Real Healthcare Reform

When President Trump was elected, one of his promises was to repeal ObamaCare. A promise I fully believe needs to happen. But I also realize that whatever replaces it is going to be something that will not address the real issue. That is what we pay for care. Whatever Washington puts forth will simply not lower prices. Why? because they are not looking at the root problem. Instead congress and the president are focusing on insurance premiums.

Here is why it will not work.

Healthcare does not participate in the free market where prices are set by consumers.

What many people do not understand is that prices for goods and services are set by the consumer. Not by production or labor costs. In regards to health care, as customers, we’ve separated ourselves by using a third-party payer to pay our bills for us. We have no idea or even care what the price for a doctors visit really is. Or for an MRI, or an other medical service except. The only concern is copays and deductibles. This leaves healthcare providers free to charge whatever they want. They have no incentive to keep costs down and don’t have to compete for your business on an individual basis.

In steps insurance. The purpose of insurance is to purchase protection from something bad happening to you. Premiums are based on how likely you are to use your insurance and the potential cost to honor your coverage. For example auto insurance. Your premium is based on the model of your car, and how good a driver you are. Auto insurance companies know what the odds are of you getting into an accident. Chances are you may never use your car insurance. Personally I’ve used my car insurance five times in the last 30 years. So the car insurance industry has done well by me. None of my accidents have ever amounted to more than a year or two’s worth of premiums. And two of those accidents were not my fault. Consequently my premiums are pretty low compared to what others have told me.

Health care insurance as we use it today, is totally different. It’s not based on risk. We now expect to have insurance pay for our routine care. The insurance company have to deal with thousands of doctors and hospitals. To negotiate prices on our behalf would take an army of staff. So they too have no real incentive to control prices, only their expenses.

One solution being touted by liberals is to eliminate the insurance company and have government act as a single payer. The feeling is that government can set prices and therefore lower costs. That simply does not work. Price controls have failed in every attempt. It either causes shortages or lowers quality.

So what does work?

Well, time after time, free markets have proven that prices go down and quality improves when left alone. The customer becomes the regulator. Look around you. There are thousands of examples. Recently there has been a resurgence of free market thinking among doctors. Many are beginning to shed their reliance on insurance as the payer, and are opting for direct payment by the patients. Known as Direct Primary Care, they are able to offer care at dramatically lower prices. Doctors no longer have to hire people to handle complicated billing systems that use thousands of medical codes. They no longer spend hours with burdensome regulations to determine if their patient is covered for the type of care they need. Instead they get to spend more time with their patients.

That’s not to say insurance still doesn’t have a role in our health care. It provides a valuable product when it comes to catastrophic illnesses like cancer or heart surgery. Premiums will be more realistically set based on risk, for example family history or lifestyle.

Where do we start?

In my mind a good place to start is stop using insurance for our primary payer. Encourage family practitioners to adopt Direct Primary Care. Lets also eliminate mandates that insurance needs to cover X, Y & Z in our plans. And let them tailor plans based on individual wants. People need to take responsibility of their health and become good consumers by shopping around for care. I think that would go a long way to solving our health care crisis.

Posted in Health-care | Leave a comment

How To Be An Effective Voter

Each election cycle we are presented with the same dilemma; who should I vote for? We compare each candidates stance on issues with our own and we make the decision as to whether we will vote for candidate A or B.

But lets take a moment and examine this. We know that a politician can only be elected if they sway enough voters their way. I live in Maine. Maine has three political parties. Republicans, Democrats and Greens. None of these parties have a clear majority.

Getting Elected

When running for office a politician’s first task is to secure his/her party base. Then he/she starts to concentrate on swing voters. Swing voters (independents) may or may not agree on all issues in regards to party stance. Therefor it is necessary for a politician to shift his/her principles enough to attract independents or voters from the opposite party. In a three-way race a politician needs 35 % or more of the vote. In a two-way race 51%. Republicans and Democrats in Maine  each have roughly a 30% voter enrollment. Democrats have a slight advantage.

How About a Third Party?

If you are leaning towards starting a third-party, then good luck. First the two parties have the rules locked down to make it very difficult to start a third-party and then keep party status. Not to mention you are once again stuck in the same paradigm of trying to attract swing votes.

Stop Being Taken for Granted.

Lets simply eliminate the party system. Take away the party’s ability to control the agenda and the ballot, and you open the electorate to a host of new ideas, possibilities and choices. And guess what, because party enrollment is so small, it’s really not that hard to have either party lose its party status. Both sides are seeing a decline in enrollment.

Stop being taken for granted. Enroll as an independent, encourage our friends to drop out and force politicians to earn our vote. There is a reason why un-enrolled voters are called independents. Think about it.

Posted in Politics | Leave a comment

Net Neutrality = Government Censorship In Disguise

Net Neutrality is a bad idea. In essence the government is asking to manage bandwidth through regulations.

