HOW TO REFORM HEALTH CARE

Here’s how to give the poor access to good health care without clobbering middle class Americans or  taxpayers.

When I wrote this, Jack Wheeler reminded me of his Health Freedom vs. Health Fascism from May of 2009.  It’s not surprising, given that we think alike, that our "here’s how" lists are so similar.   Here’s mine.  Jack’s is appended below for comparison.   

Specifics aside, one thing on which all conservatives should be able to agree is that the antidote to Obamacare health fascism is getting the government out of the way of health freedom.

Comments on the Forum will be appreciated.  And feel free to add your own suggestions on how to expand health freedom in America.

*Provide a refundable tax credit for 90 to 100 percent of the cost of median health care plans.

Because it would be refundable, Americans whose tax liability is less than the amount of the credit would receive a check for the difference. This is the most efficient – and the most fair – way to help low income Americans purchase health insurance.

The credit would go either to employers, if they provide health insurance for their employees, or to individuals, if they purchase health insurance on their own.

Employer provided health insurance is an artifact of price controls in World War II.  Companies couldn’t compete for scarce workers by offering higher pay, so they offered free health coverage instead. This is economically inefficient, unfair to the self-employed, and can put people who lose their jobs in a world of hurt, because they lose their health insurance too.

A tax credit that goes either to the employee or the individual – but not to both – would provide a seamless, painless way to transition from the system we have now to a better one.

*The one big advantage employer provided health insurance has over policies purchased on the individual market is the size of the risk pool. Generally speaking, the larger the pool, the lower the rates. We could ameliorate the disparity be permitting insurers to establish risk pools across state lines.

*Health insurance would cost much less if it were insurance – like the insurance on our cars, homes and lives – rather than a baroque form of prepayment. Coverage insurers must offer should be limited to what’s needed to protect policyholders from the economic consequences of injury or disease.

Purchasers of health insurance – not politicians – should decide whether they want their health policies to cover abortions, hair transplants, in vitro fertilization, and such like. State laws that impose additional requirements should be overridden.

*An ounce of prevention is worth a pound of cure. If more got regular checkups, engaged in healthier activities, health costs could be brought down a lot. But many can’t afford the costs of routine care.

We can fix that by permitting each adult to establish a Health Savings Account into which either employers or the government could make contributions.

Unused funds would accumulate, with interest, from year to year. Once a person reaches retirement age, funds in his or her HSA could be used without penalty for other purposes. Unspent funds could be willed to heirs.

Many physicians refuse to accept Medicaid patients, because reimbursement rates set by the government are so out of touch with reality. With HSAs, this would no longer be an issue. The poor would get immediate access to quality care.

*Prescription drugs cost so much because of two policies imposed by the Food and Drug Administration. We should lift the ban on importing drugs from other advanced countries, repeal the requirement the FDA test new drugs for efficacy as well as for safety. That would cut millions from the cost of developing new drugs, years from the time it takes to get them to consumers.

Refundable tax credits for purchasing health insurance and Health Savings Accounts for everyone would make it possible to cut back enormously on the huge, rapidly mounting expense of the fraud riddled Medicaid program, while improving the access of the poor to quality care.

Coupled with the other reforms mentioned above, they would reduce health insurance premiums for nearly all Americans, while expanding options available to them, and cut the cost to taxpayers of providing health care for the needy.

The army of well paid bureaucrats in the health bureaucracies say we need an army of bureaucrats in the health bureaucracies because the poor are too lazy, ignorant, stupid to make good decisions for themselves.

But not many of the poor could make worse decisions than those health bureaucrats have been making for them.

Jack Kelly is a former Marine and Green Beret, and was the Deputy Assistant Secretary of the Air Force during the Reagan Administration.  He is the national security writer for the Pittsburgh Post-Gazette.

Jack Wheeler’s 10 Health Freedom proposals (from Health Freedom vs. Health Fascism May 2009, in turn from the original proposal to Congress in 1994.)

