Sometime in the next couple of weeks, we will see what the Supreme Court is going to do about ObamaCare, or BarryCare as I call it, because it is a more euphonious moniker. I have no crystal ball, so I do not know what the Court’s decision will be. The predictions market InTrade [7], however, has a very definite opinion. The share price for the individual mandate being overturned spiked after that Vermicelli dude or whatever his name is ended up looking like an incompetent boob during the oral arguments in March. The price continues to climb as the rendering of the decision gets closer, and the prediction for overturning the mandate has been as high as 72.3%.
I don’t like the individual mandate on philosophical grounds. I also don’t like it because it pees in my Wheaties in terms of how I procure my health care. I choose to carry a “Hail Mary” policy in case I accidentally lop my leg off with a chainsaw and might like it reattached. I pay for the routine stuff out of pocket, mostly because my physician doesn’t accept insurance. A rather large portion of what he does isn’t covered by insurance, so he chooses not to go through the paperwork hassles.
Lest anyone think he’s some kind of snake-oil quack, he isn’t. If you’re having a heart attack, he won’t be offering you acupuncture or discussing your lifestyle choices with you. He’ll tell you to get your butt to the emergency room. However, if you have severely injured your shoulder in a terrible accident involving a floor polishing machine and a fit of pique, he will suggest a non-surgical alternative that actually works. I like that about him.
Is it wrong that I want to make the choices regarding my health care – and paying for it – that make the most sense to me and work best for me?
I have been told that my philosophical disagreements with mandated soup to nuts health insurance are meaningless, because states can mandate car insurance. The operative words here are “states” and “car.” The BarryCare mandate is federal, not state. The federal government is demanding that (almost) everyone contract with a private company for products and services, or face a fine. That MIGHT be all right on the state level. For the feds, it’s a no-no. Furthermore, one can avoid purchasing car insurance by choosing not to drive. What are the options to avoid buying full coverage health insurance? Choosing not to be alive?
Even if it were a valid comparison, there are still vast differences between the car insurance market and the demands of BarryCare. This new law doesn’t just require one to have health insurance. It requires everyone to purchase a policy that conforms to a set of expansive mandates. There are a lot of people out there who would prefer not to purchase coverage for services they will never use. Requiring a woman who has had a hysterectomy to pay for maternity and contraceptive coverage is like mandating that someone whose vehicle is a motocycle must buy glass coverage.
Also, car insurance is based on risk. A young driver with multiple DUIs who owns a Bugatti Veyron is far more likely to end up in an accident than someone middle-aged with a squeaky clean record driving a Yugo. Thus, he pays more for liability insurance. (He also pays more for fire, theft, and collision, but those are not mandated by the state and thus not relevant.) BarryCare forbids medical insurance companies from even considering risks such as smoking, obesity, engaging in dangerous hobbies, and yes, even previous bouts of cancer, when pricing their product. Saying that healthy people should pay more so unhealthy people can pay less is like saying that Mr. Yugo should pay more so Mr. Veyron can pay less. That’s only fair, right?
Furthermore, you can’t call your insurance company to sign up for a policy after you’ve rear-ended someone at a red light. Well, you can, but they will merely laugh at you, and inform you that you should have thought of that before you gave someone a Toyota suppository. Yet BarryCare allows everyone to shut the barn door long after the horse has run off to Saratoga. The “individual mandate” is supposed to prevent that, of course. But the fine is trivial, and thus utterly ineffective in stopping people from gaming the system by waiting until they need it to purchase insurance.
One more difference is that state laws mandating car insurance do not exempt a significant population, illegal aliens, from the insurance requirement. (That doesn’t mean illegal aliens who drive in this country actually buy insurance. It just means they are legally required to do so.) BarryCare, on the other hand, exempts illegal aliens, even though they are a huge part of the problem of uninsured people who stick someone else with the tab. Estimates vary, but no one denies that illegal aliens make up 20% or more of the uninsured.
