The Current Crisis
Healthcare: A Modest Proposal
There’s plenty out there preferable to the monstrosity Congress has proposed.
WASHINGTON — Well you might ask in the aftermath of the Democrats’ unseemly frenzy to create a healthcare reform that restrains expenses and extends healthcare to those who need or want it, is there an alternative? Through all the Democrats’ wheeling, dealing, and spilling of red ink, sensible healthcare innovations have been available. They are modern reforms that have been hammered out in conservative think tanks over the years. Wherever they have been tried they have shown promise. Yet during the Democrats’ Capitol Hill revels they have hardly been heard of. Allow me to suggest a modest healthcare alternative to what is commonly called the present Congress’s healthcare monstrosity.
The United States spends more than twice what the average industrialized nation spends on healthcare. Though, forget not, that American healthcare is the best in the world. Equally significant, the cost of healthcare is growing at just under 5% annually, a leading reason that some Americans are not insured and that Medicare and Medicaid are heading for financial ruin. A major reason for this rising cost is the Federal tax code’s exclusion of employer-provided health insurance. This is unfair to those who must purchase insurance with after-tax dollars. Moreover, it blinds consumers of employer-provided healthcare to the real costs of their healthcare and puts pressure upwards on healthcare’s costs.
The solution is to be found in bringing healthcare to the market place. End the tax-deductibility of employer-provided healthcare. Allow every citizen, except those enrolled in Medicare or in a military health plan, to receive a refundable tax credit to purchase Health Savings Accounts (HSAs). The key thing is that people should have a choice of plans. The tax credit should be available not only to those who purchase HSAs. Some people, for instance, have higher medical costs, so they may prefer a more comprehensive policy. But we could encourage more widespread use of HSAs by raising the cap on the amount of money that people could put in them. Also, owners of HSAs should be allowed to purchase health insurance in any state in the country. The money should be applicable to those employer-sponsored plans still available or to any healthcare plan an individual or family chooses, thus allowing product competition. Unused money in each account should be rolled over in succeeding years, and whatever money remains in each account should be part of an account holder’s estate upon death.
An additional twist to this might be to allow people with HSAs to pay for their healthcare expenses by drawing down from a healthcare debit card. This would be particularly desirable if healthcare were administered through a patient’s local hospital. Administering healthcare payments through hospitals is an innovation recently suggested by Hunt Lawrence, a New York investor and successful entrepreneur who has reviewed the American healthcare system and believes hospitals could compete successfully with insurers while offering a broader range of services. With his, admittedly ambitious reform, hospitals could simultaneously monitor a patient’s bills and health conditions. Furthermore the hospital could neatly maintain the patient’s health records, which would be portable for the patient in the event of moving from one locale to another. Of course, patients would be free to change hospitals, thus introducing competition among hospitals.
Also let us have tort reform. Reckless malpractice lawsuits account for at least half a trillion dollars in wasted healthcare expenses annually, through jackpot lawsuits and the unnecessary tests prescribed by doctors fearful of the reach of trial lawyers.
Finally for those who are impoverished and unable to pay for healthcare, let the government give them vouchers to pay for their medical expenses up to a certain amount annually.
Whatever the consequences of the Democrats’ 2009 healthcare monstrosity, conservatives should redouble their efforts to repeal its archaic collectivist requirements, if they ever become policy. Notwithstanding their promises to lower healthcare costs, the collectivists are going to increase those costs by a huge amount while reverting to government rationing and control of doctor-patient relations.
So here are some modest proposals that I have gathered up from thoughtful work that has been done in conservative think tanks and by conservative reformers. An omnium-gatherum of such domestic reforms can be found in Congressman Paul D. Ryan’s “A Road Map for America’s Future,” which is available on the Wisconsin Republican’s website. As conservatives mount their challenge to the Democratic reactionaries’ revived Great Society, replete with huge deficits and Stagflation II, I prescribe Ryan’s Road Map. Conservatives do have an alternative to economic ruin.
