The Affordable Care Act creates a new health insurance marketplace (the exchange). But because of the great uncertainty about what buyers will enter the market and who will buy what product, the law creates three vehicles to reduce insurance company risk.
Facts are easy. You can check facts. What supporters of the Affordable Care Act are doing, on the other hand, transcends factual bungling. It’s far more advanced: a warping of reality so debauched it looks like something out of a tale by H.P. Lovecraft.
The highest form of charity, argued the 12th-century Jewish philosopher Maimonides, is when the help given enables the receiver to become self-sufficient.But our systems of state charity — aka welfare — have too frequently had the opposite effect: They have actually created dependency. It is time to rethink the way we help people.I’m going to […]
Recent difficulties with implementing the Affordable Care Act have increased opposition to the program. A majority of Americans now oppose it. Problems with the HealthCare.gov website are in all likelihood temporary. However, there are serious long-term problems, particularly considering long-term finance and labor supply issues. Given the mounting difficulties with and growing concerns about the […]
Do you trust your doctor? Most patients assume their doctor is working in their best medical interests whenever he or she orders a diagnostic test or recommends a particular treatment. Customers might wonder whether an unscrupulous auto mechanic is being truthful when he recommends a brake job or a new transmission. But most patients trust […]
The faces of the Detroit bankruptcy are the thousands of pensioners whose promised benefits are suddenly part of the restructure negotiation. When Motown filed for Chapter 9 last July, the city had $11.5 billion in unsecured liabilities. The vast majority of this was pension and health care benefits owed to retired city employees.The images of […]
So you’ve maneuvered the Obamacare website, plugged in your top-secret information and found out how much you are forced to pay to avoid a fine.And for some of you, it turns out you qualify for a government subsidy — making the premium sound like a bargain. But signing on that line to accept the government’s […]
The New York Times published an interminable article on health care recently. Plenty of facts — how scrupulous are these journalists! — but the article displayed absolutely no comprehension of the basics of cause and effect. I was left wondering about the whole point.The article details how the health care system rewards specialists to an […]
Dr. William C. Padgett is a retired optometrist who has been trying to bring an elderly care facility to Beaufort County, North Carolina, for over a decade.“Our senior citizens,” he laments, “are finding that it is difficult and in many cases impossible to find an appropriate long-term care facility locally.” Though he has received several […]
Professor John H. Cochrane of the University of Chicago had an op-ed in the Wall Street Journal on Dec. 25, in which he gave a brief description of (among other things) a market in which individuals buy our own health insurance — and not from an Obamacare exchange.According to Professor Cochrane: “…we should transition to […]
A new survey from Harvard University found a large majority of young Americans do not believe the law will save them money, do not believe it will improve their health, and do not intend to sign up for insurance through the new exchanges.
Liberal supporters of the Affordable Care Act specifically, and big government in general, are quick with excuses for all the problems that Obamacare has been experiencing in these early days. We have heard: they did not have enough time, it’s complicated, it’s the insurance companies’ fault, we just need to make a few adjustments, and […]
I opened a new bottle of probiotics this morning, and it had one of those circular seals on the top. You know, the one that reads, “Sealed for your protection.”And that seal got me thinking… how much protection do we need? How much security is enough?How much homogenization, pasteurization, disinfection, national security, etc…. do we […]
As the fallout continues over the cancellation notices sent to millions of people covered by health plans in the individual insurance market, it is becoming clear that millions more workers and their families are expected to lose their employer-based coverage as the Affordable Care Act (ACA) is implemented.According to the Congressional Budget Office (CBO), 156 […]
A president stands disgraced. Congress is scattering. Bureaucrats are baffled. Pundits are reaching. Industry is scared. Politicians are scrambling to do something, anything, to make it better. One political party is in meltdown and the other loving every minute of it, hoping to ride the calamity to electoral gains.The so-called Patient Protection and Affordable Care […]
Any married couple that earns more than 400% of the federal poverty level -- that is $62,040 -- or a family of two earns too much for subsidies under Obamacare. But if that same couple lived together unmarried, they could earn up to $45,960 each -- $91,920 total -- and still be eligible for subsidies through the exchanges in New York state.
The president assures us he is not responsible for the wave of health insurance policy cancellations. The insurance companies are. OK, so where is the other side?
The saying goes that things have to get worse before they get better. But with Obamacare, things just keep getting worse — and then they get worse still. In private, even many critics of the law are at least a bit surprised by how poorly the rollout has gone. The question that many are asking […]
Though the rollout of the Affordable Care Act (ACA) exchanges has dismayed even the law’s supporters, the problem the ACA is designed to address is real enough: Millions of Americans, even those with insurance, lack access to adequate health care. In a voluntary society, civil-sector groups would step up to provide social services, like health […]
It is such a kick to read the transcripts from the White House’s health care “war room” in the first days of release. What a meltdown, and you get to watch it all in real-time.I’m not trying to be cruel to the kindly despots who have wrecked so much of what worked in the existing […]
Obamacare certainly has made history. It has set the record for the fastest-failing Big Government program in world history. This isn’t only about a website flop; it is about the failure of government to accomplish the aims of Obamacare in general, and in a way that has profoundly touched millions of individual lives.“Train wreck” is […]
A handful of reports last week suggested that the Obama administration had moved to delay the health law’s individual mandate — the penalty the law imposes on those who are uninsured. That’s not quite right: Instead, the administration will align the 2014 penalty date, which had been February 15, with the end of Obamacare’s open […]
A common argument made in favor of government-financed health care is that it is inherently cheaper than a private system. Strangely, however, the people who celebrate the government’s ability to hold down health care spending would be horrified at the same argument applied to other public-sector functions. It’s a seriously inconsistent position held by advocates […]
You didn’t want to be the guy chosen to tell Stalin that the wheat crop failed or the production quotas on trucks and cars were not met. Why?Because despots always blame people, not systems.In the same way, you don’t want to be the guy chosen to tell Obama that his health care websites are a […]
Lately, many have characterized this administration as socialist, or having strong socialist leanings. I differ with this characterization. This is not to say Mr. Obama believes in free markets, by any means. On the contrary, he has done and said much that demonstrates his fundamental misunderstanding of and hostility toward the truly free market. But […]
As the health care debate rages on, there is one reality that even the proponents of this hostile takeover of health care by government cannot ignore — and that is money. The government simply does not have the money for a new, expansive, public health care plan.The country is in a deep recession. The last […]
The online Internet exchanges created by the Affordable Care Act are up and running.OK, they’re up. Uhh, OK, some of them are sort of up.It has been almost a week since last Tuesday’s initial launch, and there have been more than a few problems.Website crashes, excessive response times and other problems have plagued the exchanges. […]
There’s so much bad news about health care these days. Maybe it’s time for some good news.
