Health Care Payment Reform

From 25 years ago: My Proposal for Health Care Payment reform.

Still, I think, more rational than anything else I’ve heard. Agree with me or convince me I’m wrong — either is a good outcome if it means we end up with something that actually works without destroying either health care or our culture of liberty or both.

The original cover letter to the Concord Coalition and to various Senators and Congressmen

The original cover letter to then-Governor Howard Dean, of Vermont

The proposal

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Politicians “making decisions about your birth control”

As a consumer of resources, I love the idea of someone else paying to support my lifestyle choices. But, as a producer of resources — and as a liberty-minded citizen of the American republic — I abhor the notion that the government should oblige me to provide for the lifestyle choices of others.

Perhaps the availability of contraception transcends mere “lifestyle choice” and comprises a public good worthy of government compulsion. Perhaps it doesn’t. That is worth a debate and I won’t pass judgement on it here.

But I must insist that those debating the issue do so honestly. No one is threatening to take away your birth control. All they are asking is that they not be forced to pay for it.

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Breaking News: People want to get things and make other people pay for them!

Suppose you want me to pay for your health care — or for your mortgage, or for your car, or for your iPod, or for anything else you feel you really need but can’t afford — and I don’t want to do so. If you point a gun at me and tell me to give you the money, it would be armed robbery. Everyone knows you don’t take what isn’t yours by force just because you want it. That would be wrong.

So, instead, you convince your Congressman to take the money from me, as a “tax”, and to give it to you. Why does that suddenly make it right?

What if I still don’t want to pay? What if I refuse — what do you think is going to happen? Federal agents will point guns at me and tell me to give them the money. Is taking my money by force suddenly righteous, rather than outrageous, because you outsourced the job? Is that what democracy is supposed to be about — lending moral authority to what would otherwise be morally reprehensible?

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“Perpetrating the Autism Myth”

Perhaps later in the season they can do a follow-on episode of “Eli Stone” in which the crusading hero sues another vaccine maker, this time to force them to continue making the life-saving vaccines his clients desperately need after the threat of massive awards in bogus liability lawsuits has forced them out of the vaccine business.

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Health Care and Profit

The self-righteousness of those who proclaim that profit is the beast eating the health-care industry and that all would be wonderful if we could just remove profit from the system is both annoying and tedious.

It’s bad enough that they ignore the fact that the potential for profit is what entices investment and is the fundamental reason that our health-care R&D pipeline is so vibrant.

But it’s truly infuriating when such fulminations come from those working within the system. So far I haven’t heard of any who connect profit with their own take-home pay or who have taken a vow of poverty to make health care more affordable.

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How (Not) To Spend a Budget Surplus

Jack Connors, Jr. argues (12 Jun) that the current revenue surplus in Massachusetts should be spent on increased Medicare reimbursements rather than being returned to the taxpayers from which it derived…

…even if you grant that shoring up shaky government budgets is the better use for the excess funds, using them to increase reimbursements for Medicare — or to fund benefit increases for any other entitlement program — is the worst possible use for the money.

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Health Care? Ask Cuba

Every once in a while a study is released comparing health care in the United States to health care in other countries. Despite the fact that we are the wealthiest nation in the world, and that we have one of the most technologically advanced health care systems in the world, there are inevitably some measures by which we lag other developed nations. We have come to expect that: no one denies that our health care system has problems with cost and access; and no one denies that there are certain groups within our society — bounded by poverty and self-destructive lifestyles — for whom our health care system is woefully inadequate. Those are problems we need to address — and solutions upon which so far we cannot agree.

But when by some measure our health care system trails the undeveloped world that attracts attention.

A recent report ranked the United States behind Cuba in infant mortality. Nicholas Kristof of The New York Times used that fact as a springboard for a broad and derisive critique of our market-based system. I agree with much of his diagnosis (and disagree with much of his prescription) but oddities in the way infant mortality is calculated in various countries makes it a dubious and slippery statistic upon which to hang a robust assessment of our current performance.

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