First, understand bandwidth is a finite resource. Every time you connect a computer to the internet, you are competing for bandwidth with every other computer that is connected. For example you may be playing an on-line game, your neighbor may be streaming a Netflix movie. Times that by millions. Thats where routers come in. They are the traffic cop of the internet. But the government can’t manage millions of routers.

The only way they ( the government) can manage bandwidth is to regulate content. In other words, they choose who’s content is prioritized or allowed. The government claims that ISPs will give preferential treatment to some internet services over others and that they can do that better. How will they decide? Should they give it to Netflix, or Hulu, or or maybe to YouTube?

Bandwidth management is complex. Its much like supply and demand.
The question to ask is how will the government decide who gets what bandwidth?
The fact of the matter is, government is afraid of the internet. Its afraid it can’t control the flow of ideas….control speech. The government can’t wait to get their hands on it. This is their excuse to do so. Do you really want that? I don’t.

Posted in Uncategorized | Leave a comment

Charity, Mutual Aid and Government Welfare

Are we loosing a part of our humanity? There was a time when government did not provide a safety net for people. Instead, we relied on ourselves, our neighbors, and our community. We did so by banding together and forming associations, clubs, guilds or fraternities. We’ve all seen the Mason Halls, the Elk’s Clubs. At one time these organizations provided insurance against unexpected events like sickness, death and even old age. Members pledged to help one another knowing they could expect the same when they too fell on tough times.

Laborers in the same occupations formed self-governing guilds or fraternities. Individuals who joined paid membership dues, building a trust used to help each other in times of trouble. Members received benefits like sick pay, medical care, burial expenses, and survivor’s benefits. Some fraternities grew into national associations with hundreds of thousands of members. By 1920, nearly 30 percent of all adults belonged to fraternal societies.

Immigrants also formed associations, such as the National Slovak Society. and the Hebrew Immigrants Aid Society. African-Americans organized fraternal orders similar to the Elks. In 1918 its estimated that more than 275,000 blacks belonged to over 4000 associations in Chicago alone.

An interesting aspect of these associations is how they dealt with the problem of people trying to take advantage of the system. Today it’s not unusual to hear about massive fraud and abuse of welfare programs. To add insult to injury, the government is not held accountable ,but merely give us lip service by promising to stop the problem. Funny how it never does stop.

Fraternal associations on the other hand often emphasized a code of ethics, enforcing a moral discipline affecting personal behavior. Fellowship and solidarity discouraged members from claiming benefits without good cause. They adopted rules to insure adherence to them. For example a member could be denied benefits because of malingering, poor choices or immoral conduct. Organizations could require members to provide a doctor’s note in order to claim sickness benefits. Other organizations contracted with a “lodge doctor,” to provide medical care to all its members for a fixed price.

Charitable institutions also play an important role in civil society. Critics often state “If you abolish welfare children and the elderly will starve or die.” Nothing could be further from the truth. People have a natural desire to help the less fortunate. We form groups ranging from local soup kitchens and church charity bazaars to national organizations like the United Way, the Salvation Army and Doctors without Borders. Americans gave over 300 million dollars to charity to help out Hurricane Katrina victims. We are a caring people. We don’t want to see people go hungry or live in poverty.

In addition to more formal associations people hold social gatherings for drinking, eating and dancing. These socials were once used for advice or to help newlyweds start a new life. We still hold them today for families who need extra financial help with someone who is ill or perhaps lost their home due to fire. Known as Keh; Korean Americans get together once a month for dinner, socializing, advice, and the contribution of money to a common pot to be given each month to one participant.

Government safety nets harm all of society in many ways. Government programs have an incentive to keep people impoverished. When we let government take over we are trapping people in poverty and making it difficult for them to become independent, self-sufficient and prosper. We take their pride, their self-respect and dignity away. The welfare system encourages poor life choices such as unwed motherhood or drug addiction.

Society is harmed by welfare in other ways too. We begin to think if government is supposed to feed the poor, then charities are no longer needed. Welfare discourages charitable giving and life becomes less fulfilling and more self-centered. In the end civil society is replaced by the heartless nanny state.

If we truly want to end hunger and poverty, we need to see the solution is not government subsidies and welfare, but rather increasing and spreading wealth. A free market economy eases and even eliminates poverty. Capitalism is responsible for lifting more people out of poverty than any other system in the history of the world.

Posted in Economy, Humanism, Libertarianism | Tagged , , , , , , , , , , , , | Leave a comment

The Medicaid Fallacy

As are many states, the Maine legislature is fighting tooth and nail to expand Medicaid under the hope that if more people have health-care coverage, the more healthy the population will be. In reality it is the opposite. You may ask how can that be. The short answer is Medicaid drives up costs and produces poorer medical treatment outcomes. That sounds backwards doesn’t it. Lets take a closer look to see why.

Medicaid is a publicly funded health insurance program run by the state and subsidized by the federal government. The Federal government matches Maine’s spending at 61.8% That means for every dollar Medicaid spends 61.8 cents comes from Washington. There is no cap on this subsidy so the more Maine spends, the more Washington pitches in.

