Washington Should Leave Healthcare to States
Despite a crisis on our borders and fears of a possible tariff wars, polls show that the #1 concern of Americans has been and remains healthcare. The public is weary of repeated assurances that Washington will fix healthcare, promises that never materialize. The ACA was supposed to save each family $2500, and instead the average family spent $28, 166 on healthcare costs in 2018, nearly half of family income! As a result of the ACA, insurance premium costs have doubled. President Obama promised we could keep our doctors and our health plans; that did not happen.
Washington should get out of the healthcare business. Here are the reasons.
The federal government has been "fixing" healthcare for 50 years, and look where its solutions have gotten us. In 1970, the U.S. spent 6 percent of GDP on healthcare. In 2018, we spent 17.8 percent. Wait times to see a physician in mid-sized U.S. cities could now exceed four months, according to a 2017 Merritt Hawkins survey. A 2015 internal audit by the VA hospital system suggested that more than 300,000 veterans may have died waiting for medical care.
A common definition of insanity is doing the same thing over and over, while expecting a different result. Americans are sane people. Yet, they keep expecting Washington to produce a different result in healthcare than they have achieved over fifty years of solutions.
Washington's approach to healthcare is always one-size-fits-all. Federal mandates apply equally to all states with very limited state-level flexibility. Rhode Island and Montana have nearly identical population numbers, 1,057,315 and 1,029,860 respectively. Rhode Island has 5146 physicians within 1212 square miles. Montana has 1100 physicians scattered over 145,000 square miles. From Providence, Rhode Island, there are three world-famous medical centers within less than one hours' drive. The nearest major medical facility/trauma center to the capitol of Montana, Helena, is in Salt Lake City, Utah, more than 7 hours away, assuming the roads are passable.
It is illogical and unrealistic to think that the same set of insurance rules and healthcare mandates will work in Rhode Island as in Montana, yet that is how Washington operates.
Coverage does not equal care. People can have coverage, especially government-provided insurance, and not get the care they need. This has resulted in "death by queueing," where people die waiting for care that is medically possible but not available in time. Evidence of such healthcare system failure can be found in the Veterans Administration Health system, in post-ACA Medicaid, and a 12-year old who died from a cavity in his tooth.
When spending on healthcare, Washington is extremely dollar inefficient. Dollar efficiency is generally defined as the amount of money expended that actually produces the desired outcome, result, or product. For healthcare, the outcome consumers want is care, not coverage. A 1999 study indicated that 31 percent of U.S. healthcare spending went to bureaucracy. That was long before the expansion of bureaucratic costs associated with Obamacare; the dollar inefficient percentage is likely to be higher today.
In 2018, the U.S. spent $3.5 trillion on healthcare. Even using the modest 1999 figure of 31 percent going to bureaucracy, that means more than one trillion dollars of "healthcare" spending produced no care! The cost of federal healthcare bureaucracy denied Americans $1 trillion of medical care.
Ask any nurse, doctor, or therapist, and they'll tell you that other people are practicing medicine on their patients without licenses. These are third party payers, government or insurance, who have taken over medical decision-making. The drug a doctor prescribes is determined by an insurance company's pharmacy benefits manager, not the patient's best interest. When, where, and even if a patient receives care is determined by insurance actuaries and government bureaucrats, not by the patient with advice from a care giver.
This is not only unethical, it is illegal. Only licensed physicians can legally practice medicine. Yet, thousands of unlicensed individuals, bureaucrats, do every day.
The Tenth Amendment to the U.S. Constitution reads as follows. "The powers not delegated to the United States [federal government] by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people." In other words, healthcare authority was not specifically delegated to the federal government, and therefore, it should be decided by the states or the people.
Medicare (insolvent within 7 years), Hillarycare, Obamacare, Trumpcare, now proposed Medicare-for-All, these are all Washington-centric, federally generated one-size-fits-all approaches to healthcare that do not work. Healthcare belongs to We the People in their states, not with politicians in Washington. Let California have single payer and Texas have market-based healthcare. That is StatesCare, the best way out of our current healthcare nightmare.
Dr. Deane Waldman, MD MBA is Professor Emeritus of Pediatrics, Pathology and Decision Science; Director on the New Mexico Health Exchange Board; and author of "Curing the Cancer in U.S. Healthcare."