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Government should stay completely out of the health care business. It should not regulate nor subsidize any treatments. Medicare and Medicaid should be shut down, and all attempts to institute universal government health care should be opposed. In addition to saving money, these reforms will actually promote better public health, as people are incentivized to focus on prevention rather than costly treatments. The elimination of bureaucratic red tape will speed the process of bringing lifesaving drugs to market and lower the cost of doing so. For most people, the best health care plan is to self-insure (i.e. pay for minor expenses out of pocket) as much as possible and buy a high-deductible insurance policy from a reputable company to cover catastrophic illness and accidents. If we were not being taxed so much, more people could afford adequate health care. Also, tort reform can help bring down the cost of medical care.

The Dept. of Veterans Affairs hospitals provide a good illustration of what universal government health care would be like. The efficiency of the Postal Service, the sympathy of the IRS, all at Pentagon prices.

Contents 1 Focus on prevention, rather than treatment 2 Abolish the FDA 3 Abolish pharmaceutical patents 4 Implement tort reform 5 Other views 6 References

Focus on prevention, rather than treatment

Many politicians are inordinately focused on pouring more money into treatment of diseases. The emphasis should instead be on prevention. More than half of all lower-limb amputations performed in the U.S., for instance, are the result of diabetes.^[1] 90% of diabetes cases in the U.S. are Type 2 diabetes,^[2] a disease whose onset can be prevented, and its symptoms reversed, through weight loss and reduction of carbohydrate intake. If people will make improvements in their health habits (such as substituting water for soda, or avoiding tobacco, for instance), it will go a long way toward reducing the incidence of costly diseases in America.

In many cases, simple remedies could be substituted for elaborate treatment regimens. Certain mental illnesses, such as depression, are prime examples. It is often believed that, because depression is associated with chemical changes in the brain, that it is helpful to treat it with antidepressants. Yet, most popular antidepressants prescribed today have the potential for side effects; and the non-generic formulations can be extremely pricy, in the range of hundreds of dollars per month. An alternate (and, in the long run, better) way to treat depression is to change one's habits of thinking. This does not necessarily require expensive therapy, as there are many books available on how to train oneself to think more positively; and one can also reach out to friends who can share different ways of looking at things as well as distract from the depressing thoughts with other activities. Shifts in thought patterns can effect beneficial changes in brain chemistry.

In any event, many prescription drugs, such as Prozac, have been shown to be only marginally more effective than placebos.^[3] Yet, the pharmaceutical drug lobby would like to see their questionable cures funded at taxpayer expense. This will encourage people to rely more on pill-popping than on natural remedies and preventative measures. Thus, it is counterproductive to the goal of improving public health.

Medicare and Medicaid can be influenced by lobbyists for equipment vendors, pharmaceutical companies, and other powerful players in the health care industry. There is a danger that, especially if government health care becomes universal, people will become reliant on such programs rather than on private insurance. Depending on how it is structured, they could be taxed so much to support these programs that it would seem wasteful to them to also maintain private health coverage. Yet, they could find that because of government's misguided health care spending priorities – influenced by the above-mentioned industries – that they are not getting quality care for their money.

Competition among health care providers (including insurers) helps prevent corruption and the exorbitant prices and poor service that go along with it. In a free market, there is a tendency for incompetent health care providers to suffer financially and eventually go out of business. Notice the proliferation of plans, such as HMO, PPOs, etc. that people can choose based on their specific needs. When government sets itself as the monopolist, however, the safeguards normally provided by competitive markets are not present, and special interests with political pull can manipulate the system for their own financial gain. As Congressman, I will get the federal government completely out of the health care business by opposing universal government-funded health care and abolishing Medicare and Medicaid.

Abolish the FDA

The Food and Drug Administration should be abolished and its drug certification functions assumed by competing private entities. This will help lifesaving drugs get to market sooner, and reduce the cost of doing so. The FDA held up approval of heart attack-treating beta blockers for eight years because it believed they caused cancer. In the meantime, according to Dr. Louis Lasagna of the Tufts University Center for the Study of Drug Development, 119,000 people died who might have been helped by that medication.^[4] This type of bureaucratic delay is unacceptable.

