I note with concern that in the health care debate, the question of individual liberty seldom arises. I believe this should be the first question to be addressed, in this debate and all issues. Individual liberty is the opportunity for each person to determine his actions according to his own evaluation of what is best for himself. No king, slave owner, employer, or government bureaucrat making decisions for us. The whole of human history has been an attempt to move away from these controls by others and to more individual liberty. That is the entire basis and meaning of the United States of America, the only place where humanity has achieved the goal of individual liberty in significant measure for any good length of time.
So, I’m going to examine the relationship between individual liberty and health care. Health care impinges on individual liberty at many points in the health care system, beginning with you and me. Your doctor and pharmacist are also impacted, as are insurance companies, drug companies, hospitals, nursing homes and other businesses in the health care field. Finally, our governments: local, state and federal, have all entered our health care system at various points. The current debate happens because the federal government is proposing to become even more deeply involved in everyone’s health care. With regard to individual liberty, the question to investigate is, “What type of system best allows me to choose how much insurance I purchase (if any), who I want to contract with for care, what type of care I purchase, how much care I purchase, where I go for care, and when do I receive care?” The answer will be a system that places “you” at each decision-making point and excludes anyone else. To highlight how a system might place “you” at the decision-making points, I’m going to compare buying health care to something simple that anyone can understand: buying a pizza.
Suppose you wake up and decide you would like a pizza for dinner tonight. When buying a pizza, you can decide the size, flavor, style, where to buy it, where to eat it, how much to pay, whether to pay cash or credit, and whether you even buy a pizza or not. In short, you decide every detail of your pizza choice, taking into consideration your own opinions of taste, preparation time, cost, freshness, etc. In health care, this is not usually true.
Our health care usually works more like this: Suppose you wake up and one eye is swollen shut and you decide you should have a doctor look at it today. So, you call for an appointment with a doctor on the approved participating list from your health insurance company. No opportunity for you to choose a doctor based on your opinions of competence, ease of visiting, cost, or anything else. In fact, you probably have never received any information on any of these factors, and could not make an informed choice if you were allowed to! If you get to see the doctor today, which is not assured as the appointment time is her choice, you do not pay as you leave the office. You have no opportunity to consider a method of payment, as you are not charged directly. Your insurance company or government plan will make payment at some future date without even asking you whether you received adequate service. They may even bill you for a co-pay without considering your opinion on cost, method of payment or anything else. If the insurance company will pay, you will find that you did not even have a voice in choosing the insurance, your employer did that for you without consideration of your opinions on cost, services purchased, history of adequate services, ease of billing, or anything else. What happened to your liberty?
For many of us, others make these major decisions in our health care purchases. Our employer may decide what insurance company we get a policy from, and all the details of the policy. Our insurance company may decide what doctors we can go to and how much we pay for services if they don’t cover them. If you are on Medicaid, Medicare, or are a Veteran, a government may decide the details of what care you get. Very few of us have a direct contract between a doctor and ourselves. What happened to your liberty?
And the proposals being debated in Congress create an even worse situation, taking away the last remnants of our individual liberty by creating a single government health care bureaucracy to decide all details for us!
Why are some people fooled into thinking this is a good idea? Employers used to create company towns to dictate where we lived, and I doubt we want to go back to those dismal days. Slave owners made all decisions for their slaves, and that’s universally thought to be a bad system now. History has endless examples of why the government is a bad way to run things when a king ran it, so we have no kings anymore. We can see by simply watching the news that government still runs things poorly by looking at our roads, schools, Veterans’ hospitals, parks, prisons, etc. We all have at least one area where we are certain that somebody could run it better than government. So, why do we want the have the government, employers, insurance companies, or anyone else in charge of our health care decisions? The simple fact is that no one can make decisions for us as well as we can do it ourselves!
So, why isn’t the health care debate focused on restoring your lost liberty? Why are nearly all parties proposing ways to steal even more of your self-determination? Why do you put up with this lopsided debate instead of insisting on your freedom? Congress is running exactly opposite of the direction they should be on health care. They are trying to create a system with less individual liberty, instead of more. The change we need is to REMOVE government, employers, insurance companies, and anyone else from the system, so that individuals contract directly with doctors, hospitals, and other care providers.
Wouldn’t this be better? Suppose you wake up and one eye is swollen shut and you decide you should have a doctor look at it today. So, you call for an appointment with a doctor of your choice, taking into consideration your opinions of competence, ease of visiting, cost, etc. You can look up plenty of information on these factors in the doctors’ ads and perhaps a rating system. Because you are choosing the doctor, if she doesn’t have the appointment time you want, you can try another doctor to get what you want. As you leave the office, you pay for the visit with your choice of cash, credit, insurance billing, or check based on your opinions of total cost, ease of payment, etc. and you’re all done. If you have an insurance company billed, it is a company of your choice, taking into consideration your opinions on cost, services covered, history of adequate services, ease of billing, etc. You have successfully bought your medical exam, with very complete freedom of choice. There’s our individual liberty!
What would it take to create such a system from where we are today?
First, we need to get employers out of buying our health insurance. There is no economic, health care, or insurance actuarial reason to group people together by their place of employment, as these people have nothing else in common with each other. The major reason this system exists is that it is given tax breaks by the government. If the tax breaks for businesses were gone, it would make no sense for the business to provide your health insurance: after all, your employer doesn’t provide your car, groceries, cable tv, child care, or movie tickets. If you buy your own health care insurance, it would act much like your car insurance and likely would be less expensive for many people.
Maybe you think you’re getting “free” health coverage from your employer. You really know better than that: nothing is free because someone has to pay for it. It may not be you at this very moment, but you can be assured that you pay for everything somewhere down the road. Let’s start with the health insurance your employer chooses for you. He pays for it. If he didn’t buy your health insurance, where would that money go? Well, it could go a lot of other places, and nearly all of them would be good for you. He could pay you more directly in your wages. He could invest more money in the business, thus making it more likely that you will keep your job. He could lower his prices and still make as much money, meaning people, including you, could afford to buy more of what he and you make, also making it more likely that you will keep your job. He could put the money in his own pocket and spend it himself, which may create more jobs in some other businesses. He could donate it to some charity, accomplishing some community good.
Actually, there is no downside for you when your employer does not buy your health insurance. You get your freedom back and the money still does worthwhile things. But, maybe you’re afraid that you won’t be able to afford your health care costs unless someone else pays for them. That may be true for the small fraction of people who really do not make enough money to buy food, shelter, clothing, transportation, and health care. We’ll get back to them later in the discussion, but for now just note that charities and welfare attempt to cover all those other survival costs and health care need not be any different. For everyone else, you may just have to make new priorities about where you spend your money, including your health insurance.
There are many ways to offer insurance and there would constantly be new choices offered as companies jockeyed for position to get your dollars, just like they do for car insurance, life insurance, house insurance, etc. With millions of customers, insurance companies would need to develop special rates and special plans to attract customers. You could likely get discounts for bundling your health insurance with other insurances, just as you can now for car and home insurance. Some might offer medical savings accounts that you could build up to pay your own health care costs, instead of buying any insurance. Some might even pay you back dividends if you cost them less to insure than they anticipated. Some companies might lower rates for people in more healthy groups, just like non-smokers get better rates on life insurance and accident-free drivers get better rates. Many people might purchase coverage only for things they cannot afford out of pocket, such as a surgery, but pay doctors cash for office visits. Another thing that should happen is that we would get insurance companies out of our doctor choices. While some companies might offer plans that limit you to a list of doctors, other companies would do business differently, allowing you to shop around for the doctor of your choice, either by price, experience, closeness to home, family history, or other factors you decide on. All kinds of plans would be possible, many of which we’ve never even seen before, and many of which would cost you less, both because you could buy just what you want and because of the intense competition. You would choose which company to buy insurance from, taking into consideration your opinions of their costs, financial stability, coverage for your personal needs, etc. And all this multitude of insurance choice would be available and priced so that the companies offering them can make a profit and therefore continue in business to provide coverage, just like food companies, lawn care, furniture or anything else you buy. There’s our individual liberty!
Lastly, we need to get the government out of all health care choices. Government now wants to “reform” its prior meddling in the health care decisions of its citizens, with more meddling. Meddling that has been going on since the decision reached during a time of government wage and price controls, to let employers buy health insurance for workers with untaxed dollars, while if workers buy the same insurance it must be done with taxed dollars. This is a clear meddling in the free market decisions between a person and his doctors and needs to be reformed by removing government from the system.
And, there is simply no need for the massive losses of individual liberty that will occur with the current proposals of even more government involvement. To provide for our every health care need, government would need to write detailed regulations on every health care procedure, review our personal records of health, finance, DNA, and lifestyle, pass judgement on how many doctors get educated and where they can practice, and likely more. Some of this is already written into the current bills and the rest would be needed in the future. Some provisions in bills Congress is considering make it illegal to pay for services out-of-pocket. Another provision states that businesses will be forced to either provide insurance to the government standard or pay an 8% tax, which would create a cost disadvantage to businesses that simply let employees go to the government plan, meaning that eventually all of us would go to the government plan. Some parts of the plan are even exempt from any court challenges! What happened to your liberty? None of this should be allowed: each person should be the only one having and using such information to choose health care for himself.
The system that maximizes individual liberty is instead very simple. You decide what insurance to buy, you decide what health care you need, you decide what doctors to go to, you decide when to go for care, you decide how to make payment. There’s our individual liberty! Your employer is completely out of the picture. Government is completely out of the picture. The insurance company is responsive directly to you as the customer because you pay the bills. The doctors and hospitals are responsive directly to you as the customer because you pay the bills. If you do not pay your bills, the insurance company cancels your coverage and the doctors and hospitals sue you for payment, in the same way any other company you don’t pay would do. There’s our individual liberty!
And, in case you think I’ve forgotten about those people who truly cannot afford food, shelter, clothing, transportation, and health care, let’s take a look at them. We attempt, through both charities and government, to help the truly poor with basic survival needs and health care need not be any different. If you cannot afford food, we have local charity food programs and government food stamps. For shelter, there are local charity shelters and government housing programs. There are also programs for clothing, education, and subsidized public transportation. Most of these provide temporary benefits, as people frequently come and go from the ranks of the poor. Our charitable and government health care efforts should be similar. They should be targeted to the truly needy and should be designed to meet temporary needs. The temporary nature of such programs will allow these people to regain their liberty, and make their own decisions in the future.
You may notice that I have not addresses the cost of government health care. That is because the idea is wrong and therefore if we simply stay with increasing liberty, the cost is not material. However, there are considerations of cost if some government health care plan is implemented. Any plan that truly intends to cover more people for more procedures will cost more, not less as is sometimes claimed. Conversely, any plan that will truly cost less will cover fewer procedures for fewer people. It is an economic impossibility to provide more care at less cost. Costs may be hidden by general taxation, government borrowing, “creative” bookkeeping or other means, but higher costs will exist if more care is provided for more people. Or, if costs are truly cut by paying doctors less per procedure, eliminating insurance companies or other means, then there will be less service provided and we will all receive poorer care and have sacrificed our liberty for no gain.
So please vote NO on any of the current health care bills, because they do not preserve or improve individual liberty. Instead, write and vote for a plan that allows individuals full choice of their own health care decisions.