The basic propositions of the Health Freedom proposal are:

1. Health Care is so incredibly expensive in America because of government intervention into the medical marketplace.

2. Health care costs can only be radically reduced by an equally radical reduction of government regulations and subsidies.

3. Both the availability and the quality of health care will be substantially increased by such a reduction of government intervention.

Ten Specific Means By Which Health Freedom Can Be Achieved

One: Open Enrollments in Medical Schools.

The American Medical Association (AMA) colludes with State Medical Boards throughout the 50 states to severely limit the number of medical and nursing schools, class size, number of teachers, and number of admitted students.

Each year, tens of thousands of qualified students are unable to get into medical or nursing school because of these artificial restrictions.  There are an estimated 10 to 20 qualified applicants for every vacancy available in U.S. medical schools. Despite a chronic shortage of nurses, most nursing schools have a two to three year waiting period for admittance.

An instructive question to ask in this regard is:  Why is there no shortage of chiropractors?  The answer is that chiropractors do not have a medieval guild which has the political power to restrict entry into their profession.  Chiropractor colleges accept virtually all qualified applicants. Those who can’t complete the curriculum or pass the licensing exams are weeded out.  The number of chiropractors is controlled by the market – not by a medieval guild like the AMA.

Health freedom legislation would terminate the AMA’s monopoly over the medical profession, allow open enrollment at current medical schools, and the construction of as many new medical schools as the market will bear.

Licensing and testing must, of course, remain strict and reliable.  But as the number of physicians and nurses rises, competition between them for patients will concomitantly increase, and thus their fees and salaries will go down with the law of supply and demand. 

This also applies to the cost of a medical education in the first place:  it will decrease as the number of students and new schools increases.

Further, health freedom legislation would end the AMA’s guildification of medical practices.

Most things done by doctors can be done by physicians’ assistants, most things done by them can in turn be done by registered nurses, and them in turn by nurse practitioners.  You don’t need a Ferrari racing mechanic to fix a Toyota.  You need free market medicine with several layers of medical practitioners.

Two: Reduce Hospital Administrative Costs

For an average stay in a hospital, fifty to seventy-five percent of the charges are due to administrative costs.

As an example, a routine appendectomy costs $12,000 or more in most U.S. hospitals today.  A cost breakdown would be: surgeon, $600; anesthesiologist, $500; hospital fess for surgical suite, equipment, and techs, $600; five days’ recovery in semi-private room @ $200 night (the cost of a good hotel room), $1,000; nursing services @ $200 day, $1,000;  food and normal medication, $300.  That’s $4,000.  Where does the remaining $8,000 (or more) go?  Up in administrative smoke.  [Triple all these costs for 2009.]

The primary cause of exorbitant administrative hospital costs is the requirements of the Joint Commission on Accreditation of Health Care Organizations (JCOAHCO), a collusion of bureaucratic health care organizations and government regulators.  JCOAHCO imposes such a morass of regulations that hospital administrators must focus their efforts on "compliance" with JCOAHCO requirements, rather than on the welfare of their patients.

Further, not every patient needs to stay in a tertiary-care hi-tech hospital, replete with MRI and CT scanners, with a capability for coronary by-pass and heart transplant surgery.  Some patients merely need a few days of IV antibiotics and rehydration, along with TLC observation.  This could be provided by a small low-tech hospital or overnight clinic. 

But the JCOAHCO requirements, which set the standards of hospital compliance, do not differentiate between large and small hospitals.  All must meet the same excessive criteria necessitating huge administrative costs, making low-tech hospitals economically impossible.

Health Freedom legislation would eliminate "one-size-fits-all" JCOAHCO hospital compliance standards, allowing the operation of "low-tech" small hospitals with minimal administrative overhead.

[An example from 2009:  computer system/recording needs are not the same for small vs. large hospitals, yet ObamaCare will force all, big or small, to buy big expensive systems.]

Three: Eliminate State Mandates and Regulatory Barriers on Health Insurance

One primary reason for the high cost of health insurance today is the monumental number of required benefits health insurance policies must provide imposed by state regulators.  Today there are over one thousand mandates on everything from hairpieces to marriage counseling.  As a result, insurers are legally prohibited from supplying low-cost basic health insurance.

