This article first appeared in The New Individualist
One of the first lessons taught to medical students is that effective treatment depends on making the correct diagnosis. A patient with a broken arm does not benefit from having his appendix removed.
Yet this concept may be unclear to Senator Barack Obama. His “treatments” to cure the ills of the U.S. system of healthcare funding and delivery are based on the following principles:
Healthcare costs are rising because individuals, not the federal government, foot the bill. Cost shifting — not cost reduction — is the answer.
Industry competition is why Americans struggle to buy health insurance. Regulation and price-fixing solve this problem.
It is not fair for employers to buy health insurance for their employees only. The number of uninsured Americans will decrease when employers are forced to subsidize healthcare for people they don’t employ.
Children remain uninsured because parents are not mandated to buy health insurance. Children should not be allowed to enroll in school without it.
The problem with government programs like Medicaid is not waste or inefficiency; it’s that they do not cover enough people. Eligibility requirements should be relaxed to expand subsidized programs.
Patient autonomy is dangerous. Improving medical safety depends on removing healthcare decision-making from the hands of patients and their doctors.
Medical malpractice suits that drive up the cost of healthcare are due to bad doctors and insurance companies, not attorneys. Regulate physicians, not lawyers.
Prescription drug costs are related to a lack of government intervention. Medicare should require more generic drug use.
The reason healthy young adults don’t have insurance is that they are not covered by their parents. This should be mandated for everyone under the age of twenty-six.
In short, the senator’s principles amount to nothing more than the tired old socialist philosophy of governmental redistribution of wealth.
That’s the theory. But what about the practice?
Plan for a Healthy America?
In May 2007, Senator Obama framed his view of the healthcare debate in a fifteen-page document entitled “Barack Obama’s Plan for a Healthy America.” Consider its provisions.
1. A new National Public Healthcare Plan: universal health insurance.
This as-yet-unnamed program would guarantee affordable access to all applicants regardless of health history, age, or illness. The plan would provide comprehensive benefits for all services, including preventive care. He refers to the “affordability” of premiums, co-pays, and deductibles under the plan, but does not define this in greater detail.
“My plan begins by covering every American,” the senator declares. “If you are one of the forty-five million Americans who don’t have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”
He claims his plan would save “typical” families up to $2,500 per year. Income-related federal subsidies would be provided to those who do not qualify for Medicaid or S-CHIP, a program for the children of families too well-off for Medicaid.
Unfortunately, according to the Kaiser Family Foundation annual survey of employer-sponsored plans, 2007 health insurance premiums for a family of four averaged $12,106 per year.
The economics of Senator Obama’s plan are based on cost-shifting from individuals to the federal government (that is, to fellow taxpayers), not on cost-reduction.
2. Creation of a National Health Insurance Exchange.
This new government bureaucracy would serve to regulate the insurance industry “to ensure fairness. . . . Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public [National Healthcare] plan.”
Senator Obama also addresses what he sees as the major cost driver for health insurance premiums: lack of regulation and the absence of price-fixing by the federal government. However, consider Medicare and Medicaid, among the most heavily regulated players in healthcare. Their prices are determined exclusively by Congress and by state governments. Between the two programs, 46 percent of all healthcare dollars in the United States are spent to cover 27 percent of the population. Total Medicare spending per recipient averages $16,000, while Medicaid spending exceeds $7,000. If this is an example of governmental regulation and price-fixing in action, it is not exactly reassuring.
3. An employer “Pay or Play” mandate.
This provision would assess payroll taxes on employers who fail to make a “meaningful contribution” toward employee health coverage. The goal of this new tax would be to compel employers to help subsidize healthcare for all Americans, not only the workers they employ.
4. An individual mandate for children.
At birth, children not already covered under a family employer-provided plan would be enrolled in a government-sponsored plan. A child’s mandated coverage would have to be verified prior to enrollment in daycare or school.
5. Expansion of Medicaid and S-CHIP programs by relaxing eligibility requirements.
No comment necessary.
6. A mandate for doctors regarding treatment decisions and care delivery.
Similar to Senator Hillary Clinton’s proposed “Best Practices Institute,” Senator Obama would “establish an independent institute to guide reviews and research on comparative effectiveness” with the goal of influencing choices made by patients and their doctors.
He will require that doctors—to participate in the new public plan, Medicare, or the Federal Employee Health Benefits Program — be compelled to utilize “proven disease management programs,” presumably approved by the federal government, and to supplement this with a program to “coordinate and integrate care” of patients with diabetes, heart disease, and high blood pressure.
In other words, this provision would further collectivize and politicize medical diagnoses and treatments.
7. Regulation of the malpractice-insurance industry.
To whitewash the role played by trial lawyers in soaring medical-malpractice claims, Senator Obama points instead to the stock villains of corporate America. Without acknowledging any need for tort reform, he asserts that the costs of malpractice suits are related to insurers “overcharging physicians for malpractice insurance” and to the errors of physicians creating a “need for malpractice suits.”
8. Prescription drug costs will be addressed with a combination of approaches: allowing Americans to buy drugs from other countries, encouraging government negotiation with private companies, and increasing the use of generic drugs for patients covered under government programs like Medicare.
Encouraging Americans to purchase drugs produced in nations whose regime is socialized medicine would undercut and even destroy domestic pharmaceutical firms, which would be forced to “compete” against subsidized foreign companies. Government “negotiation” with private companies is like “negotiation” between an armed extortionist and an unarmed victim. And compelling the use of generics similarly would undermine the brand-name pharmaceutical giants, which are the source of most new medical research and development and which need to charge higher prices to continue that investment.
9. A “slacker mandate” for coverage of anyone up to age twenty-five under their parents’ plans.
This approach was enacted in New Jersey, with the prediction by the law’s original sponsor, State Assemblyman Neil Cohen, that the legislation would take “100,000 or more off the uninsured rolls.” One year later, however the actual number was barely over 6,000. More than 500,000 New Jersey residents in the covered age group remain uninsured. And with the expected premium increase for all policies issued in New Jersey, monthly costs for low-risk individuals are as much as $300.
From Misdiagnosis to a Dangerous Prescription
Senator Obama estimates that his plan will cost taxpayers from $50 to $60 billion per year “when fully phased in”—plus a five-year, $50-billion expenditure for electronic Health Information Technology. But if the senator’s math skills match his diagnostic abilities—or his understanding of the principles of individual rights and limited government — then under Obamacare, Americans in need of medical insurance and treatments will surely face a “cure” far more painful than the disease.
LINDA HALDERMAN, M.D., is a surgeon who specialized in the treatment of women with breast cancer in rural central California. Frustrated by the unsustainable, patient-hostile world of government medicine, she recently became a healthcare policy advisor in the California State Senate. Her website is www.lindahalderman.com.