FREE MARKET MEDICINE by Stephen M. Herman MD
This letter was published by the Savannah Morning News on Friday, 12/9/16.
The dilemma of medical care financing in the United States is hard to solve. The Obamacare experiment sought to provide maximum coverage to the nation's population in an unrealistic manner. The basic flaw in Obamacare was the notion young and healthy citizens could be forced to pay large sums of money for the care of older and sicker persons in society. The young and healthy did not fork over the cash and the experiment failed.
Any person afflicted with an illness should be treated in a competent and caring manner. How will this care be financed? I will try to answer the question,
I have practiced primary care medicine for a number of years, both as a military and civilian physician. I have long appreciated the privilege of autonomy as a solo private practice Internal Medicine physician who does his best to treat all comers to the best of his ability. At the present time, however, I find the business aspect of my practice progressively more difficult in a multitude of ways. Patients are reluctant to pay any portion of their bill. Both government and private payers have become bureaucratic behemoths who use every possible trick to deny reimbursement for the most arbitrary and capricious reasons. It is very frustrating for all.
I have long advocated a free market medicine approach to solving the medical care financing problem. Give patients federal tax support to open Health Savings Accounts in a bank and give them the freedom to control their own medical care decisions without the restraint currently exercised by insurance companies, the government, and employers. Health insurance should be real insurance against risk, not a prepaid scheme that too often defrauds patients and physicians while enriching the insurance industry. That is what we have now.
The standard argument against Health Savings Accounts is that they work well for healthy persons but are not suitable for the chronically ill. I take issue with that argument. People do well, in general, feeding, clothing, and housing themselves. Those who cannot do these things for themselves get government or charity support. The government should provide medical care to the poor, but the best way to do so should be by private means whenever possible with the provision of taxpayer financed vouchers. In my experience, government medicine is not uniformly high in quality. The Veterans Administration experience is the best of many examples of government failure to treat sick people uniformly well.
In a free market, patients with Health Savings Accounts see doctors of their choice, pay with a debit card, and choose the insurance plan that works for them best. They shop for the lowest prices for all supplies and services. They are free to join groups of other patients and physicians who could negotiate with hospitals, pharmacies, laboratories, and medical suppliers for the lowest price for services.
The American people do not do well when the government treats them in a patronizing and paternalistic way. The old style of financing medical care is a total flop. Will a free market in medicine work better? I am confident it will.