Health Freedom Legislation would allow insurers to offer low-cost, basic health insurance policies with no state mandated benefits whatever.

Such legislation, according to the National Center for Policy Analysis, would reduce health insurance policy cost by twenty percent or more.

Another major cause of high health insurance costs is the regulatory barriers inhibiting small businesses from forming risk pools.  Two-thirds of all employed but uninsured workers are either self-employed or work for firms with fewer than 100 employees, and cannot afford individual or small group policies.

Health Freedom Legislation would eliminate all regulatory barriers such as business commonality and geographic proximity requirements to small businesses from freely combining into common insurance risk pools.  It would further allow non-business organizations – churches, unions, or any group of people formed for whatever reason – to form similar pools for their members.

Such "small market" reform would make health insurance dramatically more affordable to millions of Americans.  Unfortunately, such reform will be bitterly opposed by the large major insurance companies, because it would result in competition from deregulated small insurance companies.

Four: Give Health Care Providers A Tax Credit For Charity Work

One of the major sources of the "health care crisis" necessitating the Clinton [Obama] plan, its advocates say, is the tens of millions of uninsured Americans who cannot afford medical care.  They are regarded by the medical industry as "non-payers" to be "turfed" to the county hospital and receive minimal treatment.

The quality of their medical care would be very different if they were looked upon not as a liability, but as a tax credit.

Health Freedom legislation would allow health care providers – physicians, nurses, medical technicians, pharmacies, and hospitals – to deduct from their personal or corporate income taxes an appreciable amount of the income they would have derived if their charity patients paid the normal fees.

Such legislation would result in physicians, hospitals, and other health care providers fighting among themselves to provide free (to charity patients), tax deductible (to them) health care. 

Such an incentive to provide free care would dramatically reduce, perhaps even eliminate, Medicaid and Medicare costs – more than compensating for loss of income tax revenues.  The ultimate savings to the taxpayers would be astronomical.

Five:  Restore the 100% Deductibility of Health Care Expenses

Throughout most of this century, individuals were not taxed on the money they spent on health care.  When Congress eliminated the tax deductibility of most medical expenses, it made medical care and health insurance prohibitively expensive for individuals to pay for on their own.

As a result, employer-provided health care and insurance – the costs of which corporations can deduct and does not count as income to the employee – is the only option for workers.  For them, their choice is restricted to whatever plan(s) the employer offers, and they lose their coverage once they quit or are fired.  For those millions of workers who can’t get employer-provided insurance, they simply must do without.

The solution is 100% deducibility for medical expenses.  One Congressman consulted for this report estimates that "this one simple reform will enable as many as 15 million Americans who cannot now afford it to gain access to healthcare and health insurance."

This measure would greatly expand the health insurance risk pool, enabling insurers to offer more options and coverages while reducing premiums.  Further, the Congressman observes, it would "dramatically increase marketplace competition for healthcare and health insurance, as perhaps 100 million more people enter the market to shop for the best among all available services and insurance plans."

Health Freedom legislation would broaden the category of deductible medical expenses to include expenses for alternative and preventive health care.  Traditional establishment medicine is limited primarily to medication, surgery, and medical devices.  It should more properly be called "disease care." Genuine health care would have its primary focus on prevention of illness and health maintenance, and subsequent focus upon intervention to restore health.

Alternative therapies as acupuncture, nutritional and herbal supplementation, EDTA chelation, and applied kinesiology have this primary focus.  Surely, the absolute best way to reduce health care costs is for people not to get sick in the first place.

Health Freedom legislation would grant 100% tax deductibility to individual taxpayers for all healthcare expenses, including health insurance, and medical, pharmaceutical, and alternative/preventative expenses.  It would further encourage insurers to include alternative/preventative therapies in their coverage.

Health Freedom Legislation would also create tax-exempt Medical Savings Accounts (MSAs, or Medical IRAs), allowing individuals to set aside tax-free up to $3,000 per year for medical expenses.