The FDA also misleads people into believing that pharmaceutical drugs are safer and more effective than dietary supplements. It should be noted that plants generally cannot be patented; therefore, there is little incentive for anyone to devote money to the costly studies and red tape needed to obtain FDA approval. Proprietary substances, on the other hand, can provide multi-billion-dollar payouts; thus, companies not only seek their approval but are willing to make large payments to the FDA, as provided for by legislation such as the Prescription Drug User Fee Amendment.

In many cases, the efficacy of herbal supplements has already been reviewed by other bodies such as Germany's Commission E; but the U.S. government will still not allow the manufacturers to state the purpose of the medicine on the label. In fact, they require them to provide a disclaimer that effectively serves as an anti-advertisement. Some herbs are banned altogether, despite vast anecdotal evidence that they work. A small dose of cannabis, for instance, can provide rapid relief of nausea.

Abolish pharmaceutical patents

Pharmaceutical patents should be abolished. Patents impose a monopoly on the sale of certain drugs. As with any other monopoly, this results in poor service and high prices. Rather than try to improve the product, the patent-holder can rest on his laurels, knowing that no one else can compete by manufacturing that compound.

The argument for pharmaceutical patents is that they encourage companies to develop new drugs. But the costs of bringing new drugs to market would be reduced if FDA regulations were removed, eliminating the need for patents to artificially encourage research and development.

Implement tort reform

Excessive judgments in lawsuits are increasing the cost of malpractice insurance, and thus raising the price of health care. The system should be reformed by eliminating government courts. Doctors and payments can instead settle their disputes through private arbitrators specified in the contract for treatment.

Other views

Like food, health care can be a matter of life or death, but while food is available in abundance and with easy access for all Americans, health care has become unaffordable to many and typically involves extremely long waits. Moreover, while advances in technology generally both increase quality and decrease costs (think of computers), the health care system has been a major exception. Why does the market work well for food and computers, but not health care? The reason is government.

There is no free market in health care: government policies are both restricting supply and stimulating demand, and the miracle is that the market elements that remain are able to function at all. More than 50% of health care dollars are paid by the government already, and an illogical employer-based insurance system, which results from government taxing cash wages but making insurance benefits tax-free, has resulted in 85% of medical expenses already being paid for by third party payers instead of the consumer-patient. The idea that socializing the remaining 15% will solve the problem is silly: the main beneficiary of universal health insurance will be insurance companies (wouldn’t YOU like a law passed to force everybody to buy your product?).

What can we do?

1. Get the FDA out of the way — In a 34-page paper by research scientist Mary Ruwart issued in 2005, she detailed the horrifying cost of the Food & Drug Administration in money and lives. In 1962, it was discovered that an estimated 12,000 European babies had been tragically born with birth defects attributed to a German drug, Thalidomide. That year, the Kefauver-Harris Amendments to the Food & Drug Act gave the FDA the impossible task of determining that a drug was both safe and effective before allowing its sale, and empowered the FDA to prevent even the mere discussion of benefits of various substances by sellers without the same standard being met. As a result, the cost of drug development today is 7 times higher than it would have been without these rules, development time is up to 14.5 years (and still rising), countless useful drugs have not been developed, and the free flow of information necessary for progress has been stifled. As a result, virtually every person in this country has lost a loved one due to FDA regulations. Through 1999, approximately 4.7 million premature deaths occurred to people prevented from taking life-saving drugs while the FDA was deciding whether to approve them, at least 4.1 million deaths resulted from potential drugs made too costly to develop by these rules, and both these losses were dwarfed by the deaths resulting from FDA prohibitions on the discussion of natural remedies, nutritional supplements, and off-label uses of existing drugs. Against all this, using even the most optimistic assumptions, the FDA may have saved up to 68,000 lives from its extreme cautiousness. Net result: FDA regulations are the equivalent of a new Thalidomide every week of every month of every year: year after year after year. It is no surprise that the Life Extension Foundation calls the FDA the leading cause of death in this country.