About the Author
R. Emmett Tyrrell, Jr. is the founder and editor in chief of The American Spectator. He is the author of The Death of Liberalism, published by Thomas Nelson Inc. His previous books include the New York Times bestseller Boy Clinton: the Political Biography; The Impeachment of William Jefferson Clinton; The Liberal Crack-Up; The Conservative Crack-Up; Public Nuisances; The Future that Doesn’t Work: Social Democracy’s Failure in Britain; Madame Hillary: The Dark Road to the White House; The Clinton Crack-Up; and After the Hangover: The Conservatives’ Road to Recovery.
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john morton| 1.28.10 @ 6:33AM
all of your observations/recommendations are on point - except medical malpractice. while one can argue - logically - for "commerce clause" based tort reform, the underlying "facts" you outline simply don't exist. as a conservative trial lawyer, i see the tort system as a necessary part of a free mkt economy - especially where dr's and hospitals are seldom held to regulatory stds and often (over 25% of the time) alter, destroy or outright lie in medical records regarding adverse outcomes. interestingly, my experience (25%) is supported in the peer-reviewed medical literature
frosty| 1.29.10 @ 12:52AM
Mr. Morton,
Mr. Tyrell had one small paragrah on tort reform, essentially making a single statement, that the fear of lawsuits drives up the cost of medicine by at least a half trillion dollars. You then stated, speaking to Mr. Tyrell, that "the underlying "facts" you stated simply don't exist." You then changed the subject to how often doctors and hospitals lie in medical records regarding adverse outcomes (in my experience those numbers would compare favorably when contrasted to how often patients and their attorneys lie for malpractice dollars. Maybe you could give us a peer-reviewed article on that one.) Yet, you never enlightened us on the "facts that don't exist". What facts are you referring to? Tell us the true facts, please.
Michael End| 1.31.10 @ 5:30PM
Frosty, How about this? The National Practitioner Data Bank reported payments of $3.7 billion in 2008 to patients injured by doctor negligence. Since Mr. Tyrrell used a figure of "at least a half a trillion dollars", I think John Morton was correct on calling Mr. Tyrrell for his exaggeration. If you believe the myth of "defensive medicine", read "The Cost Conundrum" in the June 1, 2009, issue of The New Yorker, found at http://tinyurl.com/ptevdk. Then, ask yourself why health care costs are double in McAllen, Texas, where a $250,000 cap on noneconomic damages has been in effect since 2003, than they are in Rochester, Minnesota, home of Mayo Clinic, where there has never been any cap on damages in medical malpractice cases. The answer is that so-called tort reform has no bearing on health care costs. Does it make sense that a doctor would not order a diagnostic test if there were a limit on the patient's recovery, but would order the test with no limit? The truth is that the ordering of diagnostic tests is saving many lives every year. If the possibility of a lawsuit is what brings about good care, that is a good thing. I am a lawyer and have represnted the parents of a 5-year-old girl who died because the emergency medicine doctor failed to order a finger stick for the girl who presented with all of the signs of diabetic ketoacidosis. The test would have cost the hospital 53 cents. Or the widow of the 32-year-old man who died because the doctor failed to order a D-dimer test to determine if the man's shortness of breath was being caused by a pulmonary embolism, which it was. Or the patient who fractured his hip in a fall in the hospital but the doctor failed to order the x-ray that would have diagnosed the fracture.
Finally, where does Mr. Tyrrell come up with the notion of "reckless" lawsuits. The chances of winning a medical negligence lawsuit are very poor, even with the best of facts. In my many years of practice, I have learned that the insurance companies do not settle cases unless their backs are to the wall. Last year I lost two cases that were absolutely solid on the facts and on the medicine. As is often the case, the defense confused the jurors into finding that the doctors were not negligent, the absolutely wrong decision. My firm spent over $200,000 for those cases. Mr. Tyrrell's notion of what medical malpractice cases are like is incorrect. The patient is always the underdog and rarely wins the case. If you have time, read "Doctors & Juries", Michigan Law Review, Vol. 106, pp 1-42, found at http://tinyurl.com/ybc7aua. This law review article tells how difficult it is for a patient to win a case with merit.
Jim O'Brien| 1.28.10 @ 8:07AM
All of the above is continued manipulation of the federal income tax system. To solve the problem, first, get rid of the federal income tax and the IRS altogether by enacting the Fair Tax (www.fairtax.org). Second, turn over medical care and medical insurance to free enterprise by repealing federal restrictions and "programs". In other words, government should get the hell out of the way and let the free market work. If it had not been for free market capitalism, this nation would not exist, and we certainly would not (still) have the best health care in the world. Every time Congress adds new, socialist laws, and the bureaucrats dictate new regulations, we take a step backwards.
Shamus| 1.28.10 @ 8:39AM
Many states have a no-fault policy with respect to auto accidents. It seems to me that this would work well for medical malpractice. Set up a fund to give basic compensation to people who have adverse medical outcomes rather than forcing them to sue. This would be less costly and much more fair, as money would go to help people suffering from medical problems rather than to lawyers, who provide little or no value to the health care system.
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The American Spectator : Healthcare: A Modest Proposal Injury just to Me links to this page. Here’s an excerpt:
Dan Hirsch| 1.28.10 @ 9:21AM
I fail to see the benefit of ending employer-paid health insurance premium deductibility. This is a tax increase.
You can achieve the same end by making all individuals' health insurance premiums deductible. This increases individuals' incentive to purchase health insurance, cuts taxes on individuals, and brings them into the cost/benefit decisions on their own healthcare. This is a tax cut.
Whenever I find myself in conversation about health, I always raise this question: 'Why should anyone else pay for my health care? Should they pay for my food, too?'
Healthcare is the product of some one else's labor and time. No one has a "right" to demand someone else's labor and time for free. Therefore there is no more a right to healthcare than there is a right to own a Ferrari or a home, large or small.
Pass it on!
Dan H
Paris, Wisconsin
bluecollarbytes| 1.28.10 @ 9:49AM
Mr Tyrrell's suggestions are dependent on some level of personal responsibility, which is why I think they get rejected, in part, out of hand by liberals/Leftists.
______________
Let me take this opportunity to thank R. Emmett Tyrrell, Jr for being one of my political guiding lights since the early 90s. He was introduced to me by Rush's radio show along with the American Spectator-one of the few who delved into the World-O-Clinton beyond HIS hope-n-change. We're in a long political war that requires ongoing Opposition. Other publications oppose, and have fine writers with whom I agree. But sometimes they get bogged down in working with the 'process', forgetting that The War is taking place. (ok, nuf asksng fr tdy)
SoCon| 1.28.10 @ 11:18PM
Rush's show introduced me to RET, too! Rush and TAS helped me survive the Clinton years.
I am grateful to both of these fine conservative patriots--both have shown great courage in the face of withering liberal opposition.
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Thomas| 1.28.10 @ 11:59AM
I am always amazed by the notion that the American Healthcare system needs to be fixed. Nothing could be further from the truth. every man woman and child in the United States has access to healthcare. No one, not even illegal aliens, can be denied necessary healthcare. We have here, for all intents and purposes, medical coverage of 100% of the public.
The only fix that is likely to reduce, or at least hinder the increase of medical costs, is severely limiting the intrusion into healthcare of government. The largest factor in increasing costs of healthcare is the government third party payer system. Medicare and Medicaid effectively set the costs of medical procedures, and private insurers looking to increase profits, follow suit. This causes medical providers to raise their rates for services to maximize the return form the small percentage of that charge that will be paid by government and private insurance programs. In many states now, it is illegal for provider to charge a patient without insurance the same amount as the provider would receive from an insurance provider. This causes the non-insured customer to pay 2-4 times what the insurance company [private or government] is paying. In other words, government intervention in the healthcare market, through government run health insurance companies, has stifled the competitive free market and driven costs up disproportionate to inflation and other costs.
