No one listens to me. I get that. Still, I would like to go on record right now predicting continued dysfunction in America’s health system. This dysfunction is generated by our collective refusal to come to grips with the real world. Normally, I’d have to direct my comments towards liberals and progressives, but right now the matter is in the hands of Republicans. They are in real danger of merely ‘re-configuring the machine,’ when what we really need is to have the machine dismantled. ASAP.
We have to understand that nearly every kind of government activity is ‘socialist’ in some sense, and ‘socialism’ tends to haves several effects. 1., it never works as intended. 2., it takes perfectly normal brains and melts it into slop with every apparatus for critical thinking reduced to puss. 3., it generally needs deception and self-deception in order to persist.
I am not arguing here for anarchy. I advocate for a ‘limited government,’ and one of the reasons is that a smaller government is in itself a check and balance on all three effects, above. One of the chief lies (#3) is that with sufficient tinkering we can progressively iron out the bugs (per #1) an eventually all live happily ever after. But when you know that such a prospect is 100% unattainable, one does not delude himself with false hopes about what a government could do, if only it were given X and Y, etc.
Let me begin with an illustration of how this insanity unfolds.
I read an article recently with this headline: SF reaches deal for free tuition at City College
This is what I mean about living in fantasy-land and how socialists ideologies tend to turn brains into slop. People across the country will happily believe that its possible that some ‘progressive’ town is now offering ‘free’ tuition. After all, the HEADLINE SAYS SO. But there is no such thing as ‘free.’ The article itself says:
The money will come from a measure that San Francisco voters approved in November, Proposition W, enacting a transfer tax on properties selling for at least $5 million. [emphasis added]
So… not free.
Now, I know what you’re thinking. No one really thinks its free. You’re wrong. They really do. I have a cherished memory where I argued with a guy about the ‘free’ schooling he was receiving about whether or not it was really ‘free.’ It took fifteen minutes before this ‘highly educated’ young man understood that just because he didn’t pay for his schooling, that didn’t mean that his teachers taught for free, or that the administrators administrated for free, or that the maintenance people maintained for free, or that the builders who built the new buildings did their building for free. They all received compensation. They wouldn’t actually do it if they weren’t paid! Finally, he put two and two together. (And when he did, he ‘moved the goal posts,’ saying it was ‘ok,’ because it was only the rich who were impacted negatively.)
It was a truly amazing exchange.
Don’t get me wrong. If the people of San Francisco want to tax themselves into oblivion ‘for the common good’ more power to them. Just don’t delude yourself into thinking the tuition was ‘free.’
But now behold the law of unintended consequences:
Now, in the real world, how much things are worth, how much people are paid, and so on, are worked out on a ‘market’ system. A manufacturer would like to make such and such amount from his widget, but a consumer is only willing to pay this or that. A ‘negotiation’ takes place as each person jockeys–in their own best interest–for position. Eventually, it works itself out so that everyone is fairly content.
For the last 40 years, governments at all levels have been doing what they can to make tuition more ‘affordable’ and ‘accessible.’ The result is that higher education, something that used to be within reach to any normal fellow who wanted to prioritize it, is now completely out of reach to anyone without massive amounts of loans (nationalized by Obama in 2010). What was actually ‘affordable’ and ‘accessible’ when the ‘market’ worked things out cannot be afforded at all–unless, of course, one wishes to go hundreds of thousands of dollars in debt, shackled to the whims of the Federal government, with little reason to think most American jobs can pay off that debt in under 20 years.
We have the same problem with our health care system, where people assume that ‘free’ is free, or that having health insurance means you actually have health care.
The doctors won’t work for free. The nurses won’t work for free. The makers of x-ray machines and other modern marvels don’t give away their products. There is money involved. It is coming from somewhere. It always will. This. Is. Reality.
Look at that chart again. Crazy, right? Something weird is going on, right? Right?
I will certainly allow that there are a number of factors driving these distortions. I would maintain, however, that the biggest correlation is that since 1978, the government has become increasingly involved in ‘helping’ people, through all manner of tricks and impositions.
The inflated cost of ‘Shelter’ is the result of the same thing, even if on a percentage basis it isn’t as pronounced. Everyone was blaming Bush for the housing meltdown of 2008, but such things do not happen overnight. What one can do in 8 years can compound a problem of that scale, but is unlikely to have been the main cause of it.
You’d have to look at decades of policy, all of which done in the name of helping ‘the little guy’ have the American dream of his own home, a picket fence, etc. I would submit the most recent, actual cause of the meltdown began, not coincidentally (look at the chart again!), in 1977, when Carter passed the Community Reinvestment Act which:
is a United States federal law designed to encourage commercial banks and savings associations to help meet the needs of borrowers in all segments of their communities, including low- and moderate-income neighborhoods. Congress passed the Act in 1977 to reduce discriminatory credit practices against low-income neighborhoods, a practice known as redlining.
