Republican lawmakers face an increasingly hostile calendar and intense Democratic resistance as they struggle to find the majority needed to pass a partial repeal of Obamacare in the U.S. Senate. Reports Tuesday indicate that GOP senators, led by Budget Committee Chairman Mike Enzi (R-Wy.), will proceed with writing a new bill, separate from the American Health Care Act the House passed on May 4.
While Republicans senators struggle to stop the spiraling collapse of the Affordable Care Act at the federal level, state legislators in California are considering the creation of a state-wide, single-payer health care system — a longtime dream of liberal Democrats.
Amid the chaos and the uncertainty, here are some health care myths that need busting, if we are to control costs and ensure access to all Americans:
Myth 1). “Health Insurance” Is Insurance.
What we call “health insurance” isn’t really “insurance.” Imagine that a supermarket gave you all the food you needed for a year, in exchange for a single, lump-sum payment, but only if you purchased your food exclusively from them. You wouldn’t call that “food insurance” — since everyone knows you’re going to need to eat. It’s only “insurance” if the risks of having to use the contract or policy are significantly less than 100 percent. That’s why we have car “insurance” against the small risk of an accident, but you generally can’t buy “insurance” to cover the cost of putting gasoline in the tank or changing your oil.
Aside from terminology, imagine that this supermarket refused to tell you the prices of what you were putting in your basket, or trying to put in your basket, and insisted that the supermarket manager had a veto power to decide which of your selections he would let you take home, and which must be left in the store unless you are willing to pay an exorbitant extra charge at another, competing store, because you are not a “member” of that competing store. That sounds more like a college meal plan than an “insurance” policy— and God help you if the quality goes down in the middle of the semester. Whatever it is, it isn’t insurance.
Myth 2). We Have a Free Market in Health Care.
Not even close. First, the vast majority of us who get our health insurance from our employers have little or no say over the choice of our health insurance company. In fact, in most cases, the “insurer” is really the employer, who only hires an insurance company to process claims. Like the oppressed coal miners of the 18th and 19th centuries, most of us can only purchase health care services “at the company store.”
For those of us who purchase insurance in the individual markets under Obamacare, we are unfortunately seeing more and more companies pulling out of local and regional markets because government controls and price restrictions have made it almost impossible for them to generate a profit. Instead of increasing competition as promised, Obamacare has virtually eliminated competition in vast areas of the country. And for those insurance companies that remain, in many cases the only one in a given market, we have no say in what is covered, and even the amount paid for a particular service is hidden from view.
Finally, because our health insurance isn’t really insurance — but is a prepaid, bulk purchase of an unspecified amount of health care coverage from an exclusive provider — we cannot use a doctor or hospital that is “out of network,” even if he were willing to take the same fee our “insurer” would pay to an insider, a member of their network of service providers.
Myth 3). “Single Payer” is a Humane and Simple Answer, the Only Humane Answer.
First, “single payer” is horribly misnamed. It has nothing to do with who pays, it really is about who doesn’t pay, or who “decides” whether to pay or not. The idea behind single payer is not to eliminate the paperwork and inefficiency of dealing with multiple insurance companies. In fact, the typical insured person deals only with one company, it is only the physicians who have to deal with multiple insurance companies, just like auto body shops may have to deal with more than one insurance company.
The idea is to give one government agency the power to replace all of the existing insurance companies and give that government agency complete and unfettered discretion over who gets medical services.
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Think you’re going to sue them for violating their contract or treating you unfairly? Think again. Imagine suing the IRS for auditing you based on your political beliefs, or imagine suing the CIA or NSA for “bugging” your communications because you disagree with the government.
There is a humane and sensible alternative, and that is going back to a free market for health care services — bypassing both the government and the insurance companies. That doesn’t mean there could not also be insurance against unplanned or catastrophic health emergencies or negotiated packages of prepaid services, such as getting a discount for agreeing to a two-year phone contract, and it doesn’t mean that there can be no government subsidies or private charity to help those who cannot easily afford market-priced health care. But it does mean that “if you like your doctor, you can keep your doctor” — or change to someone else who provides better service or lower fees or both — without getting an act of Congress!
Myth 4). American Health Care Consumers Are Like Sheep.
There is no way Americans will demand health care that is worth what they are paying, in other words, since they don’t even know what they are paying. They are simply too “stupid” (as one of Obamacare’s designers said), too “poorly educated” (as the media tend to refer to Trump supporters and others who distrust establishment politicians), or too “deplorable” (you know who said that!) to take back control over this important aspect of their health and economic well-being, think those who benefit from the status quo.
We must explain to the American people, and their representatives, that, just like the notorious “free lunch,” there is no such thing as “free” health care. And we must explain to those who argue for a continued drift towards socialized medicine that you can have no “right” to health care — or any other goods or services produced with human resources — unless the government has the “right” to force someone else to provide those resources to you, as your unpaid (or very lowly paid) medical maidservant or surgical serf.
And ultimately, in a world like that, no one would choose to become a physician, nurse, or health care provider, and no one would develop new pharmaceuticals or devices. At least no one you would actually want to see if you got sick.
Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC and a senior health care adviser to LifeZette.