Freedom is the right to question, and change the established way of doing things. It is the continuing revolution of the marketplace. It is the understanding that allows us to recognize shortcomings and seek solutions. It is the right to put forth an idea, scoffed at by the experts, and watch it catch fire among the people. ~President Ronald Reagan
The question vexing every liberty-minded American is what to do now that neither party wants to repeal Obamacare. Fixing health care is the lynchpin of everything: of our entire economy, our fiscal solvency, and our future as a free and prosperous people. Are we out of options?
The core of the problem: Health care, not medical insurance
Conservatives must stop falling on their swords to save an industry that doesn’t need to be saved. The few remaining medical insurance companies have a government-sponsored and government-guaranteed monopoly, one that cuts out consumers, and stifles medical innovation. They are earning record profits. The heart of the problem is the government-distorted price of health care itself.
But all is not lost. While there are dozens of reforms needed to reduce the price of health care, there is one simple reform that is very easy to message and would set off a chain reaction of market changes to place the consumer back in the driver’s seat of health care. It’s time to require that all prices of health care be posted online — line item by line item. This reform would lead to a revolution in health care provider competition.
The Post Your Dang Prices Act
The Post Your Dang Prices Act would require that all health care providers, from hospitals and surgery centers to doctor’s offices, medical labs, and pharmacies, post their prices online. Smart entrepreneurs, such as the owners of the Oklahoma Surgical Center, have revolutionized the direct-care model and, as part of that revolution, post the prices of every surgery available online.
Then — and this is key — they must send the bill directly to the consumer, not an insurance company. Consumers would then be able to decide whether they want to submit the claim or negotiate with the insurer to cover a certain percentage, just like they do with auto insurance claims. Except now they would be negotiating from a position of strength, because they are not flying blind without prices. Watch the dominos of government-run health care fall and the heads of big-insurance lobbyists explode.
There are a number of bipartisan bills that at least broach this issue, and with some tweaks they could be made acceptable to conservatives.
Price transparency is the glue of a free market, consumer empowerment, competition, and innovation. Prices will tumble as providers compete for out-of-pocket consumers. This will force insurers to focus primarily on catastrophic coverage and actually behave more like the auto insurance industry.
When we cut out the middle man and move toward direct primary care payments, not only will consumers pay less, but doctors will be able to offer higher-quality care. Isn’t the end goal health care, not lining the pockets of insurance companies?
So many doctors who have opted out of the government/insurance scam will tell you they can spend more time with each patient and no longer have to “misdiagnose” in order to follow specific coding. The administrative costs of dealing with the government and the insurance companies are enormous but would be eliminated by direct primary care.
And this could all happen under the existing regulatory structure.
What about catastrophic coverage?
Paying out of pocket is all well and good for smaller medical incidents, but what about hedging against expensive illnesses or bad accidents? Don’t we still need insurance, at least the way it functions for automobiles and homeowners?
Yes, and that’s why we’ve all been trying to repeal Obamacare and make insurance companies return to actual insurance. Sadly, that is not happening.
Fortunately, we don’t need the insurance companies. The solution to this is already permitted under Obamacare; it just needs to be expanded.
Sec. 5000A(d)(2)(b)(i) of the ACA allows ministries to get together and form non-profit health-sharing organizations that are exempt from Obamacare’s regulations and subsidies and immune to the crony capitalist greed inherent in the insurance cartel. Rather than working like insurance, engaging in racketeering and setting the price for services, they merely pay for the medical bills directly through mutual shared payments of members.
Even under the current zombie health care market, with no innovation or price transparency, health-sharing ministries have been enormously successful. Whereas “private” insurance now costs me (for a family plan) $1,200 per month for a $13,100 deductible with limited access and many other charges, a number of the sharing ministries offer full cost sharing (with certain exceptions) for just $450 per month and a $1,500 deductible. The few full-time administrators are the most friendly, caring people around, who will help you negotiate prices and give you the money to pay the medical bills directly.
Imagine how much more effective and stable these sharing associations would be if we actually had price transparency and cut out the insurance cartel, thereby lowering the price of the actual medical bills.
Thus, if we expand access to health-sharing ministries, the problem of catastrophic coverage could be handled without insurance altogether. Expanding sharing associations to any group of individuals or communities — religious or non-religious — in conjunction with out-of-pocket payments for basic care would put the insurance lobby out of business.
Additionally, with cheaper prices and no market distortions, there will be so much more money left to cover the chronically ill, both in the private sector and in the $1.6 trillion federal and state health care programs. And we could subsidize them directly by paying their actual medical bills instead of lining the pockets of third-party payers and empowering politicians.
The way forward
In many respects, this plan will spawn more systematic reform than repealing Obamacare and will render Obamacare moot. To review, the elements are:
- Require price transparency on health care Services and that the bill be sent directly to the consumer. In exchange for this relatively minor mandate (compared to every other odious regulation), the federal government should amend EMTALA and allow hospitals to turn away those without urgent health problems from the ERs, thereby alleviating much of the unfunded liability on their operations. Doctors should also be empowered and incentivized to offer indigent “charity” care, whereas under current law there are actually many restrictions on that.
- Expand Sec. 5000A(d)(2)(b)(i) of the ACA, which allows health-sharing ministries to operate outside the system, and apply it to any association. Any group of people who share similar lifestyles and interests should be allowed to pool their resources and share medical bills. In the same way Christians are allowed to do so under current law, the practice could be expanded to small business owners, green energy lovers, or any group you can imagine.
The painful story of Charlie Gard and the great irony of his parents’ desire to come here from England to seek treatment should serve as a wake-up call for us to pursue health care, not government-run or -sponsored insurance.
Insurance is not the solution; it’s the problem. The current system is nothing but a racketeering scam between politicians, lobbyists, insurance companies, and the existing hospital establishment to block competition and protect incumbent politicians and incumbent health providers, all the while fleecing the consumer.
At this point, simply working around the insurance cartel altogether, with a focus on direct primary care and private cost-sharing associations, is the best way to achieve even greater outcomes without directly confronting the issue both parties refuse to address. When frontal assault fails, the only way forward is a flanking maneuver.