Way to go, team! Thanks to your desire to ‘meet the needs of borrowers in all segments of their communities’ and reduce ‘redlining’ you actually made it harder for the little guy to own his own home. This and various other government attempts to ‘help’ people went well for a time–until reality smacked wishful thinking upside the head–and we had the housing bubble. Here is a headline for you (in 2015): Homeownership rate drops to 63.4%, lowest since 1967
When is it going to get through your thick head?
If you really want to make healthcare affordable and accessible to all, you need to get the government the hell out of it.
The reason why the costs have gone up in healthcare over this time frame is the same reason why costs have gone up for all the other things listed and not, say, for your flat screen TV, or smart phone, laser vision surgery, and so on, is because the ‘negotiation’ between the producer and consumer is much more intimate and direct. The reasons for why healthcare, housing, college tuition, have become skewed are complicated and strange, a malignant mass of good and bad intentions covered in pustules that pop into unintended consequences, all stemming one way or another from separating the producer from the consumer.
Which means that you need to get the insurance companies the hell out of it, too.
When the government and insurance companies are no longer managing the ‘care’ of millions of people, you will see prices drop dramatically. What seems to be ‘out of reach’ today will be well within reach to anyone who prioritizes it.
This is fact. This is reality. This is the world how it really is.
So we turn now to our Republicans ‘tinkering’ with the system. The core assumption remains untouched–that the government is the proper tool for dealing with this job. It essentially is adopting the same premise of the Democrats.
Let me give you one final example.
My daughter has spina bifida. She occasionally needs certain items in order to maintain her care. We identified an item that she needed. It cost a mere $80 on Amazon. But we have insurance, so why wouldn’t we make use of something we pay for? We submitted it to insurance. Months and months later, the local medical supply company showed up at our door and had us sign for the item. The invoiced amount for the item: $500.
Based on our own assessment of our needs, we could have had the item from Amazon in just 2 days for $80. Instead, we had to wait months for a bunch of bureaucrats and government nannies to determine if we ‘really’ needed the item, authorize payment, have it ordered and delivered, etc.
The socialist reader says, “Yes, but in the former case you had to pay $80… and what if you didn’t have $80! and in the second case you got it for FREE!”
Uh. Under current Federal law, we are required to have healthcare insurance–for which we pay thousands and thousands of dollars for, out of pocket. Trust me, dude. We did not get the item for FREE.
I know how socialists think (if we can really call it ‘thinking’) so I am well aware of all the hateful responses they are prepared to put in my comment section (provided they even find this post, of course). The fact that costs for tuition, houses, and healthcare have doubled, tripled, quadrupled, etc-rupled, during the time period governments have tried to ‘help’ us will be completely lost on them. In fact, they will see these these increases as justification for even more government intervention.
But this post is not directed to the socialists.
It is directed to the Republicans.
It is directed to conservatives.
It is directed to people who really ought to know better, but still think that measures like allowing insurance companies to compete across state lines (but still letting them dictate who needs what, at what price, etc!) or constructs like health savings accounts will solve the problem.
A lot of conservatives might wonder at my problem with the health savings accounts, since “Doesn’t that give the patient the ability to more directly choose how he is going to spend his money?”
Not if the rest of the Big Government/Big Insurance apparatus remains intact. I see little in the GOP talk that suggests it will be dismantled.
Let’s say they give us $2,000 untaxed HSAs. Take the example of the medical item for $80 we needed for my daughter. Would we be able to use the HSA to buy an item off of Amazon for $80, or will we have to work through an elaborate system, ultimately where that same item will cost $500? If so, we just used 25% of our year’s HSA on a toiletry item! How stupid would that be? But you can predict that Republicans are still going to insist that people work through this system, out of various concerns that seem genuine on the face of it–eg, what is to prevent someone using their HSA to buy a flat screen TV on Amazon rather than a toiletry item? Why, you need a process in place to prevent that sort of thing, don’t you? One thing leads to another, and we are left right back where we left off with providers charging skewed amounts because the insurance companies and the government are all involved, so that the HSA doesn’t ultimately do jack squat in bringing down costs, or driving competition, etc.
A HSA only ‘works’ if the entire system is dismantled, putting the patients into direct ‘negotiation’ with doctors, hospitals, clinics, etc.
That’s not going to happen.
So, get ready for continued dysfunction. Forever, probably.
But lets not delude ourselves in thinking this dysfunction is the result of ‘Republican’ principles. No, this dysfunction will be the result of a refusal to jettison ‘Democrat’ principles. The ‘conservative’ principles will not have been tried, and found wanting. They won’t even be tried.