In addition, Health Freedom Legislation would make health insurance portable, through minor changes in existing COBRA legislation, by allowing workers between jobs to pay (tax-deductible) premiums directly to the insurer.

Many employees feel trapped in their jobs today because they cannot afford to lose their employer-provided medical coverage.  These proposals would liberate them to seek their own coverage, give them the opinion of taking their coverage with them after they leave their job, and provide them worth tax incentives for life-long savings for their health care needs.

Six: Reduce Malpractice Insurance Costs

Malpractice insurance costs are a major source of higher health care expenses. The insurance premiums have skyrocketed due to multi-million dollar awards made for "pain and suffering," which are orders of magnitude beyond the plaintiff’s medical expenses.

Health Freedom legislation would eliminate "pain and suffering" malpractice settlements; limit malpractice settlements to all costs of the patient’s malpractice-related medical bills; and limit payment to patient attorneys to normal fees, prohibiting attorney commissions of a substantial percentage of the total settlement.

This legislation would cause a drastic reduction of malpractice premiums, enabling doctors and other health care providers to lower fees.  (Remember that the increase in competition via proposal #1 above gives the incentive to do so.)

In addition, physicians should be encouraged to forego buying malpractice insurance at all, supplanting it with:  legally-binding agreements with their patients to purchase their own malpractice insurance (as an airline passenger; prior to a flight, may purchase flight insurance).  If the physician performed malpractice, the patient’s own insurance company would pay him.

Seven:  Repeal the Kefauver Amendment

Prior to 1962, for a pharmaceutical company to gain FDA approval for a new drug, it had to prove that the drug was safe.  But in the wake of the Thalidomide scare, the Kefauver Amendment was passed, requiring that a new drug, to gain FDA approval, must be proven not only safe but effective in curing or ameliorating a specific disease.

Proving a drug’s safety is not that difficult or costly.  It is proving its effectivity that is primarily responsible for the current situation:  it now costs an average of over $200 million[in 2009 over $800 million], takes up to twelve years and requires an average of 40,000 pages of documentation to get one new drug approved by the FDA.

The primarily public concern should, appropriately, be with the safety of given medication.  But the individual patient, in consultation with his doctor or health professional, should be the judge of whether the medication is working out or not.

Health Freedom legislation would repeal the Kefauver Amendment, making proof of a drug’s safety only requirement for FDA approval.

No legislative act could more contribute to reducing pharmaceutical costs than this.

Further, the Kefauver Amendment is the primary bottleneck in the flow of medicinal progress. It creates an enormous logjam delaying for years getting new drugs on the market which could have been saying countless lives during those years.  It creates such impossible expenses and regulatory disincentives that many promising drugs are never developed at all.

Thus, no single legislative act could save more lives and contribute more to the health of Americans that the repeal of the Kefauver Amendment.

Eight: Allow Truthful Health Claims for Nutritional Supplements

If there is one legislative act that could compete with the repeal of the Kefauver Amendment in saving lives and reducing health care costs, it is this.

The evidence that such nutrients as Vitamin C, Vitamin E, and selenium can radically reduce the incidence of heart disease and cancer – the two diseases which cause more deaths and are responsible for more health care spending than anything else – is simply overwhelming.

Yet the FDA has – let it be stated candidly – a perverse bias against nutritional supplements. The "knife-and-fork" mythology prevails:   that "you can get all the nutrients you need from a well-balanced diet."  Getting several grams of Vitamin C daily (the optimal amount for reducing risk of heart disease and cancer) from oranges would require eating dozens and dozens of oranges – and be far more expensive than taking one or two capsules.

The FDA enforces this bias by threatening a nutrient manufacturer who supplies information about the health value of his products with prosecution if he does so without FDA’s express approval.  No matter how truthful and supported by scientific evidence are the health claims, the FDA will attempt to fine or imprison the manufacturer for making an "unapproved health claim."

