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Friday, March 26, 2010

The True Prescription for Medical-Care Reform Is A Freed Market

The recently-passed medical-care bill a.k.a. ObamaCare, which Barack Obama signed into law on Tuesday and which will be challenged in the form of lawsuits in federal court by many state attorney generals on the grounds that it is unconstitutional, has opened a Pandora's Box in the political, legal, constitutional, moral, and anti-liberty scheme of things.

It's political, because the bill, which was supposed to be brought to the Senate for reconciliation before Obama signed it, ended up being bypassed to Obama's desk for his signature, without the "fixes" (which are actually amendments) being applied to the document. After all, the Voice of America news site reported on March 22 just before the bill reached the Oval Office: "[T]he Senate must still sign-off on a series of changes approved by the House." (After Obama signed the bill into law, the Senate had just passed the Health Care and Education Reconciliation Act of 2010.)

The law's conservative critics argue that it's both unconstitutional and illegal, because there's nothing in the Constitution that says that the U.S. federal government must coerce uninsured individuals into purchasing health-care insurance. I'm not much of a fan of the current document as established by our Founding Fathers, but the conservatives' argument is entirely flimsy. While it may be true that any constitutional scholar or historian worth his or her salt will say that this medical-care "reform" does not fall within the constitutional purview of the federal government, the Constitution is pretty cryptic in this area. So what if it is unconstitutional? Conservatives are wrongheaded to make this point. They should be arguing that the bill is wrong and unethical, because it initiates force against those who choose not to pay for other people's medical care, whether they are insured or not, and subsidizes those who would otherwise not need the insurance for a variety of reasons. Congressional Democrats, such as John Conyers of Michigan, say that the "general welfare" clause (found in the Preamble and Article I, Section 8 of the Constitution) grants the federal government the power to establish dominion of the U.S. medical-care system. But what were the conservatives expecting? That Obama would just not sign the bill into law? Democrats have historically been hostile to human liberty across the board. Republicans are the same. Face it; if George W. Bush had proposed a similar law and lobbied hard to pass it, would the GOP and its cronies have argued against it then? Of course not! They would be all for it, because they would have been getting the credit for it, and they would financially and politically benefit from it like former Massachusetts Governor Mitt Romney did when he imposed RomneyCare in his state.

Finally, it's immoral and anti-liberty, because it is an assault on individual liberty while both protecting and expanding the parasitic medical welfare state (including the entitlement programs of Medicaid [which is universal medical care for the uninsured poor and needy] and Medicare [which is universal care for mostly wealthy retirees and the elderly collecting Social Security). (Medicare recipients will not be pleased to learn that this new law, which begins to take effect in its entirety by 2018, will undercut, undermine, or eliminate their coverage or see a significant rise in their premiums.) Individuals, who are already not allowed and had never been allowed to make that many decisions on their medical-care options, will find that their insurance premium costs will rise, the quality of health care to plummet, and the pool of available doctors shrinking at a much substantially higher rate than ever. The new law, which for months had been widely touted as a "reform" of the system, will not allow wiggle room for doctors to make medical decisions on their patients' health and patients to make medical choices on their health and what insurance plans work best for them. ObamaCare does not and will not address the state's intervention in the medical-care market, research, and the system in its entirety. It does not even allow patients to shop for insurance plans from insurers across state lines.

The medical care system certainly requires reforms -- true radical reforms. ObamaCare, on the other hand, is just too expensive, and powerful medical and insurance interests are prospering and will prosper even more at the expense of all of us. The status quo will merely profit from it, which hardly leaves any legitimate reason for any sane and rational individual to admire it. With that in mind, we have no sound reason to tolerate it.

The idea that a highly-bureaucratized, highly-socialized state-propped medical-care model such as ObamaCare costing only $940 billion is nothing more than a piece of fiction. Medicare, which was launched in 1966, actually cost $3 billion. Congress projected the costs of the program at about $12 billion by 1990 (an alleged conservative estimate). By the time that year came, the actual cost was $107 billion (if inflation is included in the costs). In 2003, the CATO Institute issued a report indicating that the program was going to be price-tagged at a projected $244 billion. Moreover, the Medicare system is rife with massive fraud and abuse. Fewer than 5 percent of the medical claims filed with the agency are audited. Cost overruns, rising deficits, lower payments to physicians and hospitals coupled with payment delays, medical services and procedures rationed by doctors, hospitals, and the state coupled with treatment delays, payroll taxes paid by employers and levied on employees, and HMO-style "assembly line" medicine have plagued Medicare for the longest time.

Thanks to the imposition of the Medicare Drug Prescription Benefit Act of 2003 (a Bush-era edict that was price-tagged at $400 billion) and a month after then-President Bush issued that decree, Medicare Plan D's price-tag went up to $534 billion. According to the 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, the projected costs from 2009 to 2018 are $727.3 billion. But the economic reality is that the costs for that program are going to be higher -- much higher -- than deemed. Even James Bovard, a policy analyst for the Future of Freedom Foundation and author of The Bush Betrayal, noted in 2005 that the Medicare trustees would cost up to $7 trillion over the next 75 years (assuming the federal government and all of its various programs, including Medicare and its prescription drug program, still exist).

Obama, his progressive supporters who are behind the new model, and his medical and insurance cronies are misguided to believe that the new doomed medical-care system will be accepted by the American people, including their opponents and critics. But they are gravely mistaken. Critics of the law, for months before Congress passed it, have pointed out the obvious problems that the new system will create. Even more than 60 percent of the American people, according to many online polls, were overwhelmingly opposed (and still are) to the bill. This "reform" is nothing more of a repackaging of the current system, with the exception that it coerces more coverage and more people into the system.