But all of that – that the law isn’t analogous to car insurance and simply won’t work – is not the most malignant aspect of this attempt at reforming how we pay for our health care. The Justices nailed it when they pointed out that the law is a gigantic expansion of federal power. Matter of fact, Barry’s crack team of lawyers couldn’t answer a very simple question: If the government can force THIS contracting of a very specific set of goods and services from a private third party, what transaction can they NOT force?
I hope they start with health club memberships. Provide documentation of at least three visits a week, or three sessions with a personal trainer, or pay a fine. This will not only increase the general health of the population, but it will reduce the number of fat people. If we can use public dollars to fund the arts, then why not use the law as a blunt instrument to enhance aesthetics?
Part of the BarryCare argument is that everyone becomes a consumer in the health care market at some point. That isn’t necessarily true, but even if it were, they are starting in the wrong place. A more basic need than endoscopies and Pap smears is food. EVERYONE is a consumer of food. And the 45 million (45 million!!!) people on food stamps clearly aren’t getting enough of it. So I propose food insurance. It can’t be for the mere basics, because that would not be in the spirit of BarryCare. Food insurance must cover more than Spam and eggs. No lobster left behind!
Another argument is that health care gobbles up 17% of our GDP, so the market must be regulated. Cool. Housing is 18% of our GDP. Where’s the law forcing everyone to buy a house? It can’t be just any house, either. Purchasing an $18,000 shack in south Phoenix doesn’t help a housing market in crisis. That can only be accomplished by mandating the purchase of a house that costs $100,000 or more. Can’t afford that much house? Tough cookies. Pay your fine. The necessity argument also applies here, since everyone needs housing and becomes a consumer in the market at some point. Well, except for that guy down on Jackson Street who sleeps on the sidewalk in a puddle of his own urine. The idiocy of de-institutionalizing the chronically mentally ill is a conversation for another day, though.
While we are using Congress to stimulate ailing markets, let’s force everyone to buy an American car. Not a Ford, though, because they didn’t need a bailout, so they must be punished. General Motors or Chrysler only, please. And not the small one. Dig deep, and get one that costs at least $40,000. You can park it and ride your bicycle if you can’t afford the gas.
And what of windmills? This administration LOVES green energy. Due to the noise, the bizarrely shifting light patterns, and the perfect storm of bats burst like balloons, minced migratory birds, Rotato®ed raptors, and puréed pigeons, all raining torrentially from above, some people find living near windmills unpleasant. Can the government mandate that homeowners contract with the private companies who make the windmills, allowing them to be installed on their property? They have the Kelo decision on their side (private parties “taking” property from other private parties to gin up the local economic picture), as well as the power to force people into contracts against their will. And EVERYONE consumes electricity.
The free birth control mandate in BarryCare caused a friend of mine to exclaim, “Where’s my free condoms?!?!” He has a point. Where’s the birth control for men? Condoms also help prevent sexually transmitted diseases, so while we are in the “mandate” mood, the government should compel the use of condoms for any sex act not intended to result in pregnancy. Lots of Americans having lots of sex means Prophylactic Inspector will be the most sought-after federal job of all time.
Barry’s lawyers’ defense against any suggestion that this newly-minted mandate power could be used in all sorts of malevolent ways is that health care is a SPECIAL circumstance, and they totally pinky-swear that this is a one-time deal and they would never EVER try any funny stuff. This is clearly baloney, and not even good baloney. If the individual mandate and other parts of BarryCare are allowed to stand, you might as well dump a few tons of Miracle-Gro® on the federal government and wait for them to take over every single aspect of your life like a kudzu vine on steroids.
We the people do not like this law, and not just because it’s intrusive, unconstitutional, and downright un-American. We don’t like it because it won’t cut costs, and doesn’t fix a damned thing.
