ObamaCare may prove to be the salvation of free market health care. The curious history of U.S. healthcare has gradually created an entrenched system where everyone but the patient vies to dictate choice of medical service and control of the dollar, a system begging for a shakeup. ObamaCare has provided just that shock, and placed the future of U.S. healthcare very much up for grabs.
The megaflop of the Affordable Care Act (ACA) rollout has overshadowed the fact that years of pre-launch anticipation of the program's impact has caused adaptations in the healthcare marketplace that foster long overdue and previously little-explored free-market solutions.
There are four principal actors in the U.S. healthcare drama: patients, employers, providers, and insurers. While proponents of the ACA seek to distort the role of each actor to favor a government dictated system, the all-too-familiar law of unintended consequences has been busily fortifying the alternative of free-market reform.
Republicans, who have railed against, and often whined about, ObamaCare since its inception, may want to send holiday thank you cards to Democrats for jolting the healthcare system and leveling the playing field for a contest between the ACA and free-market healthcare. The launch of ObamaCare is at best wobbly, and at worst forecasts its demise. As with any fiasco, initial reaction has focused on berating what has gone wrong, but the opportunity lies in building the foundation of what can be made right.
The first thing Republicans need to do is take the largest lesson from the ACA playbook; then do the opposite. The ACA went large, voiding longstanding relationships among patients, providers and insurers, a strategy ill-received by many. A successful alternative plan should begin small, picking apart the vulnerabilities of the ACA and countering with more favorable alternatives. Since proponents of the ACA will strive to thwart every free-market proposal, any step put forward must be simple, popular, and difficult to oppose. Any unnecessary steps should be avoided.
If we examine our four principal healthcare actors along an axis line stretching from the ACA on one end (call it left) to free-market healthcare on the other end (call it right), we can assess where each actor currently stands and where each is likely headed.
Employers are the simplest to assess. Employers are moving right of center as they phase out of the healthcare business, eroding the free-lunch façade of employer-paid healthcare.
Let them ride off into the sunset.
Patients (that's all of us) are shifting toward right of center. De-emphasis of the employer as healthcare monitor plus the downright dumping of people from their personal plans has increasingly pressed cash into the hands of individuals to make personal healthcare decisions, arguably the single most important step in the direction of free-market reform. Moving the dollar from behind the corporate veil into the peoples' hands has dramatic consequences. Services are purchased more carefully and used more wisely. Under ObamaCare, millions are receiving notices of insurance cancellation and screaming at newfound requirements for unwanted coverage and escalating premiums.
Turn up their amps.
Providers are mostly central on our axis, but only because they are hardly monolithic, with two major constituencies straddling the midpoint. There are many categories of providers, but two are most telling: physicians and hospitals. Physicians are now well right of center. As reward for enduring lengthy and demanding training, physicians have been marginalized with Medicare and Medicaid payment schedules and interminable paperwork among other government insults, and primed to rescue their professional dignity even if it takes dusting off their old Marcus Welby bags and taking the occasional chicken in trade for care. Hospitals are sliding rightward but are still left of center, more in the mold of heavily-regulated businesses. Hospitals are scrambling for new ideas, the same as physicians, but are more vulnerable to any government pork, real or apparent. On the other hand, any glimpse of a TV ad or billboard confirms that hospitals are acutely aware of their need to be increasingly competitive.
Leave providers to work it out for themselves.
Insurers form the current healthcare battleground, and are currently a blurry smudge around the center of the left-right line. Insurers have long enjoyed the privileges of oligopoly, and have been salivating at the prospects of the ACA herding millions more subscribers their way. Now that this stampede is looking more like a few strays, insurers are snapping back to the political reality that the long-term goal of progressives is to regulate insurers to the status of price-controlled administrators or drive them to extinction with a single-payer system, strong incentives for insurers to lean toward free markets.
One of ObamaCare's central flaws is its insistence on being all things to all people, along with commensurate inflated pricing, imposing a cost burden dragging the nascent ACA toward failure. Insurer offerings will have to be rethought, and the government may well have to relax its grip on the insurer's jugular. What can insurers offer? Insurers are armed with legions of actuaries, professionals adept at risk assessment. Actuaries are like the Congressional Budget Office, except that when actuaries get it wrong, they're out of a job.The bottom line, literally, is that insurers can price just about any form of healthcare plan, regardless of size or scope.
The U.S. already has universal health care coverage, but it's delivered in a sloppy fashion through hospitals and ERs. In the vacuum created by a faltering ACA, insurers will want to sidestep the extensive provisions festooning ObamaCare and simply price the adverse pool made up of those who cannot afford medical care either due to insufficient resources or expensive-to-treat existing conditions. This pricing would give us a first public view of the cost of a form of universal coverage, and trigger a debate on if and how to pay for it. Progressives could save face with this limited version of universal health care, but in truth, it's merely a much improved and transparent upgrade of the awkward system already in place.
Free up insurers to assess and offer this one form of insurance and the remainder of free-market behavior already underway can flourish.
It's remarkable how little needs be done, at least for the moment. ObamaCare opponents can coax market behaviors along while being almost polite to foundering Democrats, perhaps befitting for statesmen attending a policy funeral. Markets are trying to operate; encourage them!