Al­ter­na­tives to gov­ern­ment health takeover

The Washington Times Weekly - - Commentary -

Six­teen years ago, a rel­a­tively young, am­bi­tious new Demo­cratic pres­i­dent ar­rived in Wash­ing­ton de­ter­mined to trans­form Amer­ica’s health care sys­tem.

His determination was not enough. When the Amer­i­can peo­ple took a closer look at the only ques­tion that re­ally mat­ters on health care re­form — will the pro­posed changes ul­ti­mately help or hurt the pa­tient? — they found Pres­i­dent Clin­ton’s ideas lack­ing. Hil­laryCare, as it be­came known, died a fairly spec­tac­u­lar death.

It seems in this case that his­tory does, in­deed, re­peat it­self, as the cen­tral premise of the Clin­ton health care pro­pos­als - fun­nel­ing hun­dreds of bil­lions of dol­lars to gov­ern­ment in the naive hope that bu­reau­crats are the an­swer to our health care sys­tem’s short­com­ings — has come back into vogue with the ar­rival of an­other rel­a­tively young, am­bi­tious new Demo­cratic pres­i­dent in the White House. That does not mean, how­ever, that the ideas have sud­denly be­come any less ob­jec­tion­able.

Whether it’s four-year wait­ing lines for ma­jor surg­eries in Canada or four-hour wait times for emer­gency care in Bri­tain, in prac­tice, gov­ern­ment-run health sys­tems by and large fail the very pa­tients they were cre­ated to pro­tect. In th­ese sys­tems, ac­cess to doc­tors, surg­eries and new life­sav­ing treat­ments are se­verely lim­ited. In­no­va­tion is dis­cour­aged, and med­i­cal tech­nolo­gies are de­fi­cient, forc­ing pa­tients to un­dergo more in­va­sive and danger­ous care. Pa­tient out­comes are worse, and costs keep es­ca­lat­ing.

Buy­ing into the no­tion that good ideas don’t have a shelf life, we would of­fer that med­i­cally sound and fi­nan­cially re­spon­si­ble al­ter­na­tives are avail­able to a gov­ern­ment takeover of health care, keep­ing in mind the fol­low­ing prin­ci­ples.

We be­lieve there’s ben­e­fit to de­cou­pling em­ploy­ment from health in­sur­ance cov­er­age by rid­ding the sys­tem of tax pref­er­ences for health care. This sin­gle change would re­duce health ex­pen­di­tures hun­dreds of bil­lions of dol­lars while eas­ing the bur­den of health costs on busi­nesses. A great un­spo­ken truth is that health ben­e­fits from em­ploy­ers come at the ex­pense of em­ploy­ees’ take-home pay. Rais­ing lost wages would be the first of many ben­e­fits to Amer­i­can work­ers and their fam­i­lies from delink­ing health in­sur­ance and em­ploy­ment.

We think it’s crit­i­cal that power shifts to the Amer­i­can con­sumer and away from gov­ern­ment, em­ploy­ers and in­sur­ers, as ev­i­dence shows med­i­cal care prices come down when pa­tients pay di­rectly. Gov­ern­ment should of­fer tax re­lief, such as re­fund­able tax cred­its, to en­cour­age pri­vate health in­sur­ance pur­chas­ing — es­pe­cially for low-in­come fam­i­lies. Sim­i­lar ideas, like those in the Pa­tients’ Choice Act re­cently put forth by Repub­li­can mem­bers of Congress, are im­por­tant for Amer­i­cans to con­sider. We would do well also to con­sider creative ideas such as chang­ing fed­eral pay­ments to state-based med­i­caid plans to in­di­vid­ual vouch­ers or ex­pand­ing health sav­ings ac­counts, as has been done in South Carolina.

Gov­ern­ment can lower the price of health in­sur­ance and in­crease choice for Amer­i­cans shop­ping for their own cov­er­age by break­ing down ar­bi­trary bar­ri­ers such as state lines and re­duc­ing costly and un­nec­es­sary cov­er­age man­dates. For in­stance, a na­tional mar­ket for car or life in­sur­ance means South Carolini­ans can buy an Ohio pol­icy or New York­ers one from Cal­i­for­nia. It makes sim­i­lar sense to al­low peo­ple to buy a health in­sur­ance plan, no mat­ter from what state, that best fits their fam­ily and their val­ues.

We be­lieve it’s im­per­a­tive that we fix our med­i­cal li­a­bil­ity sys­tem. By some es­ti­mates, abuse of our le­gal sys­tem costs our health sys­tem $80 bil­lion an­nu­ally. Key tort re­forms, in­clud­ing rea­son­able caps on noneco­nomic dam­ages; free­dom to use dis­pute res­o­lu­tion out­side of our courts; and re­quir­ing ad­her­ence to med­i­cal guide­lines as a stan­dard for li­a­bil­ity in mal­prac­tice tri­als would be a good start.

Fi­nally, an es­ti­mated 80 per­cent of all the health care in­no­va­tion in the world springs from Amer­i­can in­di­vid­u­als, com­pa­nies and uni­ver­si­ties. It is vi­tal that gov­ern­ment sup­port an at­mos­phere that en­hances such in­no­va­tion and dis­cov­ery rather than re­strict it by over­reg­u­la­tion. Specif­i­cally, the fed­eral gov­ern­ment should pro­mote state-based ex­per­i­ments in health care de­liv­ery and tech­nol­ogy in Med­i­caid and Medi­care pi­lot pro­grams (in pre­ven­tive care and home- based nurs­ing, to name two) and also fa­cil­i­tate and ag­gres­sively fund sci­en­tific re­search and in­no­va­tion in both pri­vate and pub­lic sec­tors on ad­vances in di­ag­no­sis and treat­ment as well as in dis­ease preven­tion.

It’s easy to un­der­stand the lure of gov­ern­ment of­fer­ing to pro­vide ev­ery­thing — whether dur­ing the Clin­ton years or in to­day’s eco­nom­i­cally vul­ner­a­ble times. How­ever, as Thomas Jef­fer­son warned, a gov­ern­ment big enough to sup­ply you with ev­ery­thing you need is a big enough to take away ev­ery­thing you have.

Our pro­pos­als are based on trust­ing Amer­i­cans to use their own money and make their own de­ci­sions wisely in­stead of forc­ing peo­ple to trans­fer their hard-earned in­come and health care de­ci­sion-mak­ing to the gov­ern­ment. We be­lieve that trust is es­sen­tial to im­prov­ing al­ready what is — de­spite what we’re of­ten told — the best health care sys­tem in the world.

Mark San­ford, a Repub­li­can, is the gov­er­nor of South Carolina. Dr. Scott W. At­las, a se­nior fel­low at the Hoover In­sti­tu­tion, is a pro­fes­sor at Stan­ford Uni­ver­sity Med­i­cal Cen­ter.

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