Why I am opposed to universal healthcare

SiCKO presents a dramatic portrait of what's wrong with America's healthcare system… and clearly there is a lot wrong. But it is by no means a fair or balanced documentary. It says nothing of the problems endemic in socialized medicine. It doesn't mention the people who die waiting in line for treatment in Canada or England, or who come to the US because they can't the treatment they need in their country. It doesn't mention that the US is the leading innovator in medicine, and we have the best healthcare in the world for those who can afford it. It doesn't mention the fact that healthcare is rationed in other countries, and that it may take months to get an appointment or a treatment. It doesn't mention the cripplingly high taxes required to pay for these systems, which drag down the economies of these countries.

The US system has many problems, and desperately needs reform. We need very badly to increase the number of people who are insured, both for their benefit as well as for the benefit of the presently insured, who often pay for the emergency care of the uninsured indirectly. We need to make changes to the insurance system as well. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.

However, I am strongly opposed to the idea of federal government provided, single-payer universal healthcare. Here’s why:

1. To achieve “universal coverage” would require either having the government provide health insurance to everyone or forcing everyone to buy it. Government provision is undesirable, because government does a poor job of improving quality or efficiency. Forcing people to get insurance would lead to a worse health-care system for everyone, because it would necessitate so much more government intervention. Government is bad at just about everything. It is inefficient, slow, and incompetent because it has no competition. I really do not want the people who run the DMV or the IRS to be in charge of my healthcare. I do not want beaurocrats making decisions about what services I should receive. I do not want more of my hard earned money being stolen from me through taxes. As a libertarian, more often than not I see government as part of the problem, rather than the solution to our problems. Any government beaurocracy will only become larger, more powerful, more bloated and inefficient, and more costly over time. The examples are so obvious I don’t need to name any.

2. In a free country, people should have the right to refuse health insurance. If they do, they should reap the benefits or suffer the consequences of their choices.

3. If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.” This is best done at the state level. The constitution does not give the federal government the authority to manage healthcare. Letting the states try experiment with different policies and systems will allow us to discover the best solution far more quickly than if we impose a single policy on the entire nation at the federal level.

Here is what I think we should do instead:

1. Subsidize healthcare for the very poor and children of poor families (we already to this through Medicaid… the system may need some tweaking). These are the people who truly cannot afford to buy their own insurance or healthcare.

2. Everyone else who can afford to buy their own insurance should be strongly encouraged do to so, but not forced to.

3. Get employers out of the business of providing health insurance. It makes no sense. We are the only country in the world where employers are expected to provide health insurance. Why should they? The system is a relic of the WWII era when the government imposed caps on wages, so employers found other ways to attract and retain the best employees. In order to change this, we need to fix the tax code so that there is no longer a tax incentive for insurance to be provided by employers. The best way to do this is to make medical expenses and the cost of buying your own insurance tax deductible. Then your employer could simply give you the money they currently spend on insurance as an increase in pay, and you could decide how to spend it for yourself.

4. Make insurance more portable, so that if you lose or change your job your insurance is not affected. This requires getting employers out of the healthcare business.

5. Convert our paper-based medical records system to a digital system. This will improve efficiency and reduce errors, saving both money and lives.

6. Reform the legal tort system so that fear of malpractice lawsuits and the cost of malpractice insurance no longer drives up the cost of healthcare. Bringing down the cost will enable more people to buy their own insurance.

7. Change the way most Americans think about health insurance. Insurance, in the true meaning of the word, is intended to cover major unforeseen expenses, not small regular ones. Yet in the past few decades, we have seen the system evolve to the point where we expect our health insurance to fully cover the cost of every runny nose and checkup. The problem with this is that people have no incentive to shop around, turn down services, or minimize the cost of their healthcare. When somebody else is paying the bill, why are you going to say no to anything? This is a big reason why healthcare costs keep going up. If you have insurance that only covers the major, unforeseen expenses, you will make much better decisions about what services to get and what services you don’t really need. You will also be more inclined to shop around for less expensive treatments or medication. This will lead to tremendous savings.

Look at this another way. Your car insurance doesn' t cover the cost of oil changes, and your homeowner's insurance doesn't cover the cost of fixing a leaky faucet. If they did, it would drive up the cost of these forms of insurance as well. People would go to the most expensive mechanic or hire plumbers to do all kinds of unnecessary work, since they wouldn't be paying the bills. Our system has evolved from healthcare insurance to healthcare cost insulation, and that is one reason it's so expensive.

8. Studies show that many treatments provided today are a complete waste of money, either because they are ineffective or completely unnecessary. Doctors today have an incentive to provide ineffective and unnecessary treatments for two reasons: a) to cover their asses so they don’t get sued if something unexpected happens, and b) because they make more money by providing more treatments. In order to reduce the number and cost of unnecessary treatments, we need to give patients the means and the incentive to become involved in these decisions.

When you go shopping, do you let the shopkeepers decide what you're going to buy, and then just whip out your credit card every time they ask you to buy something? Of course not! So why do that with doctors?

9. In order to make #7 and #8 work, we need to make information about the cost and effectiveness of various treatments more readily available to healthcare consumers, so they can make informed decisions. This can be done be forming an organization whose purpose it is to impartially evaluate and rate the benefits, risks, and costs of various treatments and publish that information on a web site. This will help people decide what treatments to spend THEIR money on and what treatments aren’t worth it.

10. Come to grips with the fact that as technology advances, companies will develop treatments for more and more diseases. Eventually, it may be possible to cure nearly anything, and to keep someone alive indefinitely, for a cost. In some cases that cost will be extremely high. Research is expensive, and some diseases are rare. We cannot and should not expect society as a whole to pay an unlimited amount of money to keep someone alive. What would happen if any illness could be cured for $10M? Would we expect insurance to pay $10M every time someone gets old and develops one of the inevitable diseases of old age? Clearly that is unworkable. Therefore, in the coming decades we will have to wrestle with the unpleasant decision of how much we are willing to spend on each person’s healthcare when technologically, the sky’s the limit. I, for one, do not want the government to make that decision. I think it is best left up to each individual to decide how much to spend on their healthcare.

For further reading, I recommend these:
http://www.weeklystandard.com/Content/Public/Articles/000/000/013/760hoavn.asp
http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Care/dp/1930865899/ref=pd_bbs_sr_1/102-1542867-4157759?ie=UTF8&s=books&qid=1183572929&sr=8-1
http://www.amazon.com/Healthy-Competition-Whats-Holding-Health/dp/1930865813/ref=pd_sim_b_1/102-1542867-4157759?ie=UTF8&qid=1183572929&sr=8-1

Jury nullificaition: a juror's right to judge the law, not just the defendant

Most people have never heard of it. Most jurors are deliberately kept in the dark about it by judges and attorneys. But jury nullification is a powerful tool that every prospective juror (every US citizen) should be aware of. If you are called on to act as a juror in a trial, and you feel that the law being used to prosecute the defendant is unjust, you can (and should) return a verdict of not guilty, even if the defendant is clearly guilty of violating that law.

Many judges and attorneys hate it, and refuse to inform jurors of their right to nullify unjust laws, or even acknowledge it in court, because it diminishes their power over the jury and the defendant. But this power is important because it is, in effect, a safety valve which can prevent the powerful from victimizing the weak through unfair, immoral, or unjust laws.

I think drug laws a perfect example of of why we need jury nullification. Tell all your friends about it!

en.wikipedia.org/wiki/Jury_nullification