Focus on the fact that the majority of the attention of nearly all the "reformers" centered on the health-insurance industry. The common denominator in the entire medical-care "debate" had been, still is, and will continue to be that health-insurance firms have been under-regulated. For months, what became a discussion on "health-insurance reform" soon morphed into "health insurance regulation." Of course, health insurers have been massively and obscenely over-regulated, but the "reformers" don't want to ruin the fun of their crusade against the companies because of that fact. The bulk of the "over-regulation" is imposed by the biggest insurance players such as Blue Cross and Blue Shield, Blue Care Network, and Aetna against the smallest insurers. More insurance firms will go under ObamaCare, which was the plan all along. The claim that Obama & Co. touted (saying that patients will get to keep their current insurance plans) is just bogus. Expect to see more insurance firms going under because of the massive mandates.

Another problem is that the Congressional Budget Office says that the new law will reduce the deficit in ten years. Anyone with a modicum of comprehension of economics knows that the CBO's report is nonsense. Lawmakers have been relaying dubious information to the agency with cooked figures on the issue. Conservative columnist Thomas Sowell, in his latest op-ed titled "An Off-Budget Office?," debunked this lunacy by noting with respect to the San Francisco Chronicle's article on the matter entitled "Costly Bill Seen as Saving Money":

It's not hard to understand at all. It is a lie.

What makes this particular lie pass muster with many people, who might otherwise use their common sense, is that the Congressional Budget Office vouched for the consistency of the budget numbers that say you can add millions of people to a government-run system and yet save money.

The Congressional Budget Office does honest work. But it can only use the numbers that Congress supplies-- and Congress does dishonest work. It is not the CBO's job to give their opinion as to whether any of the marvelous things that Congress says it will do in the future are either likely or possible.

Sowell even further notes:

[N]one of this money is in the official federal budget that the Congressional Budget Office sees. There are many other financial liabilities of the government that are 'off-budget,' which means that they do not show up in the official numbers.

Even research analysts find the CBO's findings apocryphal. As Marc Goldwein, the policy director of the the Washington budget watchdog group Committee for a Responsible Federal Budget, points out:

CBO is the most trusted analysis out there, but everything they say, you should take with a humongous grain of salt.

Is health insurance the most lucrative and most profitable commodity in the industry? Not quite. Such insurance on average generates a profit margin that amounts to about 3-4 cents on the dollar. These firms do welcome a guaranteed clientele, even if it's foisted upon the public, because it ensures their profitability. Although Obama & Co. will appear as an populist opponent to the industry, he's actually its best ally. Why? Because Big Insurance will accept the onerous new regulations to decimate its much smaller competitors, leaving insurance consumers with fewer insurance options to purchase. Considering they are not incentivized to innovate and compete thanks to their politically-connected, politically-protected mandates, young healthy people will find that the individual mandates are compulsory and that they must purchase highly expensive products and services from these protected government-sponsored enterprises (GSEs), thanks to the state. It's intriguing that the progressive critics of the insurance enterprises, who routinely bash their practices and support Obama's "reform," neglect to mention that the new model coerces everyone to transact with these entities.

The only objection that these GSEs have with the plan is that the penalties for not complying with or refusing to comply with the individual and employer mandates are not high enough. Most young people will likely choose to pay the penalties out of their pockets rather than purchase the insurance because of the cheap savings for them. Hence, a problem arises out of that mess: if and when the uninsured become sick and then apply for coverage, they can't and won't be denied because the new law prohibits it. Expect to see future changes (in the form of stricter penalties) in the federal law to avert more gaming of the system in the not-too-distant future. Thus, this is another victory for the already-protected insurance establishment.

Finally, the critics of the old government-created public-private hybrid of the medical-care system have been spewing ad nauseum for months that the system was the result of the free market, and that it has failed the American people. But that is a baldfaced lie. A free market medical-care system hasn't existed, nor has it ever existed over the last 100 years. The "reformers" continue to miss this paramount point every single time: what exists now, and will continue to exist, is the current system has been the result of an uncompetitive medical and insurance cartel system that has been codified by the state and thrives and exists entirely and purely, thanks to state privilege. This privilege has come into existence because of its extension of state governments through state-approved and state-sanctioned monopolistic licensing. Congress, if it wanted to, could end this nightmare by repealing the prohibition on interstate insurance sales and the horrendous tax favoritism for employer-provided medical insurance coverage. But don't let those points enter the mind of the vile, greedy, and pernicious Democrats, who stand to financially profit from the system at the expense of the poor (whom the ruling party claims to care about).

And to make matters worse, before the bill passed in both chambers of the House and were signed into law, many physicians across the country threatened to bolt from the system and give up their practices. Many of them have exited from the profession because of the low reimbursements and payments from Medicare and to avoid legal malpractice liability. Expect to see a much larger mass exodus from the system in the months and years to come.

The only good news coming out of this mess is that most Americans (if not, many) are seeing for the first time the fraudulent "reform" this law really is. It only secures and protects the government-created cartels, punishes the well-off, and merely postures as a friend of the uninsured who are largely impoverished.

At the end of the day, the true prescription for medical-care reform is a freed market. Two illusions need to be shattered. First, the idea that this is a matter between the status quo and this "reform" is preposterous. The "reform" IS the status quo in drag. Second, for generations, the state has bedded the medical profession and the insurance industry to ram down our throats the evil system we have today. A freed market is the only way out of this mess.