Let’s get real. Republicans have screwed up health care. Yes, that’s what Republicans always do: snatch defeat from the jaws of victory. Democrats, on the other hand, always win in the end with their socialist schemes. Not because they’re right, but because they have more confidence, greater staying power and ruthless, unblinking determination.
Even if Republicans had not screwed up, and had simply deleted Obamacare as they promised for the last 7 years, our problems would be far from over. Why? Because we didn’t have anything close to a free market in health care even when Obamcare first passed.
A “free market” is not some abstract and meaningless term. It means the things you take for granted when you purchase clothing, automobiles, fast food, groceries, cell phones, computers, television programs over the Internet, sports supplies, food in restaurants, or just about anything else imaginable. It means things like choice, options, preferences, competitive pricing, consumer self-accountability and service-provider accountability. Yes, all of these fields are regulated. In a truly free market, there would be no regulation at all, outside of fraud. However, these other fields are FAR less regulated than health care. Health care and education are two of the most regulated fields in America. Notice how they’re the most politicized and dysfunctional.
In health care there are almost NO choices, options, preferences, self-accountability and service-provider accountability. Since Obamacare, there are fewer all the time. If you’re reasonably healthy, you don’t get this, but talk to someone who spends a lot of time getting medical treatment and they will tell you. The only way to get these things is to open up a free market. In a tiny number of places, here and there, it’s already happening.
Consider Dignitas Health, a new primary care practice in Richmond, Virginia. It’s one example of the type of phenomenon occurring around the country.
Dignitas uses the direct primary care model, a system that does away with insurance, co-pays, and deductibles altogether in favor of an affordable per-patient fee-based model.
“‘Dignitas’ speaks to how this model of care allows me to treat people with dignity,” says the practice’s founder, Dr. Jill Zackrisson. Before founding Dignitas, Zackrisson worked in “a busy general primary care practice” that gave her only 15 minutes with each patient, and “those 15 minutes were not all my time face-to-face; that was the time to room the patient, triage, have the nurse get vitals, then my time—and somehow at the end of that you were supposed to have made a thoughtful decision, documented, coded, billed.”
The practice accepts no insurance. “It’s completely direct payment,” Zackrisson says, with a per-patient membership fee “just like at the gym, or with Netflix. You use it as you need it.” The advantages are myriad: “You know up-front what the cost will be, it helps with budgeting, there’s no per-visit fee, there’s no surprise initiation or cancellation fee.”
As well as being a more sensible way to budget for primary care, this system carries additional benefits: the numerous in-house procedures and medical amenities for which doctors’ offices routinely charge big bucks. Dignitas Health’s $60 per month Adult Primary Care subscription covers standard checkups and sick visits, plus “in-office labs” with no additional fee, minor surgeries and splinting for merely the cost of supplies, routine gynecological care, and services like “specialist care coordination.”
Zackrisson also offers an in-house pharmacy for on- and off-site medical dispensing, as she carries both a pharmacy license and a dispensing medical license. Her ability to track the prices of the pharmaceuticals she dispenses allows her to give patients highly affordable prescriptions. Where a normal prescription might run a patient $30 per month, she might be able to prescribe the same thing for $3.
“Rather than paying higher premiums to cover your primary care, your medicines, and your labs,” Zackrisson says, “if we can carve [those services] out, and put [them] at a reasonable price” then the broader insurance market’s original purpose—of covering serious emergencies and large hospital bills—might then fall into place, and insurance may once again become affordable. “I always encourage patients to have insurance,” Dr. Zackrisson notes, because, “you’ve got to have insurance for those big things.”
Some have called this private market approach to health care “concierge medicine.”
I’m not trying to promote the Dignitas or concierge model as a one-size-fits-all for your entire state, nor for the entire country. That’s the whole point: There is no one-size-fits-all. Nor should there be!
Health insurance was designed for big-ticket items such as catastrophic illness, like cancer or heart disease. In a free market, health insurance would be available, and it would be a heck of a lot cheaper if government had not saddled it with all kinds of restrictions. These restrictions do not exist to help anyone other than the pressure groups who demand them. The pressure groups include health professionals who want their services covered by health insurance. This is one of the main things that has made health insurance so expensive. When every insurance company is required to offer a one-size-fits-all package, not just for catastrophic care but for virtually everything from birth control to outpatient procedures to sore throat treatments, then health care insurance costs go through the roof. It doesn’t take an economics degree to understand this fact!
As a result, the government came up with Obamacare to make health care more “affordable,” while predictably making it even MORE expensive. So what’s left? Medicaid and Medicare. At which point there is no more free market at all. It’s all government health care. We’re just about there. We will be there very soon, unless or until we totally repeal Obamacare and set all of health care on the road to privatization.
I have almost no hope that politicians in either party are willing to pull this off, leaving aside a tiny minority in the Republican House Freedom Caucus. The free market will have to develop, if it can, despite the government. Because government programs eventually will collapse. So long as the government does not outlaw innovative solutions like Dignitas—or countless others ideas yet to be developed out there—then there’s hope. If we go full Communist, then the government will outlaw this sort of innovation as “bribery,” like they already do in socialist or Communist countries. “Bribery” means that when patients or doctors decide to go outside the government system to purchase or trade for services, they will all be fined or jailed, because people are only allowed to use the government for health care. Imagine the U.S. Postal Service if the innovators who started UPS or FedEx had been jailed for bribery. That’s the worst-case scenario, and if you think that’s unlikely in America, then you better pay closer attention to how truly rotten and depraved our swamp-thing politicians have become. They will sell out any principle or individual right for the sake of a little more power. Politicians like Paul Ryan, Nancy Pelosi and others are the true deplorables.
The bright side? Where there’s freedom, there’s hope. Because where there’s freedom, there’s opportunity for innovation and new ideas. How do you think America ever became great? By accident? No way. It became great because of innovation. But without economic freedom, there is no innovation. There’s only stagnation and despair. We’re in the early stages of that Communistic-like stagnation and despair with health care. If you think that the only or best answer is more government, then you must already be pretty happy with what we have. But once EVERYONE is on Medicaid or Medicare, and government possibly outlaws innovation by forcing everyone (except politicians and other people with pull) to take part in the public system, you had better learn to appreciate the value of what economic freedom has to offer you.
Innovation is our only hope. But it’s a real hope. And it’s the only hope left, while tiny embers of freedom still burn in the battered field of medicine.
Follow Dr. Hurd on Facebook. Search under “Michael Hurd” (Rehoboth Beach DE). Get up-to-the-minute postings, recommended articles and links, and engage in back-and-forth discussion with Dr. Hurd on topics of interest. Also follow Dr. Hurd on Twitter at @MichaelJHurd1