By Francis M. Miller
In declaring American independence, our founders sought to eliminate two perverse forms of tyranny that had ruled private lives for centuries. The monarchy and the church had become corrupt and were oppressive.
My great-great-grandfather immigrated from Poland. Peasants there were not even allowed to pick up dead tree limbs for firewood. As Walter McDougall, the historian, wrote in “Freedom Just Around the Corner,” these medieval systems were never reformed. They were replaced when the peasants dropped their hoes, walked out of the fields and boarded ships to America.
The 18th century mindset of our founding fathers did not envision predatory global corporations or the massive apparatus of government that rules our lives today. If we go back to 1776, the lands west of the Mississippi River were hunter-gatherer and the colonial economies were agrarian. Adam Smith was just writing his “Wealth of Nations” and the steam engine had just been invented. There was really no concept of a market economy. Health care was carried out by blood-letting and leeches. Our country had neither an income tax or a federal reserve. And, whether you disagree with all or part of what’s happened recently, we can all pretty much agree that if our founding fathers were alive today, they would share our anxiety about the future.
Take health care, where I work. It took 200 years for health care to become 4 percent of our economy. Since the 1970s, our so-called “competitive” health care system has hyper-inflated to where it is now 18 percent of GDP, twice that of the socialized democracies of Europe.
Sadly, it produces inferior results. Every new law passed speaks to affordability, but during implementation, it always seems that a cascade of unintended consequences conspires and results in higher insurance premiums. High health care costs have made it all but impossible to provide health care for our population without mandates and subsidies from either government or employers. A vicious cycle has been set up and we seemingly cannot escape.
The most recent law, the Affordable Care Act of 2010 promises to reshape the health care landscape on a scale not witnessed since Medicare’s passage in 1965. Everyone will be required to purchase insurance. Medicaid will be enlarged, and much of the regulation of insurance will be transferred to federal oversight. On the surface it all sounds good until you meet the devil in the details.
Consider the health exchanges that are being instituted at a cost of billions. The idea was to create an Internet-based bazaar where insurance could be compared and purchased. The application form that the exchanges recently published is 21 pages long. (It is 61 pages long if you get one with instructions.) This will require prospective applicants to go through a forced-march enrollment process.
My review has concluded that buying insurance through the exchange will be far more complicated than filing income taxes. Not only that, the process calls for constant monitoring of your income by the IRS to continue qualifying for subsidies and eligibility.
Once the form is filled out, it must be passed up the line for approval by three federal agencies. You can bet this will take another two to three weeks to be approved under the best of circumstances. You and I both know that if one ‘t’ is not crossed or an ‘i’ is not dotted, you will have to go through it all again.
In a world where we can buy a car using an iPhone, this process defies all common sense. Tell me again. Why can’t I just go buy insurance where I see fit and file for a credit on my tax forms. Why submit everyone to the “tyranny-of-the-process” about to be imposed by the exchange?
There is a serious question whether all of this is going to work. We all know what happened when Colorado implemented it’s $300 million dollar CBMS benefits management system: it has been in a state of failure for years. Now, the apparatchiks are going to layer the exchange on top of that house of cards.
The legislature has not yet talked about how to fund the exchange, but you can bet they will need to layer another 3 to 5 percent onto insurance premiums to fund it all.
I think I am a typical man on the street. I am a free-market capitalist when it comes to iPhones and a socialist when it comes to fire and police protection or water and sewer. There are private goods and public services and we need different ways to deliver and finance each of them.
The recent election validated that the public wants access to health care as an entitlement. Perhaps we should take a lesson from the Europeans. Margaret Thatcher steadfastly increased funding for the British Health Service, all the while privatizing vast tracts of their socialized economy. It is time for us to stop, rethink what we are about to do, and be prepared to pivot.
The problem in all of this, of course, is that there are huge insurance companies and hundreds of thousands of people employed to implement the federal government’s 20,000 pages of new rules. Like the church and the monarchy, these players will resist any changes not in their self-interest. Health care is bigger than education and national defense combined. This is not chump change. We, mere peasants, now that the middle class has been devastated, simply cannot drop our hoes and board a ship to America. Health care is our Alamo.
I am sanguine that the right thing will happen. I do, however, have faith in Herbert Stein’s famous dictum that stated, “If something cannot go on forever, it will stop,” In saying this he meant that if a trend cannot go on forever, there is no need for action or a program to make it stop, much less to make it stop immediately; it will somehow stop of its own accord.
Francis M. Miller is the past president of the Colorado Business Coalition for Health and the vice chairman of the Colorado Health Data Commission. He founded the first consumer cooperative for health care called the Alliance and is the current president of Health Smart Co-op.