Friday, 20 November 2015 13:38

A Path to Healthcare Serfdom

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A Path to Healthcare Serfdom

Gary Gillespie

Gary Gillespie is a retired medical doctor who practiced in Williamston Michigan.

In 1944, Nobel prize-winning economist, Friedrich von Hayek, authored a treatise which many consider his Magnum Opus: The Road to Serfdom, in polite and incisive terms, points out the hazards in allowing a nation's government to gain control of its economy, ultimately eventuating in the political transformations consistent with totalitarianism. Today, many feel America may be at a "tipping point": the future of our healthcare system perhaps represents the lynchpin in an economy which may eventually pull up and bind together the corners of a socialistic net about us.

The arguments for a socialized healthcare system date back at least to the days of the Truman administration. Those to follow, such as Senator Ted Kennedy, whose name has almost become synonymous with advancing such a healthcare plan, have worked tirelessly in attempting to bring socialized healthcare to America. The passage of Medicare legislation in 1965, although in essence representing socialized healthcare for those 65 and older, is often discounted by the media as such, possibly in an effort to dissociate its inefficiencies and increasingly precarious financial status from any future proposed socialized healthcare plans. Both Senators Clinton and Obama have campaigned aggressively for socialized healthcare, citing the need for universal coverage of an estimated 47 million Americans allegedly without insurance, and raising complaints over the growing cost of medical care in the United States. They often point to our unique position as perhaps the only highly developed nation in the world without such a plan. However, it is ultimately fair to ask whether these complaints are valid and, if so, could the majority of Americans benefit by changing from a system permitting the freedom of many choices in their healthcare to a program with significant limitations, such as seen in Canada and Europe.

There is now little doubt that the majority of Americans, together with perhaps a comparable percentage of physicians, are dissatisfied with our present system of healthcare. However, the claim that we have been witness to the failure of a free-market system in healthcare would be an unfortunate mistake. Having been a family physician for 30 years before retiring, I can say with confidence that the managed care companies with which I participated frequently crafted their fee schedules, as well as a number of sometimes restrictive regulations, in accord with Medicare guidelines, including treatment algorithms, which might be viewed as standards for care expected of their participating physicians. As a primary care physician, a number of companies also established my role as a "gatekeeper," deciding whether a patient's condition or request warranted a referral to another specialist or treatment facility, thus placing the onus for potentially limiting a patient's healthcare choices in my hands, and creating a potentially perceived false impression that I represented the de facto interests of the insurance company in such decisions. A comprehensive drug formulary for each plan, requiring special approval in order to prescribe a medication not included therein, required additional time away from patient care for both myself and my assistants, despite my opinion that the drug in question represented the one most appropriate for an individual patient's condition. These managed care policies themselves, as were their major medical counterparts before them, were in most instances the property of the employer, whose provision of their tax-favored premiums came from monies deducted from their employees' wages. Due to the existence of moral hazard, in which the individual patient was in effect spending someone else's money for his or her healthcare, a sense of ownership of the policy and a personal incentive to limit expenditures was lacking.

One could argue, in the midst of a basic economic debate over guns and butter, whether in fact we pay more for healthcare than we should. However, while examining this issue, the late economist, Milton Friedman, determined that significant medical costs stem from the administration of healthcare policies, regulation, and the marked inefficiencies embedded in our present system. As simply one example: A recent article in the Wall Street Journal points out that an oxygen concentrator can be purchased for approximately $600. However, Medicare instead pays for rental of such a unit from suppliers, who may not be required to submit competitive bids, for 36 months at a rate of about $195 per month, for a total cost of slightly over $7,000. The costs of durable medical equipment do not seem to undergo scrutiny or change, according to the article, despite the shaky financial status of Medicare, and represents but one area of healthcare's unnecessary spending. Another may be found in the mandates for coverage placed on insurance companies by individual states, running up costs for services and equipment which may generally be considered either unnecessary or not within the purview of the policies found in many other states. Such issues need to be addressed if we are serious about lowering healthcare costs.

Let's look at the question of the uninsured. Just who are these people? The Kiplinger Letter, a long-established financial advisory service, provides the following insights: of the alleged 47 million uninsured, 8.4 million are eligible for government programs, but are either not aware of this fact, or simply have not filled out forms; 10.2 million are non-citizens; 9.2 million have a household income of $75,000 or more, including those not who do not want insurance, while others may have a pre-existing medical condition which prevents affordable coverage. And 7.4 million between the ages of 19 and 24 either do not maintain access to healthcare, do not feel it is necessary, or can't afford it. According to Kiplinger, 70 percent of the uninsured are members of families with at least one full-time worker; 10 percent are members of a family with at least one part-time worker. Although few of us would likely deny that a state of insurability is desirable, do these numbers justify radically changing the healthcare system of over 300 million Americans? Should we force those who do not wish, for whatever reason, to have healthcare to accept it, as Hillary Clinton claimed recently was necessary for the viability of any national healthcare plan?

A sine qua non of any government's socialized healthcare plan is the power to control and ration healthcare to its citizens. Hopefully, the illusory claim that care under such plans is free has gone the way of unicorn sightings; its costs in reality are paid for through citizen taxation. In Canada, each province is allotted a monthly subsidy for healthcare by the government in Ottawa. Should a provincial healthcare system become depleted of funds before its next allocation of funding, those needing healthcare may not receive timely care. It recently became common knowledge in England that patients were waiting for what was considered inappropriately long intervals before obtaining care in Great Britain's emergency departments. Subsequent rulings designed to improve conditions have instead resulted in patients tying up emergency ambulance service while they wait in those conveyances, rather than in the hospital itself, in order to satisfy the government edict that patients were to be seen more promptly after signing in at hospital Emergency Departments. The documentation of those waiting weeks for service and medical interventions in Canada has resulted in discomfort, and in some cases possibly contributed to the deaths of those who, had they taken out a backup insurance policy for their care in the United States, would likely have promptly received it. It should also be noted that most of the national healthcare plans of other countries are now suffering fiscal problems of varying degrees, with increasing deductibles and co-pays added to their citizens' tax burdens in order to support their systems.

American healthcare is expensive. Through expanding such patient-driven insurance vehicles as Medical Savings Accounts, which combine a tax free allotment, similar to a medical IRA, to be used to subsidize the deductible of a catastrophic healthcare policy, a patient and his or her family can take personal ownership of their policy, can make nearly unlimited choices regarding healthcare, and are using their personal dollars, rather than those of someone else, and thus are more likely to utilize healthcare dollars in a prudent fashion. Such plans also allow price comparisons and bargaining with both hospitals and physicians; some studies show this growing trend can result in significant cost savings, as these policies increase in popularity.

It must be conceded that such plans will likely not be practical for everyone, but radical changes in our present healthcare delivery system, can only burden us with a lack of accessibility to good healthcare, and discourage the motivation of those who work diligently to provide new technology, pharmaceuticals, and a consistently high standard of care for Americans. It is crucial that any changes in American healthcare preserve our liberties and freedom of choice, along with our chosen physician, in determining the course of our diagnosis and treatment. Without preservation of individual freedom, a medical road to serfdom lies in wait: although appearing to be paved with good intentions, any socialized healthcare system transfers the freedom and responsibility for our healthcare from us to bureaucrats in Washington. America and Americans deserve better, and should understand that change does not always support the common good. *

"A man should never be ashamed to own that he has been in the wrong, which is but saying that he is wiser today than he was yesterday." --Alexander Pope

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