(Note, this is the last of a series on health care. For an index of other articles on the topic, see Health Care, Time to Choose)
OK, having identified many of the government interferences in the market that have resulted in unaffordability of health care, relative to everything else we need and desire, which the free market provides us in abundance and at reasonable costs, how do we unsnarl this mess without causing unnecessary hardship?
In some cases, we can just stop doing harm and the market will adjust quickly and favorably. In others, we have to phase out the problems gradually so people who acted rationally under the old rules will not be adversely affected. For a start, anti-competitive measures like Certificates of Need can just be immediately abandoned. If someone wants to put their own money at risk to open a health care facility, then they should need no permission from anyone to do so.
Hospitals, and health care providers, should not be required to give away their services any more than any other business. If people need treatment and cannot pay, that need should be filled by charitable organizations, and not through government. You might be surprised how quickly people will start insuring themselves, at least for basic care, when they learn they can no longer just show up at a hospital and demand free care.
Likewise, regulation of health insurance should be limited to the enforcement of the insurance contract. All mandates should be eliminated, as well as all restrictions preventing the formation of voluntary insurance groups across state lines.
True, health insurance contracts are very complex, and we would not want to have to become experts on health care in order to evaluate a contract, but that is what insurance agents are for, to guide us to a good policy through the free market.
We need to restore the General Practitioner to his primary role in health care by limiting his liability to the standard of care of other GP’s when he performs services also provided by specialists, providing the patient is informed that specialists are available for that service and he makes the informed decision to receive that service from the GP.
More controversially, I would suggest abandoning professional licensure as a State power, which is too often little more than masked restraint of trade, and leaving the determination of qualification to our professional liability insurers. Patients could simply look for a health care practitioners certificate of insurance (and health care insurers could demand such proof for payment as well) just as we look for, or trust retailers to look for, the UL certification on a toaster. Underwriters Laboratory is a product likability insurers agency which performs the same function as the Consumer Product Safety Commission, and does it much better and cheaper.
Most importantly, tax treatment for employer provided plans and private plans should be the same. This could be accomplished by allowing employers to contribute to employee Health Care Saving accounts on the same basis they now can contribute to their company plan.
One of the consequences of our past reliance on employer sponsored plans was the need the the Medicare system. Medicare is necessary only because we do not have the kind of lifetime, level premium, health care insurance described in HC, Disconnection from the Market but we cannot simply discontinue Medicare abruptly as those at or near retirement never had the opportunity to buy into lifetime health care insurance at a young age, and they are now too old to get an affordable rate over the remainder of their lifetime. It will be necessary to phase out Medicare over a couple of decades, possibly with gradually increasing co-pays to be covered by supplemental insurance in the transition, so it will take a while to get government out of health care completely, but when we do, we can expect to see quality and service improve as costs fall, just as they have with the computer you are sitting at right now.
The free market provides for our needs and desires better than any government ever has or could, if we will just trust in that market and let it do its magic.