Opposing National Health Care.

Vic Biorseth, Monday, March 23, 2009
http://www.Thinking-Catholic-Strategic-Center.com

The National Health Care “need”: I submit that doing or directing the medical treatment of citizens exceeds the authorized scope and delimited authority and reach of the United States government. Doing or directing any medical practice within our borders is not in accordance with the limitations and duties of our government, as explicitly spelled out in our Constitution, which defines the organization of and limitation upon the government of our Republic. Medical Practice is not what we instituted and Constituted our government to do. Taking command of any part of medical practice in the name of “National Health Care” or “Socialized Medicine” or any other name is far beyond the Constitutionally authorized scope of our government, and attempts to do so represent gross political over-reaching, government intrusions into the private sector and direct government interference within the strictly private sphere of the free market.

In a free market economy, the consumer “votes” for goods and services available by taking dollars out of his pocket to pay the most competitive provider. When anything – such as an insurance agent or a government official – comes between the consumer and the provider, the net effect, at the very least, is that the product or service will have an unnaturally higher price than the laws of supply and demand dictate, or, the consumer will have fewer dollars in his pocket with which to vote for his choice of the best available goods and services. Either way, the cost always goes up. Most usually, the quality and/or availability also goes down.

Bottom line: insurance companies and government bureaus add nothing whatsoever to medical treatment process other than added cost, restriction and complexity. There is nothing medical and nothing pharmaceutical that insurance agents and government bureaucrats do; yet, they too must be paid, and their pay comes straight out of the patient-doctor transaction.

A Medical Billing Business was one of the several businesses we tried after I temporarily left the Programmer/Analyst job market to try to become an independent entrepreneur. Obviously, it didn’t succeed, or I wouldn’t be driving a truck today. (We never signed our first client doctor.) Nevertheless, the experience was very educational, in more ways than one. In the training involved in becoming certified to do Medical Billing I learned a great deal about current and past law regarding medical practice, and, even more interesting, law regarding medical insurance. Most interesting of all is the relationship between our government and the medical insurance industry.

We spent thousands of dollars on the latest and greatest medical billing computer software, a major upgrade of our computer hardware capacity and speed, a giant external hard-drive to back-up the multi-client database and multiple massive history files, an ability to regularly burn client billing history records onto CDs and/or DVDs (depending on file size) for client doctor’s files in order to eliminate their need for paper files, and more; too much to list here. Perhaps the greatest single investment was in time and effort. Some day I’ll do a separate page on our attempts to start a business of our own; I’ll probably call it Home Businesses that have Had Us, or some such title.

One of the things we did was to build a really snazzy medical billing website, which was proved helpful in getting a lot of attention to our new business, but not, in the long run, in getting any potential client doctors to sign up with us. Like a couple of others, we wound up dropping that particular website. This website, of course, was and remains a sort of hobby website; it gives me an outlet for the things I feel a need to publicly talk about. At this particular moment, what I need to talk about is the relationship of government and “private” insurance to American health cares costs, effectiveness, availability, and their detrimental effects on Medical Practice as a private business.

Besides the issues regarding such things as the valid scope of government, and simple real world practicality, there is a vitally important moral question at play here. When government mandates consumption of a product – a good or a service – then the government simultaneously mandates the production of a product – the same good or service that is mandated to be consumed. Consumption and production of products by the population are within the private sphere of non-government activity; they are most efficiently and practically done in a free and open market unhindered by any government interference. Our government is not mandated by us produce goods or services, other than the normal services of government, such as defense, etc. The American government does not possess the means of production, and it does not produce the goods and services needed by the population on a day to day basis. Government is only consumptive of taxes it receives; it produces nothing “for sale” or for profit. Government consumes; people produce.

This is turned on its head when government begins to mandate what goods and services are to be produced and what goods and services are to be consumed. We are a private property culture, and we are a contract oriented culture. We depend on our government to enforce contract law and laws that keep the free market place open and fair, and nothing else.

How it works with auto insurance.

