While legislation can stimulate and encourage, the real creative ability which builds up and develops the country, and in general makes human existence more tolerable and life more complete, has to be supplied by the genius of the people themselves. The Government can supply no substitute for enterprise. - Calvin Coolidge
Governments have a tendency not to solve problems, only to rearrange them. - Ronald Reagan
The people who conceived of The Affordable Care Act typically defend it by saying its detractors offer no alternative. My first reaction to that is a better alternative to a government program is almost always "no" government program. But I think the point needs to be amplified, especially now that we know Obamacare is a failed system.
I think it is helpful to examine the whole matter on the basis of the constitution. The constitution, you may have heard reserves almost everything to the states. this it does implicitly in the Articles, and explicitly in the Bill of Rights. There. I had to say that, because it's something they don't teach in school any more.
I have trouble getting past that in the evaluation of a federal program, nevertheless I'm willing to set that aside for the remainder of this discussion. Let's pretend that the constitution does not exist, and address the question: How do you evaluate this health care program vs. the problem it was trying to solve? To examine that, we have to deconstruct a little further.
What might make sense in a free country is that we as a people might delegate certain activities to the federal government. As a free people, we may assess our certain risks, such as risks of organized invasion or of common enemies like disease and pestilence. We might reasonably allow a government to provide these essential services, and to proscribe a fair method to pay for them. So far so good.
Is it necessary to have a government for defense? No, it could be funded by merchants, like it was before the revolutionary war. But is it better to consolidate our defensive resources and deploy them in a more efficient way? Sure! Is the government the best way to do that? Debateable. But I'm going to concede that point too, to get to the end of this.
I usually come down on the side of the value added angle. Does the government provide a useful activity, or is it a net loss in value to the people.
If the idea was to get more people on the insurance rolls, this did not happen. In fact, as
Jonah Goldberg points out, the number of people uninsured increased as a direct result of the plan. For this, we need a trillion dollar program?
If the idea was to reduce the overall cost of health care, well, chapters and verses are written on the increased costs medical centers are dealing with:
"The Affordable Care Act is basically insurance reform—eligibility and
access—and basically, they are going to pay for that by reducing the
reimbursement. It doesn't modernize how we drive to higher quality
care," Dr. John Noseworthy said in a "Squawk Box" interview.
If the problem is health care for all, the reduction in doctors and nurses in the system surely makes that goal unachievable in the long run.
So, depending on what the problem was that they were trying to solve, it's clear that the opposite is happening. So, since we are reconstructing the "shouldas" with a blank slate and a beneficial unrestricted government, what could the government conceivably do to help the problems noted.
The solutions are very simple. Not easy, but simple.
- Reduce regulations on medical care.
- Deregulate most medical services, such that service can be provided at low costs.
- Revamp certification medical requirements to reduce the cost of medical school.
- Tort reform. Limit malpractice benefits.
- Reduce regulation on medicines, and allow self-prescription for most remedies (penicillin, pain meds, etc..
- Make medical insurance a private market.
- Eliminate medical benefits provided by government.
- Replace with like amount in worker salaries, and have workers contract their own insurance.
- Consider giving tax benefits to corporations that eliminate insurance plans, thereby putting health insurance back into a free market.
- Allow experimental medicines to proceed on the basis of a willing buyer signoff
These steps would reduce the cost of medical care to the point where insurance costs would naturally fall, and more people would seek health insurance. The remainder who are in genuine need can be subsidized at a very small fraction of the cost for the current program.
To proceed the way we are is proof that either our elected officials are incompetent or that they are disingenuous about their intent. Giving them the benefit of the doubt, they must be idiots.
