25 March 2010

Why Obama's health reforms are quite wrong

If you simply read and listen to many in the mainstream media talk about this story, you might ask whether any of them bothered to critically review the legislation passed by the Congress and signed by Obama on healthcare.

In the simple, binary world of so many the impression is given that health care in the US is a "privately owned fully commercial free market system where people are left to die on the streets unable to pay for ambulances or lying in hospitals not being treated because they can't pay".

This is a bold faced lie on multiple levels. How many say that half of all US healthcare is funded by government through Medicare and Medicaid, which provide healthcare for the elderly and poor families respectively? How many say that the budget for Medicare is 20% of the federal budget, with Medicaid being half that again?

How many say that the health market in the US is heavily regulated, with hospitals required to treat accident and emergency patients regardless of ability of pay? How many say that some states restrict the market to protect some health providers, so there isn't free and open competition across the country? How many talk about the burden that precedents to allow ridiculous tort law claims imposes upon the health sector? (In the last case the Republicans do, because high profile Democrats include tort lawyers).

The failure in the US is not about universality. As Libertarianz Leader Dr. Richard McGrath (himself a health professional) states:

"When the figure touted was 47 million uninsured, the breakdown was like this:

18 million earned over $50k (half of this group earn over $75k) and chose not to insure themselves;
13 million were illegal aliens;
8 million were under age 18 and had public cover available if poor;
leaving 8 million uninsured (3% of the population), many of whom were 18-20 year olds at low risk of medical problems."

So the REAL figure of those without insurance is far less than is bandied about by the press. The big issue in the US is cost, and the biggest source of cost inflation has been the public sector. Who says that? The Congressional Budget Office notes:

"total federal Medicare and Medicaid outlays will rise from 4 percent of GDP in 2007 to 12 percent in 2050 and 19 percent in 2082—which, as a share of the economy, is roughly equivalent to the total amount that the federal government spends today. The bulk of that projected increase in health care spending reflects higher costs per beneficiary"

In other words, the GOVERNMENT side of US healthcare (which is largely ignored) is growing exponentially. The legislation signed by Obama doesn't touch this at all.

The Cato Institute solution is wiser. Its proposals are:
- Eliminate tax incentives for employer bought health insurance and apply them to individually bought health insurance. This means people have a vested interest in buying health insurance that meets their needs, and puts pressure on such insurance to not provide excessive cover;
- Eliminate restrictions that prohibit people buying health insurance from providers in other states, this is an unnecessary restriction on competition;
- Eliminate state specified minimum requirements for health insurance that in some cases include cover for procedures many would not wish (e.g. in vitro fertilisation) (indeed allowing interstate competition would produce strong incentives on states to do this);
- Licensing and regulation of what medical practitioners can do, and standards for licensing should be shifted towards industry driven accredited standards.

For example, it makes sense to be able to insure against accident or disease that is not predictable. Not to insure against self injury, or the consequences of heavy drug or alcohol consumption. No bigger incentive towards healthier lifestyles would exist than for people to notice that if they smoked, they might not get any health cover for respiratory diseases.

The Obama health reforms tinker with health insurance to make it compulsory for everyone to have health insurance, and to subsidise those who can't afford it. It does not address the cost escalation in the heavily regulated market, but especially does not address cost escalation in the US's own socialised health care - Medicaid and Medicare.

Expect future years to have healthcare remain a major issue in the US, because Obama is, for now, printing money and borrowing it, to pay for his grand plans. Living for now, letting future generations bear the cost - a curious metaphor for how so many of those living at the bottom treat their own lives.

Oh and while you consider that, it is worth noting that both the UK and New Zealand are rare among developed countries in not having an insurance based model for healthcare. The result of that is a continued growth in concern about significant groups of people who live unhealthy lifestyles, and a desire to tell them what to do in order that governments ration spending on diseases of lifestyle.

A better approach is for people to pay themselves, buy insurance and face higher premiums or the inability to get insurance because no one will sell it to them if they are eating, drinking, smoking and idling themselves into chronic conditions.

However, socialists prefer to treat such people as children, and for you to pay when they don't listen.

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