Long ago I saw the unholy matrimony between government and insurance in the seemingly unrelated area of government mandated automobile insurance. It was a boon, of course, to the auto insurance companies; however, what did it do to the rest of the free market, and to the overall economy, and to us, the consumers? Q: Is the relationship between the insured auto owners and the auto repair shop simplified, or made more complex? A: More complex, of course.

As soon as your insurance becomes mandated by the state, the insurer begins to take on the authoritarian aura more typical of the Marxist bureaucrat. You are required by law to buy insurance, which infringes on the free-market aspect of the insurance product. In most, if not all, American states, if you do not have mandated insurance, you may not legally drive; your privilege of driving is dependent upon not only your valid state licensure but also upon your being currently insured. Insurance companies that sell auto insurance are therefore somewhat less free enterprises operating in a free and open market, and somewhat restricted from their own free market choices by government mandate for them to provide a product.

Consumer-customers whose driving record falls into a very bad risk group are thrown into a high risk pool of consumers that no insurance company wants to deal with. However, by government edict, insurance companies draw consumers from this pool as by lottery and offer them insurance at exorbitant rates, against their own business judgment. If the consumer cannot afford the product, he goes without, and either does not drive or drives illegally. The cost of all insurance goes up radically just to cover the expenses of covering all the bad risk consumers.

Insurance estimators have ever increasing authority to approve, change or deny the expenses of auto repairs. The most frequent occurrence involves underpayment of repairs because some parts used or some method of repair was judged by the insurer to be of lower cost or perhaps even unneeded, despite the expert opinion of the shop actually doing the work. The difference must be billed to the insured consumer.

In the seemingly normal course of events, the consumer gets insured; he has an accident; the claim is settled as above, whether to the consumer’s satisfaction or not; and then the insurance is canceled because the consumer just became a bad risk because of his accident. Or, the cost (premium) is ratcheted up. In the worst case, the consumer may enter the “risk pool” mentioned above, and the premiums charged may be so high the consumer cannot afford to pay them.

I submit that insurance, in and of itself, has caused radical increases in the cost of auto repairs over time. In a radical conflict of interest, the insurance industry dictates the details of auto repair. Insurance is supposed to make its profit from premiums; however, government intervention has caused high-risk policies to issue, the cost of insurance itself to go up, and left the industry with one other method to maintain and/pr increase profit, that being, denial of claims. The consumer must by auto insurance. Insurance companies both set the premium rates for the mandated “customers” and dictate repairs to “beneficiaries”, and, whenever they can get away with it, they deny claims.

The “free market” no longer has much to do with auto insurance in America.

How it works with medical insurance.

Government mandated and union mandated medical insurance has produced the same or worse free market results as government mandated auto insurance. Employers are required to provide medical coverage for employees. Which means that carriers and underwriters are required to provide medical coverage for employees. Employers either split the cost, deducting some fraction of premium requirements from employee paychecks, or they pay the whole thing. Either way, it represents another cost of doing business, which must be passed along to the consumer in the form of higher prices for the goods or services that the company is in business to provide to its customers. Which, in the grand, national scheme of things, is virtually everything needed by and available to the free market consumer.

The real difference between the two is that, where the auto-insurance government mandate smacks the individual citizen with the cost of auto-insurance in a less than competitive market, the medical insurance government mandate smacks everybody with dramatically increased costs of everything. But the biggest cost increase, by far, involves the cost of medicine, meaning both treatment and prescription pharmaceuticals.

I submit the argument that medical insurance, in and of itself, is the single largest factor in the increased and increasing cost of medical care in America today. Every time a bill for medical care or a medical prescription for medicine is created, a major factor in that bill involves covering the entire payroll, benefit plans, fixed and variable expenses, and the profit of an insurance company. And I further submit that the portion of your medical bill that goes to the support of your insurance company has nothing whatsoever to do with your health care.

In other nations such as the United Kingdom, the only difference is that these extraneous, non-medical health care costs are actually government costs, involving the expenses, pay and benefits of bureaucrats, other government employees and politicians, rather than insurance companies. That is why all foreign Social Democracy taxes are so much higher than ours. If you think you have problems dealing with an insurance rep, wait until his unique interference with the medical process is replaced by the even greater interference of a petty bureaucrat. Just as in the insurance industry, government bureaucracy adds nothing whatsoever to health care other than radically higher cost and radically increased complexity of the medical process and the patient-doctor relationship.

I wrote about Forced Medical Language (Opens in a New Window)on our old medical billing website, describing how the insurance industry, of all things, was forcing medical doctors to use specific and very wordy language in their own private office records in order to please, not the patients, and certainly not the doctors, but the insurance industry.

I also wrote about Insurance Companies “Grading” Doctors (Opens in a New Window), describing the dramatic conflict of interest presented by health care insurance providers publicly ranking and grading medical professionals based not on medical performance, but on insurance claim performance and insurance company profitability.

The tail is wagging the dog here.

Again, just as in the auto-insurance example above, medical insurance seeks to deny insurance to high-risk consumers, to consumers with “pre-existing” medical conditions, and to consumers outside of group plans such as those imposed by law, meaning employer-employee relationship plans. These have proven overall to be so lucrative that companies don’t even want to sell individual plans to citizens, unless at truly exorbitant premium rates. They get away with giant rates in employer plans because the employer pays part or all of the premium; individuals probably couldn’t afford the premiums; but if they seek insurance on their own, outside the employer plan, it will cost them even more than the employer plan total combined premium for the employee. Go figure.

And then there is litigation insurance to consider. A typical medical doctor in America pays something like $50,000 in malpractice insurance premiums per year. He has done nothing wrong, there have been no lawsuits, yet he stands to be sued for millions of dollars every time he treats a patient or prescribes a medicine, let alone does a surgery. We are becoming a litigious society, ready to sue someone every time we detect the slightest impropriety, whether real or imagined. Doctors, as high earners, are ever increasingly becoming targets of opportunity for frivolous “let’s take a chance” medical lawsuits in which lawyers, who profit from them, encourage clients to sue the bastards and perhaps retire.

What do you think that $50,000 annual insurance premium your doctor pays does to your typical medical treatment bill?

There are a whole lot of people in America who don’t even make $50,000 per year, yet that’s just a typical annual cost, and part of the normal cost of doing business for an American surgeon. These kind of costs, and the non-medical forced regimentation of stilted language in records, and practice changes to favor insurance company profits, tend to encourage a lot of doctors to seek another form of business, or go out of business and become an employee.

Today in America insurance providers – not doctors – direct and insist upon certain methods of diagnosis and treatment, and deny claims for un-favored diagnostic procedures and treatments. This is a fairly dramatic intrusion of non-medical expertise inserting demands into the patient-doctor relationship and attempting to direct and/or override the medical doctor’s judgment and decisions regarding the diagnosis and treatment of his own patient. Up to this point, the insurer intrusions into medical practice have been an uncalled for, costly and impractical interference with the process; but at this point, these intrusions enter into the realm of being just plain stupid.

The Provider – Insurer Wars. Some doctors formed associations with each other, whether loose or by contract, to band together and resist some of the more egregious demands of insurers. They would then agree to drop a particularly odious insurance company and not accept patients insured by that company. Some insurance companies did the same sort of thing, banding together to corner some chunk of the market, and banned uncooperative doctors from their combined coverage.

HMOs and PPOs entered the picture and became large and powerful. On the other side, various corporate entities came into being as variously named “Health Care Partners” formed by groups of doctors, and eventually by groups of hospitals; eventually, they, too, became large and powerful. Giant corporate battles ensued. In our neighborhood, within memory, there was one fought between local health-care giant Premier Health Partners and the insurance giant Anthem Blue Cross and Blue Shield. All the “Premier” hospitals and doctor’s groups dropped all Anthem coverage, and so informed all their patients. I’m sure you’ve seen similar health-care wars in your neighborhood.

What all of this is doing is slowly but relentlessly shutting down private medical practice in America. New doctors are less likely to go into private practice than to become another paid employee of (believe it or not) one of the HMO groups, one of the Health Partner groups, or just the local hospital, which sooner or later will be gobbled up by some larger corporate entity.

(How does the image of a medical insurance group employing medical doctors strike the conflict of interest gong in your head?)

