Washington is selling a false choice on health care. The American people are expected to settle on one of two masters — big corporations or big government controlling our most personal decisions.
Not for a moment does Washington want us to consider the third option: real freedom.
For most of history since the advent of medicine, doctors and patients enjoyed direct relationships with each other. There were no gatekeepers — no cartel of hospitals, insurance companies, and government agencies — dictating terms and extracting tolls.
Today, third-party payers lay taxes and mandatory premiums on the public totaling 72.5 percent of all health care spending (up from 42.4 percent in 1970). These gatekeepers justify themselves, saying hospitals would gouge patients more. Meanwhile, they drown independent physicians with paperwork, forcing doctors into the hands of those monopolistic hospitals gobbling up the industry. From 2012 to 2016, independent medical practices in America declined by 48.5 percent.
At some point, we must ask: Is this actually helping the American people?
Let us remember the “old lady who swallowed a fly.” In the cautionary children’s rhyme, she swallows a spider to eat the fly — solving a small problem with a bigger one — necessitating an even bigger solution. Next, she swallows a bird, then a cat, dog, goat, and cow. Upon swallowing a horse, she promptly dies.
The lesson is the “do no harm” principle, which modern medicine is supposed to follow, but which government medicine certainly does not. Over the last century, chasing Frederick Bastiat’s “great fiction” that “everyone can live at the expense of everyone else,” Washington shoved one failed intervention after another down the throat of the American health care system.
The core purpose of insurance is pooling risk for rare, unplanned, and catastrophic events. Freezing wages during WWII, however, Washington pushed businesses to compete for labor by offering employment-based health plans covering routine care. Since then, Americans have paid inflated premiums for the privilege of being bossed around by corporate bureaucrats.
As premiums continued rising, Congress responded in 1954 and 1974, further entrenching third-party over direct payment with preferential tax treatment. Since many Americans remained unable to afford care plus corporate bureaucracy, Washington instituted its own centrally-planned systems in 1965 with Medicare and Medicaid. In 2010, ObamaCare made participation in these third-party systems mandatory.
How is it working? Health care is more expensive than ever. Per capita health care expenses have skyrocketed by 600 percent since 1970. The fastest-growing cost driver is bureaucracy itself, accounting for one-third of the overall price.
Now, Rep. Alexandria Ocasio Cortez (D-N.Y.) and the socialist wing of her party want America to swallow the horse. Often referred to by pleasant-sounding terminologies, such as “Medicare for All” or “single-payer,” it is the final step for consolidating control. By monopolizing payment in the Department of Health and Human Services, even the limited choices Americans have today will disappear. As the old saying goes, “He who has the gold makes the rules.”
Milton Friedman observed that third parties who neither pay the expense nor receive the benefit of a transaction are the worst incentivized to maximize quality and minimize cost. For unelected bureaucrats (with near-limitless access to the taxpayer pocketbooks) to be responsible for rationing care to three-hundred million Americans whom they have never met is the worst combination imaginable.
The solution is not one payer, but millions.
Competition works. Discretionary procedures, generally uncovered by third-party payers, rely on direct payment and defy the inflationary trend. For example, the National Center for Policy Analysis found the price of LASIK eye surgery fell 20 percent from 1999 to 2011. If the customer is always right, we can make health care affordable, accessible, and accountable by putting patients back in this position of power, restoring direct payment options, and pushing third-party payers aside.
Expanding the freedom to save tax-free in health savings accounts (HSAs) will empower middle-class Americans to cover routine care and shop for the best value. Legalizing high-deductible insurance will make coverage affordable to Americans for unplanned catastrophes. Personalizing Medicaid — putting safety net dollars into the hands of patients instead of bureaucrats — would eliminate America’s biggest welfare cliff and empower those with lower incomes to engage directly with doctors.
Rather than helping the American people, a century of federal laws has entrenched a public-private health care cartel running up prices and dictating terms. We deserve solutions to fire the gatekeepers and restore the direct doctor-patient relationship.
Americans deserve health care freedom.
Eric Brakey is the senior spokesperson for Young Americans for Liberty. He served two terms in the Maine Senate as Senate chairman for the Health and Human Services Committee.