The unintended consequences of government intervention may not be felt for decades to come. One only needs to look back about 35 years ago to discover that the actions of Agriculture Secretary Butz (serving under President Nixon) have led to many of the health care ills we suffer today. It was Butz who created the corn subsidies that changed the landscape of America’s farms. With the abundance of corn – new uses were discovered. This led to the explosion of high fructose corn syrup and corn feed beef. The dramatic increase in diabetes, obesity and heart disease can be directly attributable to those events. High fructose corn syrup (HFCS) used in beverages became the empty calories consumed by millions of Americans. Unlike using sugar as a sweetener, you don’t get full when you consume HFCS, therefore you consume more than you should, leading to an explosion of caloric intake. Cows are ruminants and should be eating grasses, not corn. However, corn was in abundance and cheap to use. In order to avoid the cows getting sick, antibiotics was added to the corn. It generally takes 5 years for a cow to gain enough weight to be brought to slaughter. Eating corn it takes only about 3 years. They fatten up much faster. All that marbling in the meat, is the fat that contains all those antibiotics. It has been suggested by some that these antibiotics have led to antibiotic resistance in society today.
With the above as background, do we really want the entire healthcare system to be run by our government? The role of government should be to help regulate an industry not to run it. Let the free market determine how it will function with regulations designed to help level the playing field. We don’t need a government run public option, we need the government to mandate to the insurers that to continue writing the rest of their business they will create a low cost option that would be affordable and insure a minimum level of coverage. If we are to assume that healthcare is a right, and having access to healthcare insurance is a prerequisite, we need to change the regulations under which they operate. No longer can we tolerate the public-for-profit companies. We must change them to mutual insurance companies. Under the current arrangement there is no incentive for the policy holder to be prudent with the healthcare dollars they spend. They pay their premium and those dollars are lost forever. Under a mutual insurance premise, the policy holder stands a chance of getting a premium credit or a rebate check at the end of the year if the payouts from the large pool were less than expected. Most individuals under the age of 30 see no purpose in buying insurance. They pay for their premium and those are lost dollars.
The regulations placed in the current bill will not to anything to stem the cost of purchasing health care insurance. It will take some of the sting out of their draconian policies but not change the process by which they work.
These individuals would flock to a mutual insurance company, but more importantly be very interested in health savings accounts where the premiums are generally less and if healthy, these dollars would grown over the years so that when healthcare expenditures are greater as they got older, there would be a reserve that they had saved for future needs. This is just one small area that this current debate on healthcare reform could have taken.
We must make health insurance portable across state lines and let individuals purchase it from large pools. There is no reason it should be purchased or supplied by the employer. Let the individual buy the policy and have the same tax advantage as the large company.
We need to look no further than to the state of Massachusetts for the effect of universal health coverage. 98.5% of its citizens have health insurance. This has not solved the ills of the healthcare delivery system but brought to light the effect of providing insurance without having a sufficient number of providers. They have coverage, but no access. This has caused an explosion in the cost of health services in Massachusetts as more patients are using the emergency rooms as their primary care center. Wait times are up along with the costs. The above is an unanticipated consequence of providing coverage to its citizens without ensuring there are enough providers. This only worsens the healthcare situation. We have runaway healthcare costs. It is obvious why the citizens of Massachusetts sent Scott Brown to DC, they didn’t want to pay any more taxes to provide the country with a system that they have seen first-hand doesn’t work.
Finally (for brevity of some highlights or lowlights of healthcare reform – this bill is 2300 pages and again, probably not read by our congressional leaders), nowhere in this bill are we cutting costs in the healthcare delivery system; ensuring higher quality for lower cost. There are no incentives for prudent use of services. To try and make this work financially they are levying more taxes and stating that they will pay less to doctors and hospitals for services rendered. There are no mandates that doctors participate in either Medicare of Medicaid – so my guess is that another unintended consequence is that there will be further provider shortages for these patients. So in an attempt to provide insurance coverage for 30 million Americans – 89 million may lose the access they already have.
Michael R Marks, MD, MBA
Published with Dr. Marks's kind permission.