Here are the issues driving up health care costs: Everyone wants the latest and greatest technology. Too many people are using the system for stuff that they don’t need, such as demanding a prescription that won’t help when they have the flu. (Your grandmother was right. Eat chicken soup and get a lot of sleep.) The current payment paradigm has divorced costs of care from those consuming it. And the big one: We Americans are a bunch of drinkin’, smokin’, cheeseburger eatin’ and often chubby specimens of folks enjoying life.
Here is the human reality of health care: An article in JAMA [8] explains rather bluntly that patients want hope, a cure, a private room in the hospital, as little effort on the patient’s part as possible, and to incur no out of pocket costs. The article goes on to say that they don’t care whether their neighbor gets the same things, and they have no interesting in parting with any money to see that their neighbor does receive the care he needs.
Shocking. It rather reminded me of a robust individual I saw on the television, talking about how he had undergone bypass surgery three times. He was a member of the auto workers’ union, and his three operations were “free,” meaning the company’s customers paid more for their cars so he could consume two Western Bacon Double Cheeseburgers and a six-pack every day of his life. When asked if he might have opted for a healthier lifestyle if all those medical services had cost him money, he replied, “Of course.”
So there you have it. Everyone wants everything, and they want it for free. Yet all hope is not lost. We can fix this, vastly lower costs, and still give most people what they want. It just requires a few basic reforms.
- Eliminate mandates, so everyone can purchase the insurance product they feel suits their needs. Allow insurance sales across state lines.
- Allow unlimited tax-deductible health savings accounts. Treat individuals the same as employers in allowing deductions for insurance costs. (This is pending the passing of my beloved flat tax, which would eliminate all the deductions, but you’d have way more money, so all would be good.)
- Limit the the civil claims for medical mistakes to actual damages, and only when a mistake was indeed made. Not every bad outcome is the doctor’s fault.
- Allow insurance companies to price their product according to risk, but prohibit them from dropping customers who actually need to use their insurance. Also, tell them that having mono when you’re 16 doesn’t cause cancer when you’re 40, so they cannot claim a pre-existing condition to avoid paying. (This is really not as big a problem as some people make it out to be, but it shouldn’t happen at all.)
- Put the 5% of patients who consume 50% of the medical resources in their own high-risk pool. Don’t cut them off at the knees, but don’t give them the sun, the moon, and the stars either. At some juncture, it is hopeless, and there is no point in throwing good money after bad.
The last part of the reforms isn’t about legalities. It’s more of a PR campaign. I don’t exactly know how you get people more involved in their own good health, and their relationship with their health care providers. It needs to happen, though. Possibly the insurance companies can do it. After all, more healthy people making smart health care choices = less claims paid for heart disease and unnecessary tests and so on. If corporations respond to anything well, it’s not losing money on their endeavors.
Those reforms I listed will probably not happen. BarryCare never really was about lowering costs. It was about paving the road to single-payer health care. I suppose it doesn’t bother the people that support single-payer that THAT doesn’t solve any problems either. Sure, you can offer basic health care to all your citizens. But the private practice of medicine will never be outlawed in America. The Constitution does not allow the government to force all the doctors to work for them, any more than it allows them to indenture the servitude of all the plumbers, goat farmers, or ditch diggers. Thus, there will still be private insurance, and people paying out of pocket.
The inexperienced doctors, and plain old bad doctors, will accept the “government insurance.” The good doctors will care for the folks who pay good money. That we have a two-tiered system will not change. All that will be altered is the number of people getting great care vs. the number getting as little care as the government can provide without being called murderers by the New York Times.
The collectivists, who wanted everything they could get, and all of it for “free,” will weep bitter tears when “I’ve got mine, and screw the rest of you” becomes their health care reality. The moral of the story is, be careful what you wish for, and don’t piss off the folks who are paying your bills.
Meanwhile, back at InTrade, the voices of the many are predicting the death of the individual mandate at 65%. I’m thinking they are right, and that the rest of the law might perish with it. The countdown to Anguished Lefty Fest 2012 makes me positively giddy.
