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

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.

 

22 thoughts on “Is the Patient Dead? Or Is he Frankenstein’s Monster?”

  1. Ah, so you do believe healthcare is a right. I think that’s very logical.

    You never answered my question. What is the role of health insurance and insurers?

    1. No he doesn’t. I quote Dr. Clauson from the above article (#8 on his list): “Health care is not a right in my view”. Not sure how you missed that and assumed the opposite.

      1. Third to last paragraph. But more importantly I really want an answer to my question about the role of insurance. Understanding that makes everything fall into place

  2. We do not want to tinker with the entire healthcare system just to help a few who are in poverty”

    Only a few are in poverty?

    Really?

    When you make such statements (and there are asinine statements throughout your post), it makes your credibility look, well, impoverished.

    Moreover, it makes you look completely out of touch with the real world, where people who happen to be born with the wrong genes often end up becoming bankrupt just because they do not want to die, where many in the population cannot begin to dream to send their children to a toney liberal arts college such as Cedarville because they cannot even afford health insurance.

    As I have said before, perhaps you should post less and think more before you post.

    1. Jeff:
      Very constructive. OK, you did read the blog I presume and I did earlier in the article use the phrase “relatively small number in poverty.” Look, mathematically, if there are 310 million people in the US and 20 million are defined as truly poor, then that is either very few or relatively few. I think you missed the mark on that one.

      As for conditions like genetic disorders, etc., those people are by no means always poor. Now if you want to argue that they might become poor by having to pay for healthcare, that is fine, but again you have to read the blog to see that I have proposed a possible solution, albeit without all the policy details.

      And, why do you continue to make ad hominem statements such as the last one? I confess I can’t grasp that at all. It is fine to disagree or to point out that I might have failed to state something quite as well as you liked, or if you have other ideas–come to think of it, what is your broadly conceived solution?

  3. Dr. Clauson,

    I agree on the point about why blow up the system. One of Obamacare’s main selling points was that it was supposed to help the uninsured get insurance but rather than just do a limited scope bill that helped just the people that needed it they decided to muck up the whole works.

    However, despite Mr. Adams’ latest vitriolic vociferation that completely ignores your stated willingness to provide some type of assistance for the genuinely needy, he does manage to raise a valid question. How do we define the poor and needy? Are there really only “a few” that fall into this category? What metric would you use to make that determination.

    Also, I think it is a valid question why someone with health problems due to genetics (and not their own choices, like say smoking) should not be able to do the same things financially as someone else but can’t because of extra medical expenses.

    What would be your thoughts on this? Should those types of cases be included in the “genuinely needy” category?

    Of course, all your listed points are good things that need to be done that would help overall with costs.

    1. “Also, I think it is a valid question why someone with health problems due to genetics (and not their own choices, like say smoking) should not be able to do the same things financially as someone else but can’t because of extra medical expenses”

      Just to clarify, I am not in any way suggesting that this question applies to stuff like being able to take expensive vacations or recreational stuff but just certain things like educational or career choices (which can then lead to the future ability for the other stuff).

  4. By the way. #5 I think is a great idea, and it would be surprisingly easy understand and implement.

    Healthcare has always been a complicated service to price. There is overhead, direct materials, time, skill, and risk. All of those go into the final bill you receive. Most of the costs (I believe direct costs are the only exception) there is a standard “cost” for a region in terms of relative value units, then there’s an agreement with each payer, you pay x, he pays y, etc.

    Require that cost multiplier that turns RVUs into dollars to be the same regardless of payer and post that price. A patient won’t know how much they have to pay in advance, but they will know provider x costs twice provider y

  5. To all readers:
    An added comment and link. I forgot to add another measure that would reduce medical/health care costs:
    Legal malpractice reform, which is long overdue and should be thoroughgoing, with the goal of reducing costs by virtue of eliminating marginal lawsuits or lawsuits in which a link between an action and a health care problem cannot possibly be shown to be reasonable. This means reining in juries.

    And here is an interesting link on the healthcare problem: http://www.nationalreview.com/article/446142/american-health-care-reform-reimagining-failed-system

    1. I think it’s pretty clear that we have 2 major problems with our healthcare system and to some degree those problems are at ends with each other.

      Cost and Access, any solution seems to primarily focus on one with the hope that the other will work out (a fairly logical assumption).