One sector, technology, is advancing at a pace never seen before. Customers have a range of services to choose from, and price competition is very intense. The doctor sees you whether you have insurance or not. Customers mostly pay directly for services. Overall spending is increasing, but that’s because there are more services to purchase. Competition between providers is very intense.
Sadly, for humans, all this is taking place within veterinary medicine, and the beneficiaries are animals, mostly pets. According to The New York Times, the demand for advanced treatment is booming, and supply is responding. The paper cites the case of Tina, the 10-year-old chow that recently underwent chemotherapy and a bone marrow transplant at a clinic associated with the Mayo Clinic. The $15,000 spent on this may sound like a lot, but it is far cheaper than the same services provided to people.
“A long list of cancers, urinary-tract disorders, kidney ailments, joint failures and even canine dementia can now be diagnosed and treated, with the prospect of a cure or greatly improved health, thanks to imaging technology, better drugs, new surgical techniques and holistic approaches like acupuncture.”
To be sure, not too many people are willing to shell out this much to help their pets achieve a better life. This is a niche market. But that makes the existence of technological progress all the more remarkable. “Improved veterinary care for all pets has increased consumer spending in this area to $13.4 billion last year from $9.2 billion in 2006, according to the American Pet Products Association.”
Some people theorize that progress in medicine is possible only with massive government involvement. You have to force business to provide insurance, for example. But only 3% of pet owners have insurance on their pets, and somehow the system works. You pay for what you need. Prices are posted and openly discussed. Everyone knows what’s what. You can even find out the costs of services by looking on the Internet. Imagine that!
Also, and strikingly, veterinary medicine is relatively unregulated compared with the human health care industry. There are no budget-busting government programs to provide for poor pets or pets in their older years. There are no prescription drug benefits. There are no subsidies, mandates or third-party payment systems, much less threats, bureaucracies or a giant central plan designed to achieve universal access.
Instead, medicine for animals works just like any other normal market. There are standards, rules and private boards to assure quality control. There are strict and highly regrettable regulations on how many universities can offer certification, a fact that undoubtedly raises prices and salaries, but harms availability. But once the certified doctor opens shop, the customer is in charge.
You know it immediately when you walk in. There is not an intimidating receptionist, a long wait that takes all afternoon, detailed checks on your coverage or anything else. Instead, it is a friendly environment in which everyone speaks to you like a normal human being. You are welcome to call the doctor by his or her first name. They tell you everything you need to know. Prices are posted openly, and you can select among a vast range of services.
The customer comes first. And there is a constant awareness at every step that the customer is the one paying the bills, and that changes everything. You get thorough explanations of every option and procedure, along with a realistic look at risks relative to spending. You are in a position to accept or refuse, which gives the entire clinic a strong reason to be open and forthcoming about every aspect of treatment.
There are sometimes malpractice lawsuits, but they are rare because there is such open discussion of risks and uncertainties. The typical veterinarian pays $500 per year in insurance to guard against such lawsuits. The annual fees for human doctors are $15,000 and up.
What I find most striking in this case is the way progress in animal health care is happening as if driven by an invisible hand. There are no congressional debates, executive decisions or plans from the White House, no nationwide solutions imposed from the top down.
Now, you might say that this is a superficial example, that humans are obviously more important than animals, so it makes no sense to compare the two systems. The truth is that the same laws of economics of apply to both. The laws of economics are universal and apply to every sector in all times and all places. So there are lessons to be learned.
If the customer were not paying, and the doctor were paid by a third party through some sort of mandate with a centrally planned price list, you would see prices go through the roof. Moreover, if there were some sort of universal access provided by government funding and control, you would see further upward price pressure.
In fact, if you were to set out to wreck this industry, you would follow a path very much like what has occurred in human health care. You would have business be responsible for the insurance, and make that insurance pay not only for emergency situations but for routine care involving simple shots and fleas. Then you would create giant programs to provide funding for young pets, old pets and poor pets and contemplate the bliss of universal coverage. If anything ever went wrong, you would have courts side with the pets over the doctor every time. You would have the government fund massive pet hospitals and insist that there should be no range of services, but rather that absolutely every pet has a “animal right” to the best care available no matter what.
You would popularize arguments: “Animal care is too important to be left to the wiles of the free market.” Maybe you would even put this statement in a U.N. charter document on universal rights. In short, if you wanted to wreck this sector, you would socialize it, thereby dramatically reducing service, raising prices, increasing costs and stopping technological advance.
So far, the health care debate for humans has been driven by all the wrong impulses. The correct example of where we need to be going is right in front of our eyes. But it would mean getting the government to give up its control, and there is no more difficult task than that.