates love to tout the ability of public insurance agencies to utilize superior bargaining power to buy up pharmaceutical drugs and only charge consumers a pittance to purchase them. But rather than greater bargaining power, let’s cut out the middleman and deny these companies the very ability to charge such prices in the first place and keep our tax dollars right in our wallets. Many may object that this would kill the incentive for such companies to invest in R&D and thus innovation will stagnate, however, this ignores many possible avenues for funding. Perhaps a medical version of Kickstarter™ or Indiegogo™ would be a good way to fund research (given that the Pharmaceutical industry relies more on treatment than on prevention or cure to make a profit, this would probably be a better option than relying on them to invent the pill that cures cancer) or perhaps the government, instead of using our taxes to bargain for lower prices could simply fund the research itself. In any case, there should be no ability for anyone to charge AIDS patients an ungodly sum of money for their life saving medication just because they’ve got the patent – doing so can be called nothing short of mass-scale extortion.
Finally, the last round of healthcare reform should involve local governments and individual autonomy. To make this short: Bring back the Mutual Aid Societies. Allow each local government to set up its own healthcare policies with its residents. Travelers will not be a problem, because they won’t be making any scheduled appointments to these facilities, and any emergency care will already be covered under Medicare (see above). Perhaps they will go the Singaporean route and require each person pay into a healthcare trust fund that will diminish the more non-emergency healthcare services are utilized or perhaps they’ll even borrow a lesson from Obamacare and require people buy health insurance just like they require people to have car insurance and then regulate it from there (it’s not unconstitutional when local/state governments set up mandates, and it’s far easier for the citizenry to control).
So what say you Republicans? Ready to throw your donation money from the insurance industry and Big Pharma to the winds and embrace actual free-market reform with the smallest possible concession to the single-payer socialists? If you do, you stand a good chance of taking more future elections, if not then prepare to lose the House, the Senate and the Presidency while Bernie and his bros take away the ability of Americans to choose their healthcare plans among dozens of competing firms and local governments, opting for one federal healthcare plan that inevitably makes wealth pay the unhealthy. But I won’t hold my breath, if I do, my premiums just might go up!