      Here’s a couple examples. If your main focus is cost, you could outlaw insurance like that article suggests, prices would have to become more transparent, costs would have to fall, procedures that could extend someone’s life will be avoided because of the cost (in some cases), the average healthcare bill will greatly fall. If the drop in prices happens far and fast enough then it would probably have an increase in access.

      If your main focus is access, single payer system, you could do it a few ways, one way would be a “Medicare for all” with an insane deductible, which would also be the out of pocket max, say $5,000. Then everyone will be covered in case of a catastrophe. Another way would be a $0 deductible, this insurance covers 80% of costs you cover the other 20%. Another would of course by $0 out of pocket maximum. The last plan in particular would ensure everyone has access to life saving procedures, it would completely solve the access problem, it would have an increased efficiency over smaller insurance companies that need to make a profit and need to sell plans, it could have an overall decrease in costs in the long run if wellness or preemptive care is covered because then people could get help to prevent expensive diseases in the first place. But for the most part costs would probably continue on the same trajectory.

      It’s kind of interesting to think of them as opposing forces. Which one do you think is more important? I think from what I’ve seen it seems to fall along ideological lines.

  6. Insightful, as always. I have a quick question, however: When you refer to state/local/institutional barriers to entry as health professionals, what exactly do you mean? Because as I understand it (and I could easily be wrong) the industry imposes rigorous standards as a safeguard against malpractice. If people have easier access to the coveted occupation of healthcare professional, then aren’t we almost by default letting less qualified/thoroughly vetted people into the system? Or are you referring to a different kind of barrier?

    1. Since Dr. Clauson might not be able to answer this for a little while I thought I’d share this. You can look back over previous posts that he’s written in the past. This is a topic that frequently comes up. It’s my understanding that he believes many “safeguards” are actually just cost without benefit. He can provide specific examples, I’m speaking from memory of his posts but I believe he had said there’s a strict process to a new medical school opening up, which limits the number of schools, which limits the number of doctors, giving us a shortage of primary care doctors

  7. Dr. Clauson,

    We’re coming up on three weeks since I first asked the question, I have yet to see a response from you.

    What do you think the role of health insurance is?

    1. Look, I don’t mean to speak for him, but maybe Dr. Clauson hasn’t answered because the answer would seem to be a no-brainer, that health insurance’s role is, well, health insurance.

      One definition of insurance I found says “a thing providing protection against a possible eventuality.” This would mean that health insurance is a thing providing financial protection against possible future healthcare expenses. That definition would seem to me to be the same thing as “the role” it plays. Its purpose is not any different in theory than car insurance, which is to provide financial protection against future car damage expenses.

      1. Thank you Nathan. After Dr. Clauson recovers I look forward to a response from him.

        Nathan, if you were emperor for a day. What regulations or incentives would you put in place to make either health or auto insurance meet your idea of what the goal is? I’m sure it goes without saying that neither currently operates that way.

      2. If I were emperor for a day… I am sure just the thought of that froze anyone who read it in sheer terror. 😉

        I should think I would have a simple law that instructed insurance to work like it is supposed to, that one pays a premium for the coverage policy that they choose. As Dr. Clauson advocates, I would also divest insurance from employers.

        I would also make one provision, that a person is entitled to coverage at minimum equaling what they have paid in premiums. So if for some reason, they miss a premium payment, or become unemployed and are unable to meet premium payments, they are entitled to recieve what they have paid. Money paid in premiums should belong to the person who paid them, just like money in the bank belongs to the person owning the account.

      3. So you want insurance to be eliminated? If everyone is guaranteed to receive at least their premiums in benefits then how does an insurance company make any profit?

        Those are some interesting ideas though.

    2. Actually right this moment I am lying on my couch with the flu–first time in over ten years. I think you will have to wait a little longer.

  8. Good article that highlights some problems with the proposed act while also presenting solutions to remedy these problems. I particularly liked the point that we should think about healthcare separately as a bundle of commodities from poverty, because 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. I think that too often, people blend the two into the same problem, and therein lies a mistake in their thinking that skews their understanding of the actual problem at hand.

  9. I really appreciate this article. I think healthcare is something that we need to think about more as Christians. I agree that we can blend together healthcare and income into one and does destroy the market.

  10. I agree with you. “No” is not the always the easy thing, it can be the hardest thing. However, I do believe that governing can be hard.

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