When you read the U.S. Senate’s latest “fix” for our failing healthcare system, three phrases immediately come to mind: much ado about nothing, rearranging deck chairs on the Titanic, and the definition of insanity.
Much ado about nothing
The just-released Senate healthcare bill, the Better Care Reconciliation Act, is “an attempt to strike a compromise between existing law and the House healthcare bill in May.” Apparently, the Senate has put their political compromise above actually fixing our broken system.
This self-styled “discussion draft” proposes the following: Medicaid converts to per capita payments to states and phases out Obamacare expansion; Obamacare taxes are repealed and the Cadillac tax is restored in 2025; individual and employer insurance mandates are repealed; and insurance subsidies continued with new, even more complex rules.
There is no need to repeat Chris Jacobs’ excellent article explaining the Senate bill in depth. In fact, we should stop focusing on the veins on a single leaf of one tree and take note that the forest is on fire.
The Senate’s bill is much ado about nothing. Where is the Senate’s evidence that their bill will increase access to care? There is none and yet, care is why we have a healthcare system at all.
Opponents of the GOP plans, both House and Senate versions, will complain loudly about the millions of Americans possibly losing insurance coverage. Supporters will proudly point to debt reduction (quite small), stabilization of the insurance market (won’t happen), and a promise to cut the cost of insurance. We all remember the last such promise of savings $2,500 per year. We all know how that turned out.
Neither supporters nor detractors offer a shred of evidence to prove it will be easier to see a doctor. A recent Merritt Hawkins study showed that as Obamacare increased the number of insured individuals, the wait time to see a family practice doctor increased to 122 days! That’s four months to find out if your stomachache is gas, an ulcer, or cancer.
Deckchairs on the Titanic
Healthcare is like the Titanic. There is a big hole below the waterline. The ship is sinking. Spending is up and care is down. Meanwhile, Congress is rearranging lounge chairs on the Lido deck.
Those chairs are insurance rules, actuarial projections, eligibility standards, how to bid contracts, phase-out schedules, stabilization funds, and CBO scores. They don’t plug the holes in the ship’s hull any more than they encourage doctors to stay and care for us. Washington offers no proof that we will get more access to care as a result of the Better Care Reconciliation Act, the AHCA, or the ACA for that matter. The ship is sinking. And as we drown, they debate Congressional procedure with the parliamentarian.
Definition of insanity
A colloquial definition of insanity is doing the same thing over and over while expecting a different result. The Senate’s healthcare bill epitomizes that definition. They use the same “medicine” on sick healthcare that Obama used in 2010. It will have the same effect: make the patient worse.
Will another change in insurance rules or a new financial gimmick make doctors more available or add time to your nurse visit? It won’t. How will more government control and new regulations fix excessive central control and over-regulation? Insane.
We have two excellent examples of central economic control in healthcare—essentially single payers—in the U.S.S.R and in the Veterans Health Administration. Each controlled both supply and demand in their markets. Without free market forces, spending and prices keep going up as quality goes down. U.S.S.R. residents experienced progressive shortages of everything until the system collapsed. In the VA single payer system, “307,000 veterans may have died waiting for their medical care.” That is what we get with government-controlled healthcare, spending out of control and no care.
What would sanity look like in U.S. healthcare? If you have been going to the same doctor for decades and you just keep getting sicker and sicker despite repeated assurances you will be better, the sane thing to do is find a new doctor.
The doctor who keeps failing to fix healthcare is Washington. The new doctor should be the states, individually or in voluntary groupings.
If California wants single payer, let them have single payer. If Texas wants a free market, the Lone Star State should be able to chart its own course. Oregon wants its version of universal health care. Who is Washington to say no? Some states might band together to form a regional system of their design. And if other states want to keep Obamacare, that too should be allowed. Let states opt in to a federally mandated, Obamacare-like system if they choose, but let’s stop Washington from imposing its Father Knows Best, one-size-fits-all insanity on the entire nation.
Dr. Deane Waldman MD MBA, is Director of the Center for Health Care Policy at the Texas Public Policy Foundation; Professor Emeritus of Pediatrics, Pathology, and Decision Science; and the author of “The Cancer in the American Healthcare System.” Dr. Deane can be reached at email@example.com.