As some Republicans promise to go back to the drawing board to draft a new replacement and repeal bill for ObamaCare and others threaten to let the Affordable Care Act crash and burn, there are some hard truths to keep in mind, suggests Michael D. Tanner, senior fellow at the Cato Institute.
- Health care is neither a right nor a privilege; it’s a commodity.
Worse, it’s a finite commodity. There are only so many doctors, so many hospitals, and so much money, and there are limits to how much these things can be expanded. That’s why no health-care system, outside Bernie Sanders’s fantasies, provides unlimited care to everyone….
- Coverage is not access.
Democrats like to pretend that giving everyone a piece of paper called insurance guarantees them access to the care they need. It’s sort of like magic. Say the right words, and poof, medical care appears. But in the real world it doesn’t work that way….
- The uninsurable are uninsurable.
Let us remember that the definition of “pre-existing condition” is: someone who is already sick. It’s a little like driving your car into a tree and then trying to retroactively buy auto insurance. It won’t work. Insurance is the business of spreading risk. But for someone who, say, has cancer, there’s no risk to spread, just cost. That’s not insurance, it’s paying for health care. … The only realistic approach to dealing with pre-existing conditions is to take those people out of the insurance pool altogether and somehow pay for their care directly. There are several options for doing so, from state insurance pools to a revamped Medicaid program.
- Medicare is not a success.
Faced with the wreckage of Obamacare, Democrats are increasingly embracing the once controversial idea of “Medicare for all.” Most of them would start slowly, with a Trojan-horse “public option,” a taxpayer-subsidized plan that would undercut private insurance, but the result would still be a government-run national health-care plan based on Medicare….
- No, we didn’t have a “free market” health-care system before Obamacare.
Suggest free-market reforms to our health-care system and critics will inevitably suggest that you want to go back to the flawed system we had before Obamacare. But that system had little to do with a free market. Nearly all health care was subsidized in some way, either directly or indirectly. Actual health-care consumers paid barely 13 cents out of each dollar spent on health care, while the government directly paid for more than half of all health-care spending. This third-party and even fourth-party payment mechanism insulated consumers from the cost of their health-care choices and drove up both spending and prices….
- You are never going to make everyone happy.
Obamacare is unpopular. The GOP replacement was unpopular. Single-payer (is) unpopular. In fact, one searches in vain for a health-care reform that voters will love….
(Americans) want the highest-quality care for everyone, with no wait, from the doctor of their choice. And they want it as cheap as possible, preferably for free. At the same time doctors, trial lawyers, hospitals, insurers, pharmaceutical companies, and government bureaucrats are all trying to protect their fiefdoms, hold onto their gains, and shift costs to others. There is simply no way to satisfy all these special interests and produce a health-care plan that will be hugely popular.
There are true market-based reforms out there, advises Mr. Tanner. But first, Republicans need to repeal ObamaCare “down to the last comma.”
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