Obamacare will die at least one of three deaths: judicial, political or economic. If the Supreme Court allows this abomination to stand, voters can still deliver its death blow at the polls in November. Ideally, Obamacare will, in fact, die both of these deaths because if it survives now, it will die an economic death and take America down with it. So let’s prepare now for the post-Obamacare America.
As I travel the nation, I ask audiences two questions and always receive astonishingly similar responses to both. First question: Does America have a serious health insurance problem? Almost everyone’s hands rise; some emphatically, some applaud, some shout. Second question: Does America have a serious auto insurance problem? So far, I’ve not seen a single hand rise. Crickets chirping.
But why? Why has auto insurance maintained competitive prices, portability and amazing customer service while health insurance has not? Why aren’t people clamoring for laws that force companies to keep their 26-year-old “kids” on their policies? Are we to believe the health insurance providers are greedy scoundrels, as Democrats claim, but auto insurance providers are altruistic angels? That’s ludicrous, particularly when many companies provide both.
Some mistakenly believe medical technology causes increased health care costs, but today’s cars are as technologically advanced as hospitals. Besides, witness the $99 iPhone compared to the $5,000 first-generation cellphone: The trend of free-market technology is rapid price deflation, not inflation.
The difference between health and auto insurance is so obvious that we often miss it. Auto insurance is, well, actually insurance, a protection against an unexpected but known risk. We don’t use our car insurance - or worse yet, government - to fill our gas tanks, change our oil or replace our windshield wipers. The health care fantasy world of avoiding “out-of-pocket” expenses simply means your money will be taken out of your tax pocket and your insurance premium pocket, and usually a lot more of it. Does anyone believe that oil changes will become cheaper if our government declares them to be a fundamental right and takes them over?
What’s more, because you buy it yourself, your car insurance belongs to you. Your boss can’t take it away from you. You will never be stuck in a bad job because you’re afraid of losing your car insurance. And best of all, if your car insurance company fails to treat you right, you can simply fire them and hire someone else.
As we envision a health care system in post-Obamacare America, surely we can agree that patients deserve to be treated at least as well as car owners. What follows are straightforward steps that make the patient, rather than government, the priority in health care. Additional details of these substantial but solvable problems can be found in my book, “First, Do No Harm” (Broadside e-books, 2011).
Tax fairness: Under current law, individuals face unfair tax penalties for daring to purchase their own insurance. These laws coerce Americans into accepting employer-based policies, which often trap poor souls in bad jobs and even make some productive workers unemployable simply because they got sick. Tax fairness would level the playing field so families could choose for themselves how to purchase insurance.
End state insurance monopolies: State governments have a long history of mandating that you purchase whatever services they declare you need - coincidentally provided by those who have the best lobbyists. Not only does this practice raise insurance premiums, it is responsible for a quarter of the uninsured in America. What’s more, these mandates create the artificial state boundaries that have the perverted effect of protecting insurance companies from competition in the other 49 states. End them, either by allowing states to do so voluntarily or by employing the power of the Constitution’s Commerce Clause, if necessary.
End state licensing monopolies: Physicians, like insurance companies, are also the beneficiaries of artificial state boundaries that protect them from competition from each other. Our system should be centered around patients, not doctors. As with the state insurance monopolies, the licensing monopolies should be ended voluntarily, if possible, or using the Commerce Clause.
Health savings accounts: HSAs and other consumer-directed health plans empower patients to be consumers and have been shown to save money without sacrificing health care outcomes. Our current third-party-payer health care system is like a grocery store without price tags, where customers fill their carts with “free” steaks whether they need them or not. Since patients are blind to prices, the government has only one way to reduce health care costs: provide less of it. This is accomplished with reduced reimbursements and outright rationing. HSAs, on the other hand, would turn 310 million Americans into an army of watchdogs who are incentivized to avoid unnecessary medical expenses but are still able to get the care they need.
End frivolous lawsuits: It’s estimated that nearly $50 billion a year is wasted on “defensive” medicine that could otherwise be used to provide care for the needy. Furthermore, the sky-high malpractice insurance costs are unavoidably passed on to patients. If an obstetrician is charged $100,000 per year for malpractice insurance and she delivers 100 babies, you’re paying a $1,000 “lawsuit tax” to welcome your bundle of joy into the world. Limits on pain and suffering - but not actual damages - have been shown to reduce health care costs and improve access. For the most egregious cases, forcing losers to pay the winners’ court costs would end the lottery-ticket mentality of trial lawyers.
To be sure, Obamacare did not cause these problems - they were decades in the making - but it left them untouched or, in some cases, even made them worse. The vast majority of Americans want to scrap Obamacare, but they expect solutions to the fundamental flaws of our current health care system. Mitt Romney and the Republicans would be wise to embrace these free-market reforms.
Dr. Milton R. Wolf, a Washington Times columnist, is a radiologist and President Obama’s cousin. He blogs at miltonwolf.com.