PrintFebruary 25, 2010
America's Health Care Options
The current health insurance reform bill seems to be the new Schroedinger's cat; it is in a simultaneous state of being both dead and alive. The president wants to have a meeting with both sides in an attempt to stabilize the health of the bill. Whatever the motivation and desired outcome for this meeting, the starting point will definitely be the current bill, which multiple polls show Americans largely rejecting. Roughly half of Americans still feel that our health care system has problems, but the Obama-Pelosi-Reid solution has fallen before it could fly. So what possible solutions exist, and can the current bill be salvaged at all?
The taxation of health care is right out. The Constitution secures to all Americans a Right to Life, and no act of the federal government may interfere with one's ability to live. Health care is life, and although used slightly out of context, "the power to tax involves the power to destroy" (John Marshall). There is nothing in law to establish at what point a tax destroys and at what point it does not. If government can tax health care to the point that it becomes unavailable for anyone, then government cannot tax health care at all. Taxation for the failure to purchase health insurance is also a bust. The federal government simply does not have the power to dictate that people buy a product.
The current bill also seeks to dictate the terms of insurance contracts. It might come as a surprise to some people, but the United States of America is not a dictatorship. Congress might regulate how contracts are enacted and fulfilled, but the ability to dictate terms of contract is not one of its enumerated powers. Moreover, no regulation applied to the insurance system could possibly lower costs. If such regulations followed the common pattern, then the likely outcome would be an increase in costs.
All of the insurance reforms contained within the current bill are obvious duds, as well as the opposition's proposal to allow the interstate purchasing of insurance contracts, which would usurp the power of the states to control the terms of insurance and licensing of vendors within their own jurisdictions. The federal government could use its power of the purse to bribe the states to alter their own laws, but taxing the people of the states and then bribing them with their own money just seems wrong.
Some socialization of the payment system already exists, and it might be extended to cover more of the "hard luck" cases; however, "the problem with socialism is that you eventually run out of other people's money" (Margaret Thatcher). The current situation with the budget and national debt looks like we have already done just that. The current bill seeks to dictate pricing and treatment options (the "death panels") in an attempt to reduce the amount spent on this entitlement, but the necessity of withholding treatment from our parents and grandparents is abhorrent to us; thus, such a system will fail.
Even if we continuously adjust the definition of "hard luck," such that the public burden never exceeds a level detrimental to the society, there will always be those people who are overburdened by their bills but too lucky to receive aid. Socialism can never eliminate the overburdened, and we have already passed the point where the entitlement has become overly burdensome on the society. There is only one way to go from here, and that is to reduce the entitlement, increasing the number of people burdened by their medical bills. From the standpoint of an entitlement system, it is apparent that we are not currently in a "health care crisis," but in a health care surplus: More people are receiving government-paid health care than the system can handle.
A third-party payment system may influence costs, but the federal government does not have any means for imposing a solution through the payment system, which invalidates the entire rationale of the current bill. Congress must restart from scratch.
If the problem cannot be solved through the payment system, then perhaps it results from the costs of providing health care; however, there has been little to no discussion (in Congress) as to why health care seems expensive. Indeed, it appears that as soon as the health care crisis was alleged, the Democrats in congress immediately seized upon the solution of socialism and dictated without any consideration of why (or even if) the crisis exists.
One source of increased costs is lawsuits. The issue is certainly more complex than simply limiting awards to $250,000. Whether a lawsuit has merit or is frivolous, has convincing evidence or lacks evidence, and what the award should be is for the legal process to determine, and the process is unique to each jurisdiction. All trials present risks to the plaintiffs and defendants, which should limit the number of frivolous, malicious, and weak cases, but a malpractice allegation may never reach trial.
A number I have heard consistently from hospital consultants is that it costs a hospital approximately $50,000 before the attorney even walks into the courtroom. Even if the hospital wins a trial, it may be unable to recover its legal costs. It is common practice to settle minor allegations pretrial, before the plaintiff faces any substantive risks. There are only two potential means to curtail this behavior: expose the plaintiff to liability at the earliest stages of a complaint, or filter all complaints through a review board prior to any form of settlement being discussed or lawsuit filed. These changes must occur at the state level, so Congress might resort to using only the distasteful power of the purse.
Another potential source of increased cost is government regulation. That ten-dollar aspirin is not ten dollars. It's twenty-five. It commonly takes thirty to forty-five man-minutes per patient-day for the pharmacy to fill inpatient orders, much of it paperwork. In some places, to prepare for a state inspection, an army of plumbers adjusts the water heaters and then runs around checking the temperature in every room. Then those same plumbers have to adjust the heaters again and repeat the process in preparation for the municipality, all because the city requires a different temperature range from what the state does. There may be some federal regulations that Congress can change, and some state regulations the states can change, but no one knows which -- Congress never discussed government as a potential source of the problem.
Again, there is nothing Congress can do about state laws and regulations, a theme that seems inescapable in the health care debate.
