Slouching Toward Health Care Reform

The deadliest structural collapse in American history prior to 9/11 occurred right here in Kansas City at the Hyatt Regency in 1981 when two suspended walkways fell onto a tea dance in the hotel lobby, killing 114 and injuring 216. Emergency physician Dr. Joseph Waeckerle had just finished an eleven-hour emergency room work shift and was heading home when he received the call. Waeckerle arrived at the scene twelve minutes after the collapse and took charge, directing search and rescue as well as triage. It was an all-hands-on-deck situation, and soon the ERs of the metro’s hospitals began to fill with mangled survivors. It’s difficult to imagine that emergency responders in all that chaos would ask for the victims’ medical insurance cards.

And that’s because most folks are decent, at least they were here in the heartland back in 1981. However, the emergency response, the ER physicians, the years of rehabilitation to come, and all the modern medicine to follow, it all costs money, a lot of it. It wouldn’t make much difference, though, if the victims of the Hyatt collapse didn’t have medical insurance, because other parties were going to pay for them. For soon the lawsuits would be flying, and the hotel and the firms that designed and built the suspended walkways would all have to pony up.

But when disaster affects only one individual, as when one has been struck by a hit-and-run motorist and there’s no one to sue, then one is on one’s own and will be held responsible for one’s medical bills. If you’re having a heart attack or an aneurysm, that’s your own personal “Hyatt,” and you’ll be held accountable for the costs of your care. Then you’ll need to have insurance or very deep pockets. But how is the Hyatt disaster relevant to these more common medical problems?

It’s the ERs. You see, in 1986, five years after the Hyatt collapse, Congress enacted the EMTALA law, which stipulated that hospital ERs must take everyone, regardless of their ability to pay, or lose Medicare funding. So those Kansas City ERs that were used to save the lives of hundreds of disaster victims suddenly became the reception desk for all manner of patients.

EMTALA did, however, create a “universal healthcare system,” albeit not the Left’s beau ideal of a single-payer one. Using ERs to treat nonemergencies is poor policy. Any new legislation that would “insure” everyone should include a repeal of EMTALA. (EMTALA is unconstitutional anyway, as it uses the same blackmail scheme Obamacare used to expand Medicaid, which was struck down by the court.) But repealing EMTALA without a replacement would leave millions of Americans without. So, Congress needs to devise a better “universal” system to replace the “universal” system they created back in 1986.

The overriding issues of American healthcare reform can be boiled down to two things: coverage and cost. Obamacare failed on both counts; it failed to provide coverage for some 28 million Americans (do they not bleed?) and insurance costs have soared. The issue of coverage, i.e. access, seems simple to gauge: either people are getting medical treatment or they’re not. The thornier issue is cost. And it’s not only the cost of insurance; it’s also the cost of medical care. Americans need to understand that the rising prices we’ve seen in both medical care and in medical insurance are attributable in no small part to government.

The main reason to call the House and Senate bills “Obamacare Lite” is the subsidies, or tax credits, to help folks buy private insurance policies. But how do subsidies affect the price of insurance for those not receiving subsidies? It seems likely that the Obamacare subsidy program is serving to jack up the prices for those who pay the full price with their own money. On December 19, Insurance Journal ran “How Much Do Health Insurance Subsidies Cost Taxpayers?”:

The study estimates that the cost of premium subsidies under the Affordable Care Act will increase by $9.8 billion next year, rising from $32.8 billion currently to $42.6 billion.

The average monthly subsidy will increase by $76, or 26 percent, from $291 currently to $367 in 2017.

Currently more than 8 in 10 consumers buying private health insurance through and state markets receive tax credits from the government to help pay their premiums. Those subsidies are designed to rise along with premiums, shielding consumers from sudden increases. But the bill ultimately gets passed on to taxpayers.

Subsidy programs don’t seem to exert any downward pressure on price inflation. Would Medicaid cost the feds less per enrollee than the subsidy program? You see, they don’t pay for Medicaid patients unless they’re sick, but with the insurance subsidies, the feds pay regardless. But Americans don’t want Medicaid; they want private insurance. Too bad, the subsidies should end.

There seems to be a lot of resistance from some conservatives and libertarians to any kind of single-payer, taxpayer-funded, government-run healthcare system. Some of the folks who cleave to this position are absolutists, and justify their position by saying there’s nothing in the Constitution that allows it.

As the inventor of Compassionate Social Darwinism™, I’ve long held that the government shouldn’t be involved in healthcare other than compassionate pain relief. I also think that private health insurance, except for so-called “catastrophic” policies, is fairly crazy. But lately I’ve moderated by views. I now believe that the GOP needs to “out-compassion” the Democrats. Republicans need to institute their own “universal healthcare system” that will allow them to repeal the one provided by EMTALA. But my idea for a GOP universal system is not free; in fact, it has a claw-back feature. Read “The ‘Free Market’ and Universal Health Care” and “Universal Healthcare with a Conservative Twist,” both at American Thinker, and decide for yourself if my idea for universal coverage has any merit.

There is much skepticism about whether Republicans in Congress can come together and pass a replacement for ObamaCare. They say that replacement is a three-phase ordeal, because only certain things can be done with reconciliation and senators don’t want to end the legislative filibuster. But there is a phase-3 item that Congress could act on now, and it concerns one of the oldest laws that affects healthcare: the McCarran-Ferguson Act (1945). In fact, the House voted in 2010 to repeal the part of the Act that affects health insurance with Health Insurance Industry Fair Competition Act (HR 4626). The thing passed 406-19 when the House was run by Democrats, but the Senate never brought it to a vote and let it die. Congress should correct that and pass a repeal of McCarran-Ferguson ASAP; it could turn out to be the only thing they can agree on… call it “Plan B.”

Republicans might be able to get some bipartisan buy-in for this bill, because many of America’s counties are down to one insurer, and some have no insurers. Repeal of McCarran-Ferguson would allow health insurance to be sold across state lines, which would create a national market. Repeal of McCarran-Ferguson is a necessary step to pushing prices down, but it’s not sufficient. To get real competition, not only does one need to be able to choose from a variety of insurers, one also needs to be able to choose from a variety of insurance plans. To get real competition, we need to repeal ObamaCare.

Jon N. Hall of Ultracon Opinion is a programmer/analyst from Kansas City. 

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