January 21, 2004

State of the Union: Medical Bureaucracy

There are certain very unhappy, very complex realities in our medical system. As government involvement increases there is a decrease in efficiency. Somewhere in the middle between a free market in health care and a completely socialized system there is a low point. The US is at that low point in efficiency.

The shape of the curve is under dispute. Statists assert that the shape is something of a J, with small efficiency gains by going to a free market system and large costs while going whole hog to a government system will provide great advantages at a small price. Free market advocates believe the exact opposite. Moderates just want to get off the bottom part of the curve in any direction because they know that what we have is the absolute worst of all worlds.

The President has made it clear that he wants to push the system in a free market direction and made his only veto threat in that regard.

I signed this measure proudly, and any attempt to limit the choices of our seniors, or to take away their prescription drug coverage under Medicare, will meet my veto.

On the critical issue of health care, our goal is to ensure that Americans can choose and afford private health care coverage that best fits their individual needs. To make insurance more affordable, Congress must act to address rapidly rising health care costs. Small businesses should be able to band together and negotiate for lower insurance rates, so they can cover more workers with health insurance - I urge you to pass Association Health Plans. I ask you to give lower-income Americans a refundable tax credit that would allow millions to buy their own basic health insurance. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care. To protect the doctor-patient relationship, and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits. And tonight I propose that individuals who buy catastrophic health care coverage, as part of our new health savings accounts, be allowed to deduct 100 percent of the premiums from their taxes.

A government-run health care system is the wrong prescription. By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America's health care the best in the world.

The key part of the veto threat is not in limiting benefits (no alternative will do anything but increase them) but in taking away choices for seniors. Choice is the hallmark of the free market and now that seniors have more than one choice, the statists are fighting the clock until these choices are rolled out into actual plans that seniors like. Once that happens the game is over and we're off the low part of the efficiency curve. After 2007 the game is lost for statists in health care and President Bush has drawn a line in the sand on this issue.

Association Health Plans are an incremental way to back out of the long distortive consequences of WW II era wage freezes. Prior to WW II, health care via employer was rare. It was inconvenient and tended to tie you to a job. With wage freezes imposed by government to limit exploding labor costs due to too few available workers (most everybody being in the armed forces) benefits like health care exploded on the scene as uncontrolled proxy compensation. These benefits stuck around long after the wage controls disappeared and they have long outlived their usefulness. Association Health Plans would take healthcare out of the hands of business and put them in much more stable associations. You could get healthcare via Rotarians, the Lions, the Catholic Church, the B'nai B'rith, the Hari Krishna, an organization that you're not likely to leave which will empower you to leave your job based on wage considerations. For a pro-big business president, he sure has empowered workers over abusive employeres.

The confusing paperwork antiquated IT systems of medical care are another example that sucks up enormous amounts of money and time. Streamlining it into a standardized, extensible system that private and public insurers can easily plug into would both improve healthcare quality and very much reduce cost.

I wasn't aware that premiums to catastrophic plans under HSA's weren't already deductible but they should be, just as they would be if they were done under and employer plan. It's another instance of empowering workers over employers.

Finally, frivolous medical malpractice claims. I lost a week of my life serving on a jury that dealt with a frivolous medical malpractice suit. Don't tell me these things don't exist. All things being equal, an ENT should not be hauled before a jury because of a lung tumor that's what his internist is for. And when the sole negligent act is supposedly not making a phone call to notify the patient but somehow the patient shows up for lung cancer treatment that very week, things are truly idiotic.

For those who suffer real malpractice, their right to sue should be preserved. The right to work out your grief by lashing out at doctors and costing society a great deal of money in the process has got to go.

Posted by TMLutas at January 21, 2004 10:53 AM