Margaret Thatcher famously said that the only problem with socialism is you eventually run out of “other people’s money.”
The misnamed Affordable Care Act produced an even juicier quote — “I was all for Obamacare until I found out I was going to have to pay for it.”
Now that UnitedHealthcare, the biggest health insurer in the nation, has essentially dropped out of the individual market, another truism comes to mind: “If you buy high and sell low, you can’t make it up on volume.”
Whoever wins the election, Obamacare as we know it will end up in the dustbin of history. If the Democrats are in power, they will come up with a clever rhyme like, “Mend it, don’t end it.” If Republicans are in power, they will resort to alliteration, calling for the law to be “repealed and replaced.”
Either way, it is over. The only question is what will replace it.
Unfortunately, “single payer” is only a tired euphemism for one of two types of government programs, both of which have utterly failed.
One very popular form of “single payer” is Medicare. You get all the health care you want, from the doctor you choose — and the Chinese pay for it by buying our government debt. How long do you think that can go on with a national debt of $20 trillion? Even the left-wing Urban Institute acknowledges our taxes and premiums pay only a third or less of that program’s costs.
If you “feel the Bern” and want income redistribution, we already have it in Medicare. To pay the real costs, Medicare taxes would need to triple from 3 percent of wages to 9 percent. For a couple jointly making $100,000, that would be a tax increase of $6,000 per year — every single year of their working lives. The “rich,” by the way, do pay the real costs, and more, ever since the Medicare tax cap was eliminated. If you think taxing them more is going to pay for out-of-control Medicare, you’d better get in line. The Democrats have already spent that money, in their minds, on free college, free cell phones, free food stamps, and “disability” payments.
The other form of “single payer” is the Veteran’s Administration. There, you also pay nothing — aside from the years of military service you gave to your country — but you often get next to nothing in return. In that program, single payer really means single provider. And unlike with Lucy in the “Peanuts” comic strip, the doctor too often isn’t in. As in the Soviet Union, there is no alternative. That’s the “single” in single payer.
What can be done? How did we bring down energy and airline prices, improve the postal service, get local taxi monopolies to reduce prices, and improve quality? Competition by providers. And the corollary — making consumers take personal responsibility for their health and health care expenses.
Specifically, here is what’s needed:
1.) Publish the real price of every doctor’s visit and hospital procedure — and make everyone pay at least something, say 10 or 20 percent. If you want to be compassionate, make that only 5 percent or 1 percent for those with very low incomes. But everyone needs to have the ability, and incentive, to consider whether a procedure or visit is really necessary, and whether they are getting it at the best price.
2.) Stop subsidizing drug prices for other countries. The American pharmaceutical industry and Congress are too corrupt to make “negotiation” work. We need the deep surgical cut of a simple rule: No one can charge Americans more for drugs than the lowest price charged in any developed country.
It’s time to try what’s worked in every other area of our economy: competition and personal responsibility.
3.) Cover pre-existing conditions, with a catch. A toothless “mandate” to carry insurance will never work to stop “free-riders.” What we need is another simple rule. If you want to sign up for health insurance without regard to pre-existing conditions, do it now — in a nationwide “open season” for 2017 and 2018 — or within 90 days of changing your job if that causes you to lose your group insurance.
After 2018, if you miss the window, you pay the full price to the insurance company — again, unless you’ve just lost your existing insurance and sign up within 90 days. This is essentially what we already do with Medicare. If a healthy 65-year-old tries to play the “health lottery” by not signing up for Medicare, his or her premiums are jacked up by 10 percent for every year they fail to pay.
We’ve tried toothless mandates and “hope and change.” It’s time to try what’s worked in every other area of our economy: competition and personal responsibility.
It’s time to prove that Winston Churchill was right when he reportedly said, “You can always rely on America to do the right thing — once it has exhausted the alternatives!”
Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC.