Today there are politicians clamoring for “Medicare for all.” This would change partial socialization of our health care to a fully socialized system. No matter that socialism always ends in bad outcomes; cost explosion and unsustainable debt for starters. Worse, invention and innovation and improvement will stop. And worse yet, supply will decrease in an attempt to reduce cost resulting in longer wait-times for everyone, and services becoming unavailable. The end result will be unhappiness by everybody; patients and the doctors. Doctors will retire early or change careers. Students will no longer be attracted to study medicine. If you don’t believe me, check out things in England and Canada.
Health care in the United States is almost 50% socialized. Here are the numbers: out of 328 million citizens, 153 million get their care through one of the social programs, while 175 million are on the private side. The social side is 47% of the total. In the political debate there is strong interest pro and con over complete government take-over of health care.
The social programs breakdown as follows, in millions: Medicaid 75, Medicare 58, Obamacare 11, and the VA 9. On the private side 155 million get their insurance from their employer, leaving about 20 million to provide for their own health care.
My book explains why capitalism benefits everyone, and why socialism always leads to no good ends. I write here about why health care delivery must change more and more to the private side. Only then will the most people be satisfied. And who is the key and most important person or thing in health care; it is the Medical Doctor. It is not the government. It is not hospital complexes, or insurance companies. It is the physician, and all the surrounding support people; the nurses, the physical therapists, and on and on. The ones you see when you encounter the health system. Remember, only people take care of people. Buildings don’t. Government doesn’t. Doctors must be free to be both able to charge patients directly and to also accept government and insurance assignment for payment; their choice. Only then will they have incentive to provide the greatest quality of care. Only when patients are free to pick and choose for their health care what both meets their needs and which they can afford, in an open and free marketplace where prices are set by competition, will patients be most happy. And only in a free marketplace can new invention and greater innovation take place.
If you still want government to pay for your health care (which is us, the taxpayer), and still believe that the system will improve if totally taken over by government, you have only to look into how satisfied the Canadians and the British are with their health care. It’s why the Canadians get their serious health care delivered to them in the United States.
The Medicare recipients, even though they have to pay substantial amounts of premium, are probably pretty happy, but the problem is this: Medicare is basically bankrupt and cannot be sustained. Medicare, Medicaid, the VA system and Social Security; that is, all the entitlements, currently cost over 50% of all the Federal expenses. Worse yet, the annual budget deficit is running over a trillion dollars, and that gets added every year to the unbelievably huge Federal Debt of 22 trillion dollars. Something has to give, or eventually our government will fall. So, for me to say the cost of the entitlements will have to be constrained or else, is not hyperbole!
For those unable to care for themselves for reasons of poverty and disability, there needs to be Medicaid, but it should be run by the States, bringing to bear 50 state experiments in government taking care of their citizens, with federal matching funds. By putting control closer to home is always better than putting control far away and remote. Of course, attempts to keep raising the bar for eligibility to those able to pay for their own care has to be stopped, otherwise, Medicaid will become unaffordable.
I advocate for ending the VA Health Care Administration as too costly, with long wait times, and consumer dissatisfaction. Facing difficult politics, the only solution to the Medicare budget crisis, is to convert to a government-paid voucher system, where the recipient collects the voucher and then picks and chooses health care which makes the most sense to him or her.
We already have a voucher system on the private side, which with subsidies paid by Medicare to their recipients could be the route to ending the ever-increasing Medicare expense. Here is how it works on the private side.
Congress created a system for the general public’s health care a few years back, whereby the public can create a Health Savings Account (HSA). Similar to an IRA (Individual Retirement Account), the government sets the annual contribution limits, and those willing to participate, do two things; (1) buy a qualified high-deductible health insurance plan, and (2) put money into the fund. The deductible amount must be at least $1,350 for individuals, and $2,700 for families. The contribution is with pre-tax income. Then, as medical costs are incurred, funds get withdrawn from the account for payment. Funds left at years end, roll-over to be used in following years. The young, as we all know, with low medical expenses can build up a cushion of funds to be used later in life when we all know medical costs increase with age. Contributions for 2019 are $3,000 for individuals and $7,000 for families.
There are innumerable problems that concomitantly need to be addressed before meaningful change of our Health Care System can take place. Prices have to be transparent and not hidden or confused by cross-subsidies. Let private citizens shop in the marketplace to find their care that makes the most sense to them, and at a price they can afford. End the 10,000 I.C.D. coding system that everyone finds difficult and confusing, and which the public doesn’t understand. Let the major software companies invent a new system we can all use. Abandon the Government created Electronic Medical Record (EMR) which takes doctors longer to fill out than to see the patients themselves and encourage the medical profession to create common medical records that can travel with the patient, and which can be easily updated, and with a copy maintained by the patient so that when errors enter, they can be corrected. Hospital complexes controlling employed doctors have to face competition from private practicing physicians. Insurance companies need to face new competition from being able to sell across state lines. All costs in health care need to be analyzed by cost accounting; for example, the $1000-dollar cat scan cost has to be broken down into equipment cost with reasonable allowance for replacement, amortization of the square-footage of the space housing it, the cost of technical personnel operating the machine and the cost of expendables. No more taking of the price from last year and adding 10% or whatever for inflation and repeating and repeating, year after year. And then either hide the cost or have another charge to subsidize the first; e.g., cat scans subsidizing the hospital room charge. Finally, the cost of malpractice has to be seriously addressed. No more shaming of physicians over accidents and poor outcomes. End the trial lawyers’ lobby to get rich and replace with openness and full-disclosure leading to re-engineering resulting in fail-safe processes.