This policy is such an egregiously clear violation of the First Amendment protection of free speech it is now being challenged in court.  Judicial procedures, however, can be lengthy, and while this is being adjudicated people continue to die. 

Current estimates are that widespread dissemination through nutritional advertising of how 400 i.u. of E and 2,000 mgs. of C per day via supplements can reduce one’s chances of heart disease or cancer by over 40% would save hundreds of thousands of lives and save billions of dollars in health care costs each year.

This is just one example with two nutrients.  The savings in lives and money applied to all nutrients is far greater.

Health Freedom legislation would, therefore, prohibit the FDA from prosecuting any nutritional or medicinal manufacturer or supplier for making an "unapproved health claim" if that claim is truthful and non-misleading.

[Update:  in January 1999, the Ninth Circuit Federal Court in Pearson v. Shalala determined that FDA regulations regarding unapproved health claims for certain nutrients was a violation of the First Amendment. 

The FDA’s implementation of the ruling has been slow and begrudging ever since.  Its latest attack on the nutrition industry is to require the same "good manufacturing practices" (GMP) requirements as for pharmaceutical companies.  The purpose is to make it too expensive to produce supplements.  The solution is to replace GMPs entirely with purity standards.  All that should matter is the purity of the supplement or pharmaceutical, however that purity is achieved.]

Nine:  Remove Government Restrictions Regarding the Importation of Foreign Drugs.

While not widely known, it is currently legal for an individual to import a "reasonable" amount (e.g., a three-month supply) of a medication for personal use.  Yet it remains illegal to promote or profit from such importation.

Most Americans are consequently unaware of their drug importation rights and do not know how to obtain medication overseas.  Further, those who do are frequently harassed by the Postal service, DEA, FDA, and Customs.

Health Freedom legislation would allow the promotion of and profit from importation of foreign pharmaceuticals.  It is important to note that most medications sold in the U.S. are sold overseas for pennies on the dollar over the U.S. price.  These medications are manufactured by foreign divisions of the same companies that make them here in the U.S.

Quite often, in fact, many medications sold in the U.S. are actually relabled foreign-manufactured drugs.

Ten: Allow the Purchase of Non-Controlled Medications Without Prescriptions

An American visiting a pharmacy overseas, say in Europe, for the first time, is astounded to discover that the medications he needs cost a fraction of their U.S. cost – and that he can purchase them over the counter without a prescription.  Medications requiring a doctor’s prescription is the exception, not the rule, in most countries in the world.

The incidence of adverse drug reactions is no higher in these countries than in the U.S.  Nor is medication abuse.  What is different is that in America, you must schedule an appointment with a doctor, take the time to see him, pay him $40 to $75 for an office visit, so that you can get a prescription.

And because you can only get the medication needed by prescription, the pharmaceutical company may charge much more money for it.  Over-the-counter medications usually cost much less than prescription medications.

Health Freedom legislation would allow all non-controlled, non-addictive medications to be purchased over the counter without a prescription.

Dramatically reducing unnecessary doctor visits, and reducing prescriptions prices to over-the-counter price, would greatly contribute to lowering health care costs.

Conclusion

Government programs and regulations are not the solution to health care problems.  They are the cause of the problems in the first place.

What must be avoided absolutely is capitulation to the demand for free lunch entitlements such as "universal coverage."  Such capitulation to fascist intrusion will guarantee the destruction of the health insurance industry and pave the way for government seizure of the entire U.S. health care system.

Only by offering a genuine alternative to the Clinton plan can the threat it poses to America’s health care system be removed.

Only be offering genuine free market solutions can America’s health care system be improved and be made affordable.

Only by offering the American people a clear choice between Health Freedom and Health Fascism can the Clinton [Obama] Health Care Plan be defeated.

America’s health – and freedom – hangs in the balance.  [It still does, even more now than in 1994.]

[Note for 2015:  Congress, controlled by Republicans for a majority of the last 21 years since this report was issued, has not managed to implement one of these common sense free market reforms, with the result of Obamacare health fascism on the verge of destroying health care in America.]

Discuss this item on the forum. Click Here!