2. Replace government licensing with private certification — Early in the 20th century, the American Medical Association was openly discussing another health care crisis. Their concern? Medical care was too widely available! Responding to the demand, many people were choosing to be doctors, others were providing simpler care requiring less training, midwives were common, and competition was keeping AMA member incomes lower than desired. Well, they managed to solve that health care crisis. The AMA successfully lobbied to have the exclusive right to decide who should be a doctor, and to require that many types of care be performed by such a licensed doctor. They also obtained control over the licensing of medical schools and hospitals. Quickly, many schools were closed (including a disproportionate share of those that accepted women and minorities as students), and nurse and midwife “competitors” put out of business or restricted to limited subservient roles. “Lodge” doctors, referring to those who made contracts with the enormous number of mutual aid societies that served the needs of poor and middle class working people, were threatened with the loss of their licenses or hospital privileges if they didn’t cease providing low cost care under these contracts. Today, many procedures are performed by doctors which nurse practitioners, midwives, paramedics, or pharmacists could competently perform. The AMA is also trying to close down low cost clinics being opened by nurse practitioners in department stores such as Wal-Mart, or at least require that doctors be hired to oversee operations. Quality certification, relying on reputation, is very helpful to consumers, but the licensing monopolies should be eliminated. The AMA can continue to certify, but not compel people to use their services: this will ensure that only reasonable requirements are imposed. Other specialty certifications will also naturally develop, and people will be able to choose the level of expertise and not be compelled to pay a physician for services far below their competence but required by law to be performed by them. (Note also that private certification will replace FDA licensing of medications: prior to the formation of the FDA, Consumer Reports and Good Housekeeping magazine hired independent researchers to test new medicines and provide the results to their readers. In today’s Internet world, objective advice will be easily available to all.)

3. Deregulate insurance — It should be possible to obtain a health insurance policy that covers catastrophic costs, and doesn’t include coverage for ordinary medical needs or for services the insured will never utilize. It should be, but it isn’t. Consumers are held hostage to the rules of the state of residence, and most states have loaded up the law with mandates for coverages, often requiring that alcohol treatment programs, routine care, or other services the consumer prefers not to have. Mandates should all be removed so that consumers can decide for themselves what they’d like to pay for, and prohibitions on the purchase of policies from other states should be removed.

4. Repeal personal income taxes — One of the early driving forces to increase the cost of medical care was the special tax status of employer-provided coverage. During World War II, the government imposed wage controls, and employers got around the limits by offering medical insurance benefits, which were not included. Today, many employees are forced to stay in unsatisfactory jobs because they cannot risk losing health care coverage, and those who have to buy coverage individually compete at a disadvantage. While making all health care expenses deductible, or expanding medical savings accounts, would be improvements on the present system, a better solution is to repeal personal income taxes, simplifying the system, removing the artificial stimulation of costs resulting from deductibility, and combined with the reduction of government spending and regulation, increase prosperity so that people can afford more of everything, not just quality health care.

5. Allow liability waivers — Allow patients and medication users to agree to liability wavers in exchange for lower prices. Also, allow patients and doctors to opt out of the government legal system and agree in advance to private arbitration of disputes that will be limited to restitution for actual harm.

6. Eliminate paperwork requirements — The Health Insurance Portability & Accountability Act piled extensive requirements for frivolous paperwork and unnecessary documentation. A 2003 Harvard Medical School study revealed that 31% of the total cost of medical care was the cost of bureaucracy. Allow doctors to use judgment in deciding what paperwork is needed.

7. Return Medicare and Medicaid to the private sector — The only way for a permanent, stable solution to health care is to get the government completely out of the health insurance business. Without the adoption of the other proposals in this essay, Medicare and Medicaid are ticking time bombs anyway, with default only a few years off, and cracks already showing in the reduced reimbursements to doctors and restrictions on covered treatments. With the adoption of the other proposals, the cost of health care will have been reduced so far that health care will, in fact, start to resemble food, as a necessary good reasonably priced. Private charity along with free care for those who can’t afford to pay (which was a regular practice of doctors well before any laws were passed requiring it in the case of emergency rooms) will easily handle the rest.

BTW, universal health care insurance does not provide universal health care (as the Canadian Supreme Court said in rebuking Canadian health care authorities, “Access to a waiting list is not access to health care”). Moreover, universal health care does not provide universal health. There is plenty of evidence that lifestyle, not health care expenditures, is the key factor in living a long and healthy life, and the correlation between health care expenditures and health outcomes is disturbingly low. Along with all the other problems caused by having health care become a government program, the worst is that the proper goal, health, has been almost totally forgotten.

References