by Jon N. Hall 5/4/17
With Obamacare, Democrats destroyed the market for private health insurance and then supplanted it with what they had the chutzpah to call “the Marketplace.” The people whom Obamacare hurt the most were those who had been buying health insurance in that pre-existing market and who had paid the full price for it themselves but who are now paying more and getting less. Everyone else, those receiving federal subsidies to buy private insurance policies and those thrown onto Medicaid, got welfare from Obamacare. Consequently, the first objective of Republican repeal and replace efforts should be to undo the harm visited upon those who, by buying health insurance, were already doing what Democrats forced other Americans to do under Obamacare.
How to achieve that objective? Congress must restore the “free market.” America hasn’t had a free market in health insurance for decades. If the GOP wants to create a free market for private health insurance, they might consider this:
In a free market, prices are the Great Regulator. But why would health insurance companies compete on price when people are required to purchase their product? So scrap the individual mandate to buy insurance. And how can the price of premiums moderate when policies must cover every conceivable outlay? So the “essential health benefits” that Obamacare requires insurance companies to cover, such as birth control, need to be optional. Congress also needs to require all healthcare providers to charge the same prices to all payers. Charging different prices for the same thing is the most blatant form of cost-shifting.
The Obamacare subsidy program also needs to be scrapped. It’s one of the worst ideas of Obamacare, and it stymies the possibility of a truly free market. And the subsidies shouldn’t be supplanted with Ryancare’s tax credits. The federal government shouldn’t be assisting people to buy private health insurance policies. In healthcare and most other things, the public and the private should be separate. The folks receiving Obamacare subsidies can be put on Medicaid.
Private health insurance should be mainly for folks who are very serious about taking care of their health. Everyone else — the obese, the junkies, the smokers, the inert, and the “uninsurable” — need not apply. The Obamacare policies of “guaranteed issue” and “community rating” are not applicable to the insurance industry; e.g. companies that insure against fire aren’t required to sell policies to owners of straw houses. Calculation of risk is everything in the insurance business; something Democrats can’t grasp.
If that means that Medicaid would be getting a disproportionate share of patients with “pre-existing conditions,” so be it. Insurance is a business. Businesses cannot keep prices low for paying customers if they must insure the uninsurable and accept whatever remuneration the government deems appropriate. (Read what Madam Coulter has to say about free markets in “A Health Care Plan So Simple, Even A Republican Can Understand!” at Human Events.)
Ages ago in a Kansas City restaurant, I happened to be sitting next to former K.C. Mayor Charles Wheeler. Among Wheeler’s many titles was that of medical doctor, and I remember him saying something to the effect that America already had a “universal healthcare system.” Surely, the good doctor was referring to the system provided by EMTALA, the 1986 law that requires hospital emergency rooms to treat all patients lest they be stripped of government reimbursements.
Though they both had legitimate concerns, Ryancare managed to tick off both factions of the GOP. Here’s an idea for “universal healthcare” that might appeal to both the Freedom Caucus and the GOP moderates: If patients neither have private insurance nor can muster the money to pay out-of-pocket for the healthcare they receive, then the feds will pay for them.
Sounds budget-busting, no? Well, here’s the kicker: medical bills that are not quickly settled would be turned over to the feds, who would then put a lien on patients until they pay off their medical bills. Patients’ wages could be garnisheed, their income tax refunds could be seized, if they win the lottery or if they come into an inheritance or whatever, the feds would get paid off first. And when they die their estates could be seized by the feds, not their heirs. So, debt incurred in the U.S. medical system would never be forgiven, never written off, never discharged in bankruptcy.
The system just outlined might be called “Medicaid for All,” not the Medicare for All touted by socialists like Sen. Bernie Sanders. Folks would no longer enroll in Medicaid; it’d be there for everyone. But it would be “free” only for those who could never pay, such as the permanent underclass. Everyone else would end up paying for their medical care. Repayment schedules would not be onerous for those with low incomes, and interest rates would be modest. But pay you must.
The big problem with the EMTALA program is that Congress didn’t fund it, so hospitals often must write off ER treatment as “bad debt.” Which means they have to make up for that uncompensated care by “cost-shifting”: other patients have to pay for the care the non-payers receive. That means that premiums for health insurance must rise. Under Medicaid for All, EMTALA could be repealed. (It’s a stain on America’s lawyers that EMTALA is still on the books, as it’s clearly unconstitutional.)
This system would be a better universal healthcare system than the one we have now, but it wouldn’t be single-payer. Hospitals and doctors would be paid, but the costs would not be shifted over to private insurance policyholders. And there’d be a mechanism to recoup what the feds would be paying out. Democrats probably wouldn’t like it because the new-and-improved Medicaid wouldn’t be “free.” If the new system were to still be considered an entitlement, it would be an entitlement to receive treatment, not to get it for free. Those Americans who don’t buy health insurance will still get healthcare, but under the new Medicaid system they’ll have to pay for it, even if that takes the rest of their lives.
Perhaps the main upside of Medicaid for All is that the prospect of the feds having a permanent claim on one’s earnings and property would be an incentive to buy private health insurance. It might also serve to push folks to take better care of their health and to not take stupid risks, like rock climbing without insurance.
It should now be clear that the Democrat minority in Congress is not interested in working with Republicans. All the Dems are thinking about is getting back their majority. And now they have forced the end of the filibuster for Supreme Court nominees. Therefore, Republicans should end the filibuster for legislation, too. They should craft a complete replacement for Obamacare, replete with tort reform, buying across state lines, and everything else that would create a free market and bring prices down. And then, if need be, pass the thing with 51 votes.
If this seems a bridge too far, remember that one of the reasons Obamacare is such an awful piece of legislation is because of having to dance around the filibuster; read this short history by Dr. Brian Joondeph. The Dems waited for months for the election in Minnesota to be finalized and to provide them their 60th vote, (some think that Senate seat was stolen in the recounts). Americans are less concerned about the institutional niceties of Senate rules and traditions than in getting some relief and certainty. So end the filibuster now, Republicans, because when the Dems come back into the majority, they’re sure to.
Jon N. Hall is a programmer/analyst from Kansas City. • (722 views)