Medical malpractice litigation is a problem, but that is endemic to the legal system and should be addressed by non-government means.
frosty| 1.29.10 @ 1:09AM
Mr. Thomas,
I'll give you one other thing that needs to be fixed about our current healthcare system. As it stands, 100% of Americans and any other non-Americans who reside in our country, have access to medical care. The problem is that this statistic is made possible by the government FORCING emergency room doctors to see all patients who present to the emergency department for care, regardless of the nature of their complaint, and regardless of their ability to pay. Those patients who present by law must have a medical exam and all tests necessary to prove that an emergency medical condition doesn't exist or is unlikely to arise from the current complaint. With such a wide ranging and vague definition, as well as with the specter of malpractice lawsuits everpresent, the practical result is that essentially all patients get evaluated, tested, and treated. It is the MOTHER OF ALL UNFUNDED MANDATES. Most emergency rooms, the doctors and hospitals, receive payment form less than 50% of the patients they see, many as low as 30% to 40%. Please name another industry or sector of our economy where a citizen is forced by law to provide goods and/or services free to those who ask for it 50% of the time. A true life-threatening imminent death emergency, pro bono no problem. All the others? If the federal government chooses to make the emergency room the safety net for all of America, regardless of the severity, acuity, or urgency of the illness, they should either pay the provider for their work or require the patient to do so. As it stands, an ER doctor cannot even write this mountain of unpaid bills off as bad debt.
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The American Spectator : Healthcare: A Modest Proposal Federal Me links to this page. Here’s an excerpt:
Jim O'Brien| 1.28.10 @ 1:53PM
Instead of expanding the role of government in medical care and medical insurance, Congress should be reducing the role of government. Most of us recognize that the United States owes its amazing prosperity and high quality of life to freedom and capitalism, not to government programs. The government kills competition and innovation. In contrast, free enterprise invariably leads to higher quality products and services, easy access, freedom of choice, and lower prices. For example, competition largely unencumbered by government interference and regulation has given us amazing computer technology available at affordable prices, including the internet and the iMac I am currently using.
Unfortunately, Congress is hostile to free enterprise. It thinks it can micro-manage virtually every aspect of life in America, including health care. A majority of Congressmen and women have learned almost nothing from the collapse of the former USSR, and the failure of other socialist governments around the world. Congress doesn't get it. It doesn't understand that if we had a truly free health care market, then Americans would enjoy even better health care than they already have, and at lower cost. Congress should tear down the barriers it has erected and let medical insurers compete nationwide. Congress should abandon it's socialist schemes, such as dictating that insurers must cover everyone regardless of pre-existing conditions, or dictating the details of coverage including co-pays and deductibles. Existing legislation such as the HMO Act should be repealed. Medicare should be converted to private control. Tear down the medical Berlin Wall and let hospitals, doctors, medical device providers, pharmaceutical companies, and insurers compete. In other words, government should get the hell out of the way.
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Franklin| 1.28.10 @ 3:09PM
I worked in the health care indursty (insurance and provider) for over 20 years. I can tell you that one of the largest increases of the cost of health care are all of the government regulations billing insurances for services.
For several years I was in charge of the billing department for a modest 400 bed hospital. Our department alone had 70-90 employees. That was just for hospital charges NOT including doctors, clinics, outside labs, etc.
By the way, I never once saw or even heard of a person dying because they lacked insurance.
James G| 1.28.10 @ 3:38PM
As a tactic the Republicans should insist on serious tort reform. First. Before anything else is even considered.
Tort reform would -- by itself -- have a serious reduction of costs since MDs would no longer be exposed to heavy insurance premiums. They would be less inclined to over-test patients also reducing costs.
By making insisting that tort reform be adopted first it will put the Dems in a bind. Either do the right thing for "the American people" or place their own interests first and don't scare off the trial lawyers, their major contributors.