The affect on patients of these trends has been to anesthetize us into seeing our medical insurance as an entitlement. So many generations of us have had employer insurance that it is now expected and normal to have it. We have grown accustomed to paying some small co-pay each time we see the doctor, and some small (or no) co-pay when we get our prescriptions filled. We have lost all track of what procedures and drugs actually cost in the real world, and we are terrified of the thought of loosing our coverage.

In other words, we are already primed for Socialized Medicine.

The affect on providers of these trends has been to discourage private practice and encourage employment in some larger entity that takes care of medical and malpractice insurance problems, billing, staff, equipment and all the problems attendant to being in business. So a doctor winds up making one or two hundred thousand in salary while taking his orders from some MBA with about one third of his education and none of his medical expertise. If that sounds like a lot of pay, consider the fact that today’s practitioner needs to generate an average of $15,000 per month just to cover his fixed expenses. Medical doctors should justifiably make a whole lot more than the salary they get as an employee, for the simple reason that they generate a whole lot more income.

The affect on America is that the whole health care system, on the insurance side and on the provider side, is gradually being concentrated into entities that will make it easier for them all to eventually be nationalized.

With Marxists (I mean Democrats) in charge of the White House and both houses of Congress, the writing is on the wall. They have already snuck in elements of Socialized Medicine hidden in among the Pork Barrel Earmarks of Bills that were supposed to have something to do with stimulating the economy. Have you seen any stimulation lately? That’s funny, neither have I.

Insurance providers are prime candidates for nationalization, having already morphed into bureaucracies and behaving as petty bureaucrats are normally expected to behave. Giant health care provider organizations are also primed for nationalization, with medical doctors gradually morphing into employees and growing accustomed to just showing up for work and taking orders from non-medical, MBA-type bureaucrats.

We can look around and see what’s coming for us. Canadians will no longer be crossing the border just to actually see a real doctor, instead of waiting in line for years. Just as predictable as sunrise in the morning, various drugs and various diagnostic procedures and various treatments will be rationed as they are virtually everywhere outside our own borders. The ends justify the means. Older patients will be denied certain life-saving drugs in favor of giving them to younger patients who will be working tax-payers for more years. After all, you can’t make an omelet without breaking some eggs.

Naïve, starry-eyed utopian idealists who actually believe that Cuba has a wonderful public health care system have been duped by the Marxist rhetoric and propaganda from the likes of Michael Moore, Jiminy Carter, the UN and the SLIMC. Just like its so-called Tourist industry, Cuba has a not-identical twin set of socialized medicine operations: one for the upper class Communist Party officials, foreign big-shots and propaganda film crews, and another one for the Cuban people. Even at that, probably all the very best Cuban doctors are practicing in America. All the Cuban doctors that are officially sent to other countries must leave some family members behind, just to ensure that the good doctors will actually return to Cuba again. You don’t see many doctors, or anyone else, breaking into Cuba these days.

Bottom line, we have the best performing health care system in the world today. No one who goes to an American hospital is denied treatment, by law. Everyone in America can get actual medical attention in a timely manner. That cannot be said in Canada, or in the United Kingdom. But, like I said, Marxists are now occupying the seats of power in America, and things are about to change for the worse.

The very nature of the United States of America is being changed. We are all being prepared for obedience, subservience and herding.

What to do: There is no reason, and never was, for insurance coverage for all medical treatment. For catastrophic illness, maybe; for the common cold, no. Employers should not be required to provide medical insurance to employees. If that one thing were changed, the cost of insurance would plummet immediately. Nobody would be buying medical insurance at today’s prices if the total bill fell to the actual consumer, meaning the patient. Eliminating the employer’s mandate would, I believe, bring all health care costs down, reducing final bills.

No one – neither an insurance representative nor a petty bureaucrat – should be standing between the doctor and the patient. The transaction is between the doctor and the patient and no one else. As I said at the beginning, medical practice is out of scope for government. It is also out of scope for insurance. Insurance needs to be mostly, if not totally, removed from the whole process to make the market more free.

Perhaps costs would stop rocketing and doctor bills would become manageable again.

Pray for America.

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