On Sunday, President Trump tweeted, "Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck."
But there’s a problem with deals: They’re worthless unless everyone agrees on the underlying terms. Imagine if a gunman held you up, demanding all your money. Would you try to negotiate how much he’ll get? Of course not. That’s not what he wants to hear.
When it comes to health care, there can be no deals unless we get rid of coercion. For example, non-seniors are forced to put money aside for old-age health insurance. In theory, it’s a savings account. In practice, because Medicare pays out way, way more than it takes in, the non-elderly finance the health care of the elderly. The program is fiscally unsustainable. Everyone knows it, but nobody will talk about it — not even the otherwise fearless Donald Trump.
It’s morally unsustainable too, because people eventually tire of coercion, and Medicare will reach that point. If you’re 50 or 60 now, look at today’s 20-somethings and ask yourself if they’ll be willing — and able — to finance your health care. Not likely, especially since the demand for Medicare 20 years from now will far outstrip anyone’s ability to pay for it. And frankly, why should they be willing? They’ve got enough problems with student loan debt and other issues created by the government.
President Trump is used to deals as they apply to willing parties in a business transaction, i.e., somebody wants to buy and somebody wants to sell. The art of the deal consists of reaching a mutually acceptable agreement among voluntary parties. In that realm, the president knows what he’s talking about. But in politics, aka, coercion — Medicare, Medicaid, and Obamacare — the terms are not voluntary. Participation is coerced. There’s no deal — art or otherwise — when you’re threatened with prison or fines for not participating!
If we’re ever to fix health care, we’ve got to phase out the coercion. This will not be easy. Making the case that the American people must learn to fend for ourselves in a deregulated and unfettered free market could be a hopeless task. But there is no other rational option.
Another example: Nearly everyone agrees it’s the government’s job to outlaw pre-existing conditions. Probably even the Freedom Caucus agrees. But this is no different than the federal government demanding that auto insurance companies sell insurance to people who’ve already had an auto accident. When that happens, it’s no longer auto insurance; it’s nothing more than a(nother) federally run program, exactly like Obamacare. But nobody wants to repeal the worst part of Obamacare, the pre-existing condition requirement.
Because our assumptions dictate conditions that could never happen in a truly free market, we’re going to end up with single-payer health care. In this respect, Democrats are more consistent as they flatly say, "Insuring people is the job of government. Single-payer is the best option." That’s why Bernie Sanders’ approach will absolutely be in the Democratic Party’s 2020 platform. There’s no other option left.
Republicans, on the other hand, want it both ways. They try to claim, "Insuring people is the job of the federal government. But … we should also have a free market." Yet in a free market, government does not take responsibility for insuring people. People are responsible for figuring that out on their own. In a free market, many more options and price ranges would be available. The ability to purchase insurance or health care across state lines would be the least of it. (Congress can’t even manage to pass that minor reform.) Doctors and hospitals would innovate and economize to meet the needs of their customers, rather than to comply with the bureaucratic whims of a hapless government.
We can’t even imagine what a free market would look like, were it permitted to exist in the United States. It would be infinitely superior to what we have now. And charity would function much better in order to help those who had no other option.
The best thing government can do is get the hell out of the way of health care. Tragically, neither Donald Trump, the Republicans nor their outright socialist Democratic adversaries will permit it. Free and unfettered health care has no friends in Washington, D.C.
Sorry, President Trump. This isn’t real estate. Until or unless we get coercion out of health care, there will be no art of the deal or anything close to it.
Michael J. Hurd, Ph.D., LCSW is a psychotherapist and author with a private practice in coastal Delaware. He is the author of “Bad Therapy, Good Therapy (and How to Tell the Difference).” For more of his reports, Go Here Now.
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