Why must it cost $75-150 for a five-minute consultation with a doctor?
Why can’t I email my doctor and get a reply the way I do with my accountant, attorney, financial planner, pastor, kids’ teachers, etc?
Does it really take a professional who scored a 1350 on her SAT’s, finished top of her class at UT, then completed seven years of expensive post graduate education and residency to determine whether my kid has an ear infection?
Why can’t I know what a test, procedure, or visit will cost and a) compare that cost among providers, and/or b) make some judgment about which care makes sense based on what it will cost and what I need?
If our restaurants and grocery stores had no prices listed and you only got a coded bill weeks later partially covered by someone else, do you think you spending would be efficient? Would we as a society have serious problems with the cost of food?
Those who complain about a government takeover of healthcare should check their facts. We already enjoy all the frustration, bureaucracy, and obstacles to innovation of a government-run health system without the benefits. We live under government-run healthcare, we just pay a fortune for it and don’t cover everyone.
The challenge of making affordable insurance coverage available to all Americans is actually a just one component of our healthcare problems. Our process for delivering and paying for healthcare was cobbled together about eighty years ago and has been slow to adapt to changes in our society. It is a system that has become spectacularly rigid, mostly hidden from view, influenced by innumerable separate state, federal, local, corporate, and professional bureaucracies and presided over by none of them.
This doesn’t mean that pure deregulation will work. Medicine does not and never will function as a truly efficient market. After falling off a ladder, you are not going to shop ambulance companies for the provider best suited to your particular needs. Consumer choice is limited by the specialized knowledge required, the vulnerability of the patient, and difficulties in comparing value. Regulation of the healthcare industry can’t be eliminated, but it needs to be loosened and updated.
Obama’s plan takes the healthcare industry in the wrong direction. Instead of bringing simplification, it adds layers of new bureaucracy. It does nothing to strip back the generations of largely irrelevant regulation; building instead a concrete monster on top of the muddle. It addresses cost by moving toward rationing instead of opening the field for greater efficiencies and better practices.
As Republicans we should understand this one fact – You will never choose healthcare the way you pick which brand of peanut butter to buy. And some more effective system will have to be put in place to address the needs of the less fortunate. That system will cost money in the form of taxes. Have a drink. Say a prayer. Whatever it takes. Make peace with it.
However, simply creating the largest government entitlement in history (largest in anyone’s history, not just America’s) on a party line vote with no fundamental restructuring will be a recipe for disaster.
There may not be a more technically complex problem we have ever been asked to solve as a nation. As Obama’s plan falls apart, Republicans are positioned to propose a conservative process that could bring meaningful improvements and set the stage for wider reforms. Before we can do that, we have to get over our favorite solution for everything, better than aspirin – “how about a tax cut/credit?”
First step toward a solution? Empower states to come up with their own solutions. Give them greater regulatory freedom over existing programs like Medicare/caid. Offer greater funding from the federal government for state programs that extend coverage significantly. I’m not saying this for the frequent Republican reason – toss a problem we don’t care about to the states so it can disappear from the agenda. I say it for these reasons:
- States already have far more experience, breadth of authority, and insight into the healthcare system. States regulate medical professionals, administer Medicare and Medicaid, along with their own programs. Any structural changes in the way we administer healthcare would almost have to originate at the state level in order to make sense. Imagine for example of version of Obama’s plan that was made available for states to adopt or not.
- States have more freedom than the federal government to innovate. They are smaller, more accountable, and in a worst case, have the larger federal government to fall back on for assistance if their efforts fail. Who do the feds fall back on…?
- There are fifty states and only one federal government. Again, more opportunity for ideas to emerge.
Congress could help further by clearing obstacles that limit insurance company competition at the state level.
We are not Canada. We are not France. We could adopt their healthcare legislation down to the last silent “g” and not see the same results. The best approach to making quality healthcare available to everyone will take into account our size, our existing systems, our politics, and our values. There is an opportunity here for the GOP to take a leadership role on an issue we have given little attention. We need to have the maturity and courage to seize it and act.
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