2013-08-02

Replace It With What?

Sharon Schultz-Elsing opines that the desire to repeal the ACA (aka ObamaCare) is nothing more than partisan obstructionism. Of course, imposing the ACA in the first place was also partisan obstructionism, so I took her to task a bit. Blaming one party for opposing a monstrosity while not simultaneously blaming the other party for originally creating the monstrosity is kind of pointless.

I think Ms. Schultz-Elsing was reaching for a coup de grace by asking me what I would replace ObamaCare with if it were repealed. This question is also a little silly because it assumes that some sort of legislation is required. As I have previously pointed out, the pre-ObamaCare health care industry was actually starting to heal itself by de-coupling from the health insurance industry. So what ObamaCare actually did was lay waste to the very medicine that would have fixed the system.

Oh, well. Let's humor Ms. Schultz-Elsing anyway. Here is what I told her on Google+:
People do not want health insurance. What they want is health care. Insurance is simply a means to an end. How do you decrease health care costs? 
(1) By increasing the number of physicians in the United States. The quickest and easiest way to do this is by eliminating immigration restrictions and importing doctors from India, China, Africa, and Latin America. A secondary means of doing this is by eliminating barriers to becoming a doctor, and YES that does mean we will have to deregulate the industry a bit. 
(2) By decoupling health care practice from health care insurance . The easiest way to do this is simply by shopping around. 
A more relevant way of doing this is by eliminating Medicare. Why would that work? Because Medicare has monopsony power, meaning they are such a large purchaser of health care services that they have become market price setters. While it is a tempting knee-jerk to clutch at any government program and say the poor needs it, when you stop to consider the adverse impact Medicare has had on health care prices, you start to come to remarkably different conclusions. If necessary, we could replace Medicare with a simple transfer payment of cash to the poor. That would at least save us from distorting health care prices while still maintaining the social safety net that [many ACA supporters will not let go of]. 
(3) By eliminating or at least streamlining the FDA. I don't really need to explain this one, but I will anyway. This organization has extended pharmaceutical product lifecycles from maybe 10 years to at least double that, and longer in many cases. This translates into a pure cost increase to medicine manufacturers, who then pass this increase onto the consumers. It takes billions of dollars to produce a product 20 years in advance of its actual marketability - more than the entire GDP of many small countries. Think about that. What if, rather than heaping on additional regulatory hurdles, we cleared some out so that medicine makers could bring their products to market faster, without sustaining a multi-billion-dollar investment decades in advance of any actual profit generation?  
(4) By eliminating medical patents. Completely. Maybe you consider this a radical idea, so let's compromise by agreeing that we should at least shorten the lives of these patents - while simultaneously reducing the FDA-imposed regulatory burden - and allow US citizens to freely import medicine from other countries. 
Start there. That's the low-hanging fruit. None of this can happen, by the way, unless and until the ACA is repealed, nullified, or rendered impotent.
It is simply dishonest to pretend or imply that there aren't other ways of addressing rising health care costs on a national level. Many health care market cost drivers are government-imposed. Imposing more government on the health care market will certainly not result in an alleviation of self-imposed cost-drivers. There are real solutions to this problem if people will but acknowledge that there are more participants in the discussion than Barack Obama and John Boehner.

But, of course, I think Sharon Shulze-Elsing's real point was that Republicans are bad. So why let a pesky thing like good health care market policy get in the way of a good partisan zinger?