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Is the Patient Dead? Or Is he Frankenstein’s Monster?

26 Mar 2017

Ted Poe, R-NC, and a House member of the Freedom Caucus, has quit the group, uttering these words among others:  “saying no is easy, governing is hard.”  This was in reference to the Caucus’s opposition to the American Health Care Act, which was pulled by Paul Ryan before a vote.  Poe says he wants to be more effective as a senator by finding common ground with Democrats as well as other Republicans.  I am certain that my view on Poe’s words and the bill’s fate will be thought wrong-headed.

Nevertheless, I believe Poe was wrong.  Saying “no” is not always an easy thing to do, but is sometimes the best thing to do to govern well.  Don’t we say “no” to our children?  Don’t teachers say “no” to students?  Don’t the police say “no” in a different sort of way to real and potential lawbreakers?  Don’t judges say “no”?  I could go on.  But the point is we should not always give someone what they want just because they want it, and especially in this case, for largely political reasons.

The AHCA was fatally flawed, and passing it with the very slim hope that we could get to Phases two and Three was not going to help.  The bill did nothing to create any conditions for competition in the healthcare and insurance market and did create incentives to raise premiums and to cause a “run” on the use of health care and on insurance.  Now it did repeal the mandate and that is fine.  But it did little else to create a truly quality healthcare system and insurance market.  By the way the figure provided by the CBO on how many people would lose their coverage were misleading.  A good deal of that is calculated as those who voluntarily opt out–they don’t want insurance even though they can afford it.  Nevertheless, the CBO only compounded the perceived problem.

It is time someone said no at the risk of political damage, and for Congress to start looking for a feasible bill that addresses both sides of the issue: demand and supply.  In addition, the poverty issue must be disconnected from the healthcare problem.  Let me explain.

The first thing we must do is think about healthcare separately as a bundle of commodities from poverty.  Both issues are important.  But using the healthcare market as a vehicle for addressing an income problem for some destroys the very market one wants to make better for all.

We first make the healthcare “industry,” including insurance competitive so that we achieve lower costs, and therefore prices, more choice and even better quality in the long run.  That by the way will help many who otherwise could not afford healthcare.    How?  There are several fronts on which to address this issue.  Here is a brief list:

  1.  allow free competition among insurance providers across state lines.
  2. remove regulations that stifle insurance providers–and in some cases, protect them from competition.
  3. make it easier to get into medical schools, not by reducing standards, but by admitting more worthy applicants to medical schools and removing meaningless barriers to new medical school establishment.
  4. removing state barriers to entry of new healthcare providers–like hospitals, or services such as MRI, etc.
  5. requiring healthcare providers and insurance companies to price openly and transparently for all services.
  6. allowing different and separate providers to offer different services–why should a doctor or hospital be the only ones allowed to provide certain health related services?
  7. separate the insurance from the employer, so that an individual is able to transport his policy wherever he or she goes.
  8. address the pre-existing condition problem.  Here I am at a loss. It seems we have reached a crossroads in our view of entitlement and many view insurance as simply a transfer program whenever they decide they want to get insurance or encounter a problem not covered by their existing insurance.  Health care is not a right in my view (though it has been asserted by many as such in the past 70 years–see Franklin Roosevelt’s “Second Bill of Rights” of 1944).  How should we handle this?  Perhaps we could allow people to purchase policies that cover any condition–but we should not require this.  And it could be expensive.

My last issue points up a major problem we must face collectively.  Do we believe healthcare is a right or an entitlement?  If we do then I suppose we cannot even discuss the problem of pre-existing conditions, even though it is not an insurance issue if we cover it.  Either we begin to tell the truth that a healthcare system cannot be viable if everyone can simply get insurance whenever they choose or we throw up our hands and use taxpayer money to pay anyone any time for any condition whenever they can show some condition.  That of course is the end of insurance, if it had survived at all.

I suspect Americans have unfortunately reached a point where a majority can and would vote for the others to support them, no matter what.

But moving on to another element of this issue, if we try to make healthcare more competitive what do we do about those who really can’t provide for themselves, who really are poor?  This is where I separate the health issue from the poverty issue.  For the relatively few who cannot afford healthcare (assuming we still have real insurance and not everyone claims to be “poor”) we do something like give them the money directly and allow them to use it for healthcare expenses using any doctor and any hospital of their choice.  In the meantime, if we can bring down prices they won’t need as much to get quality care and decent insurance.  We do not want to tinker with the entire healthcare system just to help a few who are in poverty.

But all this presumes we will not make demands on healthcare that the market or a government-run system simply cannot bear.  And we also have to take responsibility for our health.  Recent studies have indicated that health problems are becoming more a matter of simply refusal to tale care of ourselves even moderately.  See here: http://www.nationalreview.com/article/446089/white-mortality-rate-rises-health-insurance-angus-deaton-anne-case.

Christians, it really is true that our bodies are temples of the Holy Spirit and also that we should not ethically believe we ought to presume on others for everything we think we want or even need.  So in part this is not just an economic issue, but a worldview issue fraught with many crucial questions of ethics.  We have to take them seriously and respond Biblically.