Monday, May 6, 2013
Homogenization Versus Individualism – The Issue That May Decide Obamacare’s Fate
They (the makers of the Constitution ) conferred , as against the Government, the right to be left alone – the most comprehensive of rights and the most valued by civilized men,
Louis Brandeis (1856-1949), Olmstead v the United States, 277, US, 438-478
When the history of Obamacare is written, and I plan to write it, its fate will depend on the public’s response to the issues of comprehensive standardized coverage for all versus individual choice of coverage.
Let’s look at the issue from the government’s and the individual point of view.
· The Government - The government seeks to establish a one-size-fits-all system that covers all citizens, that provides essential benefits to all, that is uniform and comprehensive, and that is enforced by mandates for the states, employers, individual taxpayers, young and old, all populations, all cultures, all regions, poor and rich, needed and needed, desired and undesired. The goals are admirable – to make costs affordable, to improve health, and to avoid catastrophic costs. The government plan is politically unpopular, because of daunting complexities , adverse consequences, uncontrollable costs, unexpected loopholes, failure to improve overall health difficulties in explaining the 2,700 pages bills, and the 15,000 regulations required to enforce it. But the government’s dream lives on, as explained in this sentence by Jonathon Chait in an article in the May 4. New York Magazine, “The United States has very high levels of income inequality, a very stingy welfare state, and is the only advanced economy that does not guarantee access to medical care” If only we could correct these deficiencies, presumably we could join other civilized nations with advanced welfare states.
· Individual Choice - In “The Disconnect of Health Secretary Kathleen Sibelious, “ Real Clar Politics, Scott Atlas, MD, of the Hoover Institute explains the flaw in the Government’s thinking, namely that Government knows better than citizens what insurance should buy for themselves and their families. The Government’s approach, claims, results in “bloated coverage” for services that individuals and their families do not want and rarely use but have to pay for. He also bemoans the fact that rules, regulations and mandate costs physicians $33 billion to comply with and results in 2271 mandates at federal and state levels for acupuncture, chiropractic, circumcision, in vitro fertilization services that others have to pay for. Instead of these services, Atlas recommends that the Obamacare administration should aggressively promote health savings accounts with high deductibles and catastrophic coverage, In these individually owned plans, consumers can pick services they need and want at much lower costs. These plans are surging in popularity among employers and workers and give their holders the opportunity not only to pick services they desire but the opportunity to accrue tax-protected savings. These plans would be included in Obamacare health exchanges.
Maybe the time has come to leave individual health consumers alone. Let them choose their own health policies. Let them pick what they think is best for their own health and the health of their families. Let them save money not spent. Let these accounts protect them again catastrophic expense. Let these plans among the choices on Government sponsored and subsidized health exchanges.
Tweet: When the fate of Obamacare is writ, it may come down to comprehensive Government mandates v. individual choices of health plans.
Posted by Richard L. Reece, MD at 11:59 AM
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