Why We Are Angry

Why are conservatives so upset about the Obama health-care bill? Don’t they want medical care for the uninsured? Don’t they want to control the escalating costs of health insurance? Don’t they want people to be able to count on their insurance to be there when it is needed? Well, I am a conservative, by some definitions at least, and I want all those things. And it is pretty close to home for me. I have just undergone a very expensive medical procedure which is supposed to keep me alive. That is a pretty big deal and I didn’t have the money in my checking account to pay for this procedure. I will be paying a small fraction of the cost because I have a good health insurance plan. But I was and am bitterly opposed to the newly passed legislation. Am I a hypocrite? I don’t think so. Let me explain my opposition.

The United States is, more than anything else, an idea. Men sat down and talked about how a nation ought to be run. As they hashed out their ideas, they realized that this nonsense of governments ruling people was a false concept perpetuated by those in power. People are born with an inherent right to live their own lives. There are legitimate reasons to band together and form governments, but the power of that government comes from the people. The corollary is that people can’t legitimately give government power they do not have themselves. That idea created the most powerful and wealthiest nation in history. It also created a nation that evolved to eliminate slavery, insist on civil rights for all people, regardless of race, religion or sex and has been the most magnanimous toward conquered foes of any the world has ever seen. That idea has enabled power, wealth and compassion to spring up from the raw material of a new land and the hearts of a free people in a short period of time, in historical terms.

An integral part of that formula that has worked so well is a free market economy. Men and women have been able to utilize their resources to invent and create. It is a free wheeling process that produces some winners, some losers, and some incredible jackpots of success. There are medical treatments available today because people have been able to invest money in an idea, the idea has worked and made them fabulously wealthy while saving and improving the lives of countless others. That kind of thing can’t work without the possibility of profit to match the risk. Philanthropists can’t do it alone. When you invest money in a mutual fund that invests in a biomedical firm you are part of that process. The risks are high. More drugs fail the screening process than succeed, and each failure is incredibly costly. You invest your $100, or $1,000, or $10,000 because there is a possibility of a medical breakthrough that will cure cancer, or diabetes, or enable the paralyzed to walk again. And if it works, your investment will be returned to you several times over. You are contributing a small fraction of the cost, but your small fraction is pooled with thousands of others and that enables medical breakthroughs to happen. It is expensive, but the payoff is incredible. In the new health-care bill, this is going to be harder to do. The government is going to levy taxes on medical device makers that will make those devices more expensive and less available and therefore less profitable. They are going to have more control on what insurance can cover and how much it will pay. That will negatively impact the cash flow that allows medical breakthroughs. That is one problem.

Insurance companies have been demonized during this process because the Democrats needed an adversary to rally the troops. But the villain is not the insurance companies. It is power. Outsized power is always the problem. The ironic thing is that it has been a powerful government that has been persuading people to give them more power in order to remedy an inequity. That doesn’t work, because power is the problem. Power concentrated anywhere is a problem. But power concentrated in government is, perhaps, the worst kind, because it is so hard to take power away from government once it has it, and government already has the power of law and vast resources of institutions to enforce that power, and to do so violently. What the government should have done was not to take more power upon itself, but to give more power to the people to overrule the insurance companies.

One of the biggest problems with the current system is that it removes the patient from the cost equation. So employers, insurance companies, and drug companies are the only players with a significant financial stake in medical decisions, but the patients are the ones that are utilizing the benefits. There is a disconnect here. The government could have given the power back to the people, by allowing anybody who pays a health insurance premium to deduct it from their taxes, and encourage the use of high deductible medical insurance plans in conjunction with health savings accounts. Remove barriers to cross state purchase of insurance (a version of this is in the bill) and implement tort reform to minimize the incentive for doctors to perform defensive medicine.

The bill requires everybody to buy medical insurance. As I have written before, that is an understandable requirement if you are going to mandate that insurance companies take all applicants regardless of health. But this is the government in charge approach, not the freedom of choice approach. What if we incentivized people to buy high deductable medical plans with health savings accounts? What if instead of fining people who do not, or can’t afford to, comply, we provided a tax incentive to those who do comply by buying an inexpensive form of insurance that makes them more aware of the cost of their care? Why does the government opt for compulsion and control instead of freedom and incentive?

Then there is the cost. Any government entitlement has an inherently unknowable cost. The bill, as passed, utilizes some tricks to control the costs as scored by the Congressional Budget Office. One such trick is that the bill includes a takeover of student loans from the private sector. This has nothing at all to do with health-care, but because it is part of the bill, the profit from student loans is included in the accounting. The bill does not address the “doctor fix”, which is an annual dance congress goes through because Medicare & Medicaid underpay severely for medical care. In the case of primary care the underpayments are so drastic that physicians often lose money on Medicare patients. As a result congress regularly makes an adjustment to the built-in reimbursement cuts to primary care physicians. It is still not profitable for them to treat elderly patients, but the “doctor fix” keeps the losses at a more modest level. Because this routine practice is not addressed in the bill, it is using inaccurate revenue savings to come up with its numbers. These are two of several sleights of hand the bill uses to give the impression it can be fiscally responsible. We have a national unemployment rate of 10%, we are clawing our way out of a long and painful recession, and the Democrats have added to our economic burden.

Conservatives aren’t and have never been opposed to health-care reform. We have been opposed to government taking more control of our lives. Several individual bills that addressed the shortcomings in the existing system could have made a significant difference without undermining a system that has worked well for most Americans and damaging an already damaged economy.