Because of the matching fund formula states like Maine are reluctant to adopt cost-reducing policies. This creates a bias in favor of maintaining or expanding the program. Additionally, any savings a state realizes must be shared equally with the federal government, further reducing incentives to cut costs.

Medicaid payments for care vary from 58% to 75% of what private insurance pays for the same care. In addition excessive and complex paperwork result in late payments or denial or payment. As a result Doctors are reluctant to accept Medicaid clients. Or the reduced reimbursement fee is passed on to patients with private insurance. The end result is an over all reduction the availability of health care for Medicaid recipients.

Medicaid contributes to poorer treatment outcome. Limited access to doctors and treatment are likely to cause patients to put off seeing doctors and are more likely to use emergency care. Medicaid recipients are three times more likely to use emergency room than patients with private insurance. As a result patients on Medicaid have a greater frequency of a late diagnosis. As a result patients on average stay an extra three days in hospital visits over patients with private insurance. The mortality rate among Medicaid patients is twice that of a patient with private insurance.

Last but not least Medicaid has shown no overall positive effect on health for the general population. Data from the Oregon Study ( a two-year randomized controlled study) suggests that Medicaid has no real impact o the over all health of Oregon’s population. The two-year study revealed that there was no change in hypertension or high cholesterol. In fact the risk of diabetes increased. The only positive outcome was a reduction in depression.

Instead of expanding Medicaid it should be at a minimum be reformed. For example, replacing the matching grant formula with fixed payment will give states freer reign to adopt reform without seeking permission and give states stronger financial incentives and greater ability to manage their programs. By using block grants you can create a fixed grant, that is indexed to inflation. Block grants do not increase as program spending increases. This gives states a stronger incentive to control costs without penalizing them.

In conclusion Medicaid is the largest public health program for low-income individuals and families. Expanding Medicaid recipients will add significantly to the cost of health care and will result in lower patient outcomes for the poor enrolled in Medicaid and no significant change in the overall health. Clearly private insurance is a better alternative. it should be the goal of the federal and state government to exit the insurance market all together and let free markets and consumers control costs.

Sources: “Oregon Experiment – Effects of Medicaid on Clinical Outcomes” New England Journal of Medicine and “The Economics of Medicaid” Mercatus Center

Posted in Economy, Health-care, Politics | Tagged , , , , , , , , , , , , , , , , | Leave a comment

Freedom of Association

The article referenced below is a great example of one class of individuals having rights or privileges over another. A photographer is being forced to shoot a lesbian wedding. Somehow I don’t think that is how it is supposed to work. But then I guess freedom of association was thrown out long ago with the advent of civil rights.

Don’t get me wrong, I have nothing against people living their private lives as they wish. I don’t care about your sexual preferences, race or religion. It’s really none of my business. But it’s supposed to work both ways.  In this particular example if someone refuses to do business with you for whatever reason that may be , it is their right.  It is also an opportunity for another entrepreneur to step in to meet that need. I’m certain there are plenty f capable photographers eager to take photos of this couple’s wedding.

Personally, I recall wanting to rent a house many years back. I had just met my wife. We looked at several houses in our price range and settled on one that met our liking. Just before signing the lease, the owner told me he and his wife did not want to rent to me because they felt it was immoral to have an unmarried couple living on their property. I was surprised and annoyed. Especially since I had given my landlord notice and had to be out in a couple of weeks. Needless to say I scrambled to find another place. Could I have complained? Was it inconvenient? Yes to both questions. But then why would I want to associate with people that draconian? Why hand them my hard-earned money? Instead I respected their beliefs and their right to use their property as they see fit. So I looked for another house to rent. On that note, I cannot imagine how well the photo shoot would turn out. Would you want someone to photograph your wedding against their will?

The Constitutional Right to Conscript a Wedding Photographer

Posted in Humanism, Libertarianism, Politics | Tagged , , , , | Leave a comment

Can the Republicans Be Saved From Obsolescence?

What a very interesting article. It resonates with me to my core. It speaks of a GOP that is out of touch with Americans. A party that seems self centered and blind to today’s reality and doomed to be trivialized because of its greed, inability to connect to today’s American and a lack of vision.

Data shows many Americans, especially our youth, are very much in favor of limited government AND the freedom to live our lives without interference of government. Or as Jefferson so eloquently put it “… the pursuit of Happiness.” The problem is the GOP is perceived as old and close-minded.

Many people voted for Obama even though his views are contrary to their beliefs. You have to ask why that is. The author provides us with plenty of proof the issue is an out of touch and out of date GOP.

Until the GOP changes this perception it will be marginalized and irrelevant. That is until there is a generational change in leadership. Something that will not take place for at least another ten to twenty years. Until then the our country will move further from the ideals we hold dear; liberty and prosperity for all by a very cleaver and organized left wing. Wake up GOP!

Can the Republicans Be Saved From Obsolescence?

Posted in Humanism, Libertarianism, Politics, Technology | Leave a comment