Flee| 1.28.10 @ 4:04PM
Why should an individual be taxed for insurance premiums paid by their employer when they may never access the insurance? It is deductible because it is a business expense for the corporation. There is no requirement to accept the coverage and employees are free to go on the open market and acquire their own coverage (I did and for much less than I could get at work). I will be able to deduct the after-tax contributions to the HSA I opened and begin saving for retirement health care needs or current needs. The system is not broken despite all the hot words from DC. Can it be improved? Of course. It would be a helluva lot better if the govt just got out of it but then that goes for a lot of problems we face everyday.
Flee| 1.28.10 @ 4:07PM
Regards tort reform, can't they just set a fixed price for each occurence rather have a lawsuit to decide the value? That would take the lawyers out of it completely much like supplemental insurance pays a fixed dollar amount when you break a leg or toe, etc... I believe this would help control costs for the insured and relieve the pressure on doctors and practitioners when they know they are ultimately on the hook for X rather than some unknown amount. These are practical solutions rather than radical.
Michael End| 1.31.10 @ 5:51PM
Flee,
Check the website for Institute for Healthcare Improvement, which is an independent not-for-profit organization helping to improve healthcare throughout the world. The organization is located in Cambridge, Massachusetts. That organization estimates that 15 million incidents of medical harm occur in U.S. HOSPITALS each year. Do the math and determine how many injures and deaths there are when you include events outside of hospitals. According to the National Practitioner Data Bank, in 2008 there were 11,022 payments made to people injured by doctor negligence. Your plan would exponentially add to the cost of compensating injured people. The actual incidence of medical malpractice is vastly greater than the relatively few number of people who are compensated for their injuries.
James G| 1.28.10 @ 4:35PM
Re tort reform Megan McArdle suggested a separate court for malpractice and (her best idea) a 30 percent limit on lawyer fees if they settle and a 20 percent limit if they go to trial. I'd make it 30 and 15.
Michael End| 1.31.10 @ 6:06PM
James,
People now have a hard time finding lawyers to take their cases. I practice law in Wisconsin, a state with 5.6 million people. In 2008, there were only 139 medical malpractice lawsuits filed in the entire state, with only 64 people receiving compensation for injuries suffered by doctor negligence. Many cases are lost by the patients that should be won because of a reluctance on the part of jurors to determine that a doctor acted negligently. Google "Doctors & Juries", a 2009 Michigan Law Review article that discusses how infrequently injured people are able to recover compensation for their injuries caused by medical negligence. If your notion of how to compensate the few lawyers willing to take on medical negligence cases were put into effect, there would be no medical negligence cases filed. We can barely afford to take such cases now. You might think it would be good if no malpractice cases could be filed, but that would fly in the face of what our founding fathers determined to be the law of the land, namely, that people injured by another's negligence deserve to be compensated for their injuries. It is likely that doctors practice more carefully knowing that there may be a lawsuit filed if the doctor acts negligently. Remove the possibility of the doctor having to be held responsible for injuries caused by the doctor's negligence and we will have worse medical care and more people being injured or dying because of doctor negligence.
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Anthony| 1.28.10 @ 8:15PM
The health reform issue is far from over.
Our ultra-liberal first term House member from Maine, Chellie Pingree (whose sole real world experience is running a tiny knitting company in the 70s) is one of the people now trying to force reconciliation through. After Brown, I couldn't believe it, but she and Rep. Collins from CO are now circulating a letter, which goes to Reid on Friday. Her interview re this is on (where else?) the Maine Public Broadcasting Networking web site; it was aired last night.
Naturally, there was nothing on this in the state's largest newspaper, the lefty Portland Press Herald, this morning.
Luckily, a good guy, Dean Scontras, is challenging her next Nov.
MBT Chapa GTX Women| 1.28.10 @ 8:40PM
Luckily, a good guy, Dean Scontras, is challenging her next Nov.
