Tuesday, August 19, 2014

Retreat from Social Welfare Utopia

To arrest a downward movement is the utmost to which a Utopia can aspire, since Utopias seldom begin to be written in any society until after its members have lost their expectation and ambition of making further progress and have been cowed by adversity into being content if they can succeed in holding the ground which has been won for them by their fathers.

Arnold J. Toynbee( 1889-1975 ), A Study in History

Yesterday I joined a meeting of twelve senior citizens. The group was discussing how to best use Internet technologies to their advantage.

they learned I was a doctor, the meeting quickly deteriorated into an exchange concerning government’s role in health care. The seniors unanimously distrusted government – its motives and its methods. The language was sometimes profane and was flavored with dark conspiracy theories, such as the government will withdraw all cancer treatment for those over 75. I tried to correct their misconceptions but to no avail.

It was clear to me that ObamaCare had lost its momentum among these small group of seniors. And so, I maintain, have social welfare reforms across the globe. It was always Utopian to believe governments could provide universal health care to all citizens without adversely affecting private economies, or antagonizing demographic subgroups receiving government assistance, and such has proven to be so. Governmentcan giveth, but it cannot taketh away.

Everywhere social welfare states are struggling to goose their economies and salvage their nationalized health systems without giving away the goose that laid the golden social welfare egg.

Everywhere these states are turning to the private sector for help. In Britain, NHS-funded hip and knee replacements by private doctors have increased by 19%. The Swedish government is aggressively introducing private market forces to improve access, quality, and choices. In the U.S, the government has agreed to spend $17 billion, mostly for private referrals, to shorten VA waiting lists to prevent veterans from dying on the VA waiting list vine.

The reality is, as Scott W. Atlas, MD, physician and senior fellow at Stanford University’s Hoover Institute, says,

“The key goals for health reform -reducing spending, preserving personal choice and portability of coverage, promoting competition in insurance markets, and maintaining excellence in medicine – do not require government to directly provide insurance or health care.” (Scott W. Atlas, “Where ObamaCare Is Headed, WSJ, August 14, 2014).

How to preserve these goals without government? It has become obvious bloated governments cannot, at the same time, resuscitate the economy, generate jobs, micromanage health care, and change health care behavior and health care choices of individual citizens through individual and employer mandates.

One answer is to let consumers, using their money, through health savings accounts, to take responsibility for their own health and to choose their own doctors and health plans after being fully informed through transparent pricing, transparent information about quality, and transparent competition among care providers.

In other words, give consumers sufficient information, trust consumers to choose the best providers and to make the right choices for their health. Let the marketplace and consumers decide. Meanwhile, the U.S. government is struggling to hold its ground on the safety net gains it has won for Medicare and Medicaid patients without alienating 85% of the population who must pay for those gains by giving away some of their benefits to others. Only economic prosperity can lift all boats, and economic prosperity is something governmeent is not good at.

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