MBT SPORT
anti-shoe| 1.28.10 @ 8:43PM
The health reform issue is far from over
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Branda| 1.28.10 @ 11:00PM
Whenever I find myself in conversation about health, I always try to raise this question: 'Why should some other person pay for my healthcare? If its correct they should'nt they pay for my food, too? breastactivesreviews
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John R. Salverda| 1.29.10 @ 2:15PM
You've heard it said, "we need universal health insurance," and yet I say unto you, "nobody needs insurance." People need water, food, shelter, and sick people do need health care, but insurance is not a necessity to anybody. The argument favoring insurance is, "health care costs too much," however, the insurance industry itself sets the price. They want to make health care expensive, thereby forcing us into purchasing insurance. It’s tremendously expensive to operate an insurance company. There are shareholders who want big profits, the company's officers make millions, they have huge office buildings, employ a fleet of lawyers, and there are lawsuits that they have to pay. They afford these things with our "health care" dollar. Their fiduciary responsibilities are to deny health care claims wherever they can. Furthermore those clinics that control our doctors and nurses, also have to pay for specialized receptionists who know all about insurance, claims adjusters, and medical coding specialists. Obviously these are all administrative costs and aren’t related to health at all! Does anybody seriously believe that funding the entire insurance industry with our health care dollar makes health care cheaper? Our politicians seem to think so, but then again they take money from the insurance lobbyists as campaign contributions. The media seems to think so, but then again they are heavily sponsored by insurance companies who can withdraw that sponsorship at any time. The public is thereby being deliberately misinformed as to the value of insurance.
Healthcare and Insurance are two completely different things. Healthcare is what you may need if you get sick or injured, insurance is not needed by anyone it its merely some kind of a payment scheme. People who buy health insurance are greedily hoping to receive their healthcare cheaper than, and at the expense of, those who remain uninsured. People would not have purchased insurance unless they thought that they were getting some kind of a deal.
Insurance is an unnecessary third party parasite on the doctor patient relationship, sucking as much money out of our health care dollar as it can. From doctors as well as patients. I have no insurance because I hate insurance!
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Michael Kirsch, M.D.| 1.31.10 @ 10:12AM
You are spot on re tort reform. I'm a practicing MD who has been unfarily victimized repeatedly. We are torturing the medical profession, wasting billions of health care dollars on defensive medicine and exposing patients to risks of tests that are unneeded. And, most patients who have been true victims of negligence are missed by the system. This medical liability system makes the health care system seem robust. See www.MDWhistlblower.blogspot.com under Legal Quality.
Jim Vafier, M.D.| 1.31.10 @ 11:17AM
As a practicing emergency physician, I am astounded at Mr. Morton's claim that physicians "alter, destroy or outright lie" in medical records in over 25% of cases. Mr Morton refers to "peer reviewed literature" that confirms his statement. I would like to see the reference!
There are several practical and simple steps needed for successful health care reform. First, make insurance tax deductible for all Americans. Second, based on income, provide tax credits (which are different than tax deductions) or vouchers to those who cannot otherwise afford insurance. Third, allow people to own and tailor their policies to their individual needs. Fourth, allow interstate competition among insurance companies. Last, but certainly not least, is tort reform. How about the simple concept of "loser pays?" Seems fair to me!
Oh, and regarding illegal aliens- let's not forget that there is a federal law (Emtala) which requires us to treat all who present to our emergency departments and hospitals. How are hospitals supposed to survive if they are not reimbursed for this significant expense? Think about it!
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L Tod Schlosser | 11.4.11 @ 11:37AM
Such an amazing article! I really enjoy reading it, very good insights, the article is very ell-said. A thumbs up!
L Tod Schlosser
newtony| 9.25.10 @ 10:14PM
I have to agree that the healthcare reforms were pushed through with a lot of questionable fervor. Although American health care may be the best in the world, it was based on unfair Federal tax exclusion policies. So I applaud your suggestion of a refundable tax credit to purchase an HAS. And the idea of a healthcare debit card and the idea of government vouchers for the impoverished would certainly make things even easier for both patients and hospitals. You also make a good point about unnecessary tests and the predatory practices of trial lawyers shooting up the costs astronomically. Frankly, I find it somewhat bewildering to understand in retrospect why the carefully thought out ideas offered by the think tanks were not seriously considered and applied. Why was Congressman Paul D. Ryan’s "A Road Map for